UNC Health Talk

How—and Why—to Become an Organ Donor

Right now, more than 100,000 people in the United States are on organ transplant waiting lists. Each day, 17 people die waiting.

Last year, more than 39,000 transplants were completed, the second highest ever, even with the COVID-19 pandemic. Still, the numbers tell the story: The need is far greater than the supply.

Donating an organ “is one of the most generous and noble things that one person can do for another,” says UNC Health transplant surgeon Alexander Toledo, MD. We asked him common questions people have about organ donation.

Do you have to die to donate an organ?

There are two ways to donate organs. The most common way is to register to be an organ donor and to commit to donate organs or tissues when you die. Deceased donors can provide their heart, lungs, liver, kidneys, pancreas, intestine, corneas and vascularized allograft (a type of transplant that may include skin, bones, cartilage and other tissues that are connected, for a hand or face transplant).

Another option is to become a living donor, and to give a kidney or part of your liver to another person. Less common living donations include the pancreas, lung and intestine. Living donations can be directed, meaning given to someone in particular, or nondirected, meaning an organ goes anonymously to the person at the top of the waiting list who is the best match.

Who can be an organ donor?

Anyone can register to be an organ donor. Don’t assume you couldn’t give an organ because of your age or health status. There have been successful transplants in which both the donor and the recipient were in their 70s. Even if you have a chronic condition, experts will make the call about what is possible.

Living donors start the process with a questionnaire and a conversation with a donor coordinator, who can help determine if you are a good candidate. “Don’t count yourself out” without checking first, Dr. Toledo says. “Often there are conditions that can be medically managed or improved upon to make someone a suitable donor.”

How does organ donation work?

Registering to donate is the first step. Decades may pass before that decision and the end of a person’s life, when the donation process begins.

It’s important to know that the medical team will take all lifesaving measures for people who are organ donors, the same way they would for people who aren’t. When a person is declared brain-dead, meaning that he or she requires machines to live and will not recover, a separate team of professionals from an organ procurement organization, such as HonorBridge in North Carolina, determines which organs may be viable for transplant.

The next step involves a discussion with family members about the patient’s wishes to donate. Having a legally binding registration makes it easy for family members to know your intentions, but it’s best to also tell your loved ones your wishes in case you do not have them documented.

After confirming death and talking to the family, surgeons remove the organs, which are carefully packaged and transported to the recipient for transplant. The donor’s family will be notified of the number of lives saved or improved because of their loved one’s generosity.

Of course, the process is different for living donors. Once potential living donors have connected with a transplant center, they will undergo a medical exam that assesses their physical and mental health.

We look for “sound mind, sound body and sound kidneys” for kidney transplants, Dr. Toledo says. That means the remaining kidney needs to be high functioning so the donor can continue to live a healthy life. Donors also need a strong support system in place to help them physically and emotionally as they recover from surgery.

How can I become an organ donor?

The easiest way to register to donate your organs at the end of your life is to sign up as an organ donor when you obtain or renew your driver’s license or state identification card. You can also register online. iPhone users can register via the Health app, if you have a model running iOS 10 or later. You will be guided to submit information that is sent to Donate Life America. All of these registration methods result in a valid legal document.

If you are interested in becoming a living donor, there are several ways to register. If you know your intended recipient, then you will work with his or her transplant center directly to go through the process. If you want to give a nondirected donation, you can join a national registry or contact a transplant center near where you live. Living donors must be 18.

When family members or loved ones are screened to donate but are not a match, transplant center staff can sometimes help set up a paired donation. That means you don’t match for your loved one, but you do match with someone else and that person’s donor matches with your loved one. This way, otherwise incompatible patients can get living donor transplants quickly and avoid waiting on dialysis treatment for a deceased donor.

Through a nondirected donation, donors can help people they don’t know. These donations can be anonymous, or the donor and recipient can meet if they both wish.

What is life like for living donors?

Living donors go on to live healthy and full lives, Dr. Toledo says. “Being able to dramatically change somebody’s life with that gift is a really special experience. A lot of our donors feel really good about that, and it helps them get through their recovery,” he says.

Dr. Toledo encourages living donors to stay in contact with their primary care provider and keep up with annual physicals. This would be important in the rare case that a kidney donor happened to develop kidney disease, not because of the donation specifically but because the condition is relatively common. If your doctor is monitoring your health, you’re more likely to spot problems early, when they’re more easily treatable.

“I always advise prospective living donors that when they become a donor, they haven’t just donated a kidney, they’ve made a lifelong commitment to be vigilant about their health,” Dr. Toledo says.


North Carolina residents can register to be organ donors at Donate Life North Carolina. Anyone can register at Donate Life America. Talk to your doctor if you are interested in becoming a living donor, or visit the United Network for Organ Sharing.