POST (Parliamentary Office of Science and Technology)
Living organ donation
This POSTnote describes the scale and nature of living donation in the UK, its regulatory framework and the ethical considerations around this highly regulated procedure. It also analyses challenges within living organ donation, and the strategies implemented to address them.
Documents to download
Living organ donation (385 KB, PDF)
Download ‘Living organ donation’ report (385 KB, PDF)
Living organ donation refers to the transplant of an organ (such as a kidney or a lobe of liver) from a living donor. Kidneys are the most donated organ, accounting for 98% of living organ donations in 2019/20. As of March 2020, 4,960 patients were waiting for a kidney transplant. The average waiting time for a deceased donation was 2.5-3 years. Living organ donation is a highly regulated procedure. It offers better patient outcomes and a more cost-effective approach than deceased organ donation or alternative therapies but carries with it potential risks for the donors. These are minimised through rigorous health and psychological evaluations, and extensive donor aftercare. While there is a 1 in 3,000 risk of death for living kidney donors, living kidney transplants are not associated with any excess donor mortality, kidney failure or other disease. It is widely accepted that the risks are outweighed by the benefits to the recipient and to wider society (through reduced waiting lists and improved population health).
The new 10-year strategy for increasing living organ donation and transplantation is due to be published by NHS Blood and Transplant in Spring 2021.
- The number of living organ donors in the UK has trebled over the last 20 years and is currently stable at around 1,000 doors per year. This accounted for 35% of overall transplant activity in 2019.
- Living donor kidney transplants are the most cost-effective treatment for kidney failure on the NHS, with the potential to save £25,800 per year when compared to dialysis.
- Transplants performed in the UK from living donors must comply with the requirements of the Human Tissue Act 2004 for England, Wales and Northern Ireland, and Human Tissue (Scotland) Act 2006.
- Before becoming a donor, individuals must first undergo multiple rigorous evaluations to confirm they are suitable for donation. These include health and psychological tests, together with motivation and consent assessments.
- The Human Tissue Authority is responsible for assessing all applications for living organ donation. To be granted approval, the donor must give consent freely and there must be no reward attached to the donation.
- There are 4 routes for living organ donation; 1) Direct donation to a known individual 2) Directed altruistic donation to a specific individual with no pre-existing relationship 3) Non-direct altruistic donation to a complete stranger 4) Paired/pooled donation where donor and recipient are incompatible so join a sharing scheme in which they are matched with other registered pairs to increase compatibility for the transplants.
- The UK Living Kidney Sharing Scheme is managed by NHS Blood & Transplant and uses algorithms to find matches for the recipients registered in the scheme. This runs every 3 months and is responsible for over 1,200 transplants since its inception in 2007.
- Social media may be used to find potential donors but this is rarely achieved. Matching sites are not permitted by the NHS due to ethical and regulatory concerns.
- Health inequalities are present within living organ donation as individuals from socio-economically deprived communities or minority ethnic groups are less likely to find a living organ donor. Barriers include lack of awareness and knowledge, reduced patient engagement and attitudinal barriers such as uncertainty around religious permeability and lack of trust in health professionals.
- A series of initiatives have been implemented to increase living organ donation in the UK. For example, the 2017 NHSBT campaign to target Black, Asian and Minority Ethnic communities included working with faith leaders and investing into the National Black, Asian and Minority Ethnic Transplant Alliance to address myths about living organ donations through trusted community organisations.
- The new 10-year strategy for Organ Donation and Transplantation is due to be published by NHS Blood and Transplant in Spring 2021.
POSTnotes are based on literature reviews and interviews with a range of stakeholders and are externally peer-reviewed. POST would like to thank interviewees and peer reviewers for kindly giving up their time during the preparation of this briefing, including:
Members of the POST Board*
Lisa Burnapp, NHS Blood and Transplant, British Transplantation Society*
Jessica Porter, Human Tissue Authority*
Jen Lumsdaine, NHS
Paul Dooley, Matching Donors
Dr Adnan Sharif, University Hospitals Birmingham*
Dr Pippa Bailey, University of Bristol*
Dr Greg Moorlock, University of Warwick
Mr Videha Sharma, University of Manchester*
Dr Sara Machado, London School of Economics
Professor Gurch Randhawa, University of Bedfordshire*
Professor Neil Lunt, University of York
Professor Nithya Krishnan, University Hospitals Coventry and Warwickshire
Dr William Pettersson, University of Glasgow
Dr Daniel-Clement Osei-Bordom, University of Birmingham*
Katharine Wright, Nuffield Council of Bioethics*
Jan Shorrock, Give a Kidney*
*denotes people and organisations who acted as external reviewers of the briefing.
|Academic Fellowships||Upcoming work||POST Publications|
Latest News from
POST (Parliamentary Office of Science and Technology)
Smart Cities24/09/2021 16:10:00
"Smart cities" describes places that incorporate a range of technologies (especially those that collect and use data) to address economic, social, and environmental challenges. Projects usually take place in urban areas, but are also deployed in rural settings. This POSTnote looks at smart city innovation in the UK and the technologies involved. It considers the factors driving the adoption of smart city technologies, and the potential benefits, barriers and risks associated with their implementation.
Blue carbon06/09/2021 16:25:00
Marine ecosystems around the UK can both increase and decrease atmospheric carbon dioxide levels. Carbon loss and gain globally by these ecosystems has the potential to influence climate change.
Local nature recovery strategies06/09/2021 11:25:00
The UK Government is introducing Local Nature Recovery Strategies (LNRS) from April 2022 to map where local habitat improvement and restoration could address national-scale environmental objectives.
Environmental housing standards02/09/2021 15:15:15
Buildings have varied impacts on the environment, arising from energy, water and land use as well as the release of pollutants.
Mental health impacts of the COVID-19 pandemic on adults23/07/2021 12:33:00
The impact of the COVID-19 pandemic is a significant public health concern, with a growing body of research describing the effects on the population since March 2020.
Coastal Management16/07/2021 15:33:00
The UK coastline is shaped by interactions between complex social, ecological, and physical processes.
Low-carbon hydrogen supply11/06/2021 15:33:00
Hydrogen could play a significant role in tackling climate change. Using it does not produce carbon dioxide, so it could replace fossil fuels in a range of applications.
Regulating Product Sustainability11/06/2021 14:43:00
Products can be designed to maximise life cycle energy- and resource-efficiency, from raw material extraction to end-of-life treatment.