Despite common misconceptions, most people who register to be organ, eye, and tissue donors can ultimately save or heal lives. Medical professionals thoroughly evaluate each potential donor at the time of death to determine which organs and tissues are suitable for transplantation. This individualized assessment means that a specific diagnosis, or even a chronic illness, does not always preclude donation. It is the overall health of the organ itself, rather than the donor's medical history, that is the most important factor.
Absolute Disqualifications for Deceased Organ Donation
Certain medical conditions pose a significant risk of transmitting disease to the recipient and are generally considered absolute contraindications for donation. These include:
- Active Cancer: The presence of actively spreading or metastatic cancer is a definitive disqualifier due to the risk of transmitting malignant cells to the recipient. However, donation may be possible if the donor has a history of certain past cancers that have been successfully treated and are considered to have a low risk of recurrence.
- Active Systemic Infections: Severe, uncontrolled bacterial, fungal, or viral infections (sepsis) are typically a contraindication for donation, as they can be transmitted to the recipient, who will be immunosuppressed and highly vulnerable. However, some deceased donors with bacterial infections have been successfully used for transplantation with careful monitoring and antibiotic prophylaxis.
- Prion Diseases: Conditions like Creutzfeldt-Jakob disease (CJD), a fatal and degenerative brain disorder, are absolute disqualifiers. These diseases are caused by abnormal proteins (prions) that are extremely difficult to sterilize and can be transmitted through transplant.
- Certain Blood-borne Cancers: Cancers of the blood, such as leukemia and lymphoma, disqualify a person from donating solid organs due to the high risk of transmission.
Conditions with Evolving or Conditional Eligibility
Medical advancements and new protocols have transformed the eligibility criteria for donors with conditions once considered automatic disqualifiers. This has significantly expanded the potential donor pool.
- HIV: Due to the HIV Organ Policy Equity (HOPE) Act, HIV-positive individuals can now donate organs to HIV-positive recipients as part of approved research studies. This has created a vital pathway for transplantation within the HIV community, increasing the availability of organs.
- Hepatitis: A history of hepatitis B (HBV) or hepatitis C (HCV) does not automatically prevent organ donation. Organs from donors with hepatitis can be used to treat patients who also have the virus. For deceased donors with a history of HBV exposure (positive core antibody), the organs can often be safely transplanted into recipients who are already immune to the virus. With the advent of effective direct-acting antiviral (DAA) medications for HCV, organs from HCV-positive donors can also be used in HCV-negative recipients, who are then treated with medication.
- Chronic Diseases: Conditions like diabetes or high blood pressure do not automatically prevent a person from becoming a deceased organ donor. For example, a person with diabetes might not be able to donate their pancreas, but their kidneys, liver, or heart may be perfectly suitable. The decision is made by the transplant team at the time of death based on the health of the specific organs.
Living Donor vs. Deceased Donor Restrictions
Eligibility criteria are much stricter for living donors compared to deceased donors, primarily to protect the donor's long-term health.
Comparison of Donor Restrictions
| Condition | Deceased Donor (post-mortem) | Living Donor (for kidney or partial liver) |
|---|---|---|
| Active Cancer | Disqualifying | Disqualifying; a history of certain successfully treated cancers may be acceptable |
| HIV | Permitted for HIV-positive recipients | Currently disqualifying in many centers |
| Hepatitis | Permitted with appropriate recipient matching | Active infection usually disqualifying |
| Diabetes | Permitted for unaffected organs | Usually disqualifying due to risk of future kidney problems |
| Hypertension | Permitted if organs are healthy | Uncontrolled high blood pressure is disqualifying |
| Active Systemic Infection | Disqualifying, but evaluation is made for bacterial infections | Disqualifying |
Why You Should Not Self-Disqualify
If you have a medical condition, you should not automatically assume you cannot be a donor. Doctors are best equipped to make that assessment. Many people with chronic illnesses, or those who are considered too old, have successfully donated life-saving organs or tissues. For instance, the oldest organ donor in the U.S. was 95, showing age is not a barrier. The ultimate goal is to save lives, and medical advancements continue to expand the possibilities for donation. Registering your decision is a powerful act of generosity and allows the medical team to consider you as a candidate.
Conclusion
While certain absolute conditions like active systemic cancer and prion diseases prevent organ donation, these are exceptions, not the rule. The vast majority of medical histories do not automatically exclude someone from being a deceased donor. The decision is a medical one, made at the time of donation, based on the health of individual organs. By registering as a donor, you are making your wishes known and entrusting medical professionals to make the best possible use of your gift, regardless of your health history. The expanding criteria for conditions like HIV and Hepatitis underscore that the field of transplantation is constantly evolving, creating more opportunities to give the gift of life. To learn more about organ donation, you can visit the Organ Procurement and Transplantation Network website.
