There may come a day when you honorably decide to become an organ donor — not just as a dead vessel full of handy spare parts, but as an actual, living person. The need for such living donors has never been greater: They offer a life-saving alternative to waiting on the national transplant waiting list for a deceased donor, a list that’s freakishly long — more than 116,000 people are currently on it, and another person is added every 10 minutes. Unsurprisingly, the number of people on the list grows larger than the number of potential donors with each coming year.
As you might imagine when volunteering a part of your body, though, there’s a lot to consider before becoming such a donor. Such as…
You Can Only Donate Certain Organs
While deceased donors can donate up to eight lifesaving organs — heart, lungs (2), liver, pancreas, kidneys (2) and intestines (other donatable body parts include eyes, hands and even faces) — living donors have fewer options, since they obviously need to continue living: One kidney, a lung or a portion of the liver, pancreas or intestines.
Kidneys are the most frequently donated organ among living donors, since a single kidney is more than capable of removing waste from the body. Donating a portion of the liver is also relatively common, because the remaining cells will regenerate until the liver nearly returns to its original size. (This re-growth occurs in both the donor and the recipient.) And while a lung (or portion of a lung), a portion of the pancreas and a portion of the intestines won’t regenerate, both the donated portion and that remaining with the donor are fully functional.
Alternatively, You Can Donate Tissues…
…and we’re not talking about the kind you blow your nose with. In addition to organs, living donors can donate skin (which can provide skin grafts to burn victims) after undergoing surgery to remove excess skin after, say, extreme weight loss; bone (which can replace those that have been invaded by cancer) after knee- or hip-replacement surgery; bone marrow (which can replace that affected by bone marrow diseases, like leukemia); amnion (which can expedite the healing process after reconstructive surgery) post-childbirth; and, of course, blood (which is administered to trauma victims suffering from blood loss). A healthy body can easily replace both bone marrow and blood, meaning those two tissues can be donated multiple times if you so choose.
While blood donations are extremely common (and well-understood), bone marrow donations tend to be shrouded in hearsay. For instance, the commonly-held belief that donating bone marrow is extremely painful simply isn’t true — the procedure itself takes place under general anaesthetic, meaning you won’t feel any pain whatsoever. In fact, many donors go home the same day as the procedure. “I’ve felt worse after a few bruising encounters on the football pitch,” one donor told U.K.-based charity Anthony Nolan. “Within a week of the donation, I was back on my feet and feeling much better; all in all, it’s a very small price to pay for what could be achieved.”
You Might Ruin Your Relationships by Saying ‘No’
Should you be approached by a friend or relative in need of, say, a kidney, and you decide to not go through with the donation, it’s a very real possibility that this person may seriously resent you for it. Philadelphia resident Joseph McMillian, for instance, told the Chicago Tribune that he and his son are no longer on speaking terms after the son refused to even consider giving him one of his kidneys.
Know also that, whatever your decision, it will be extremely difficult to make. “You have up until the point that they put anesthesia on you to back out,” says Scott Logsdon, a man who donated his kidney in 2016. “And your decision affects that person, their family and the hopes of their family.”
The widespread effect of that decision goes well beyond the recipient’s family, as well. “I was very comfortable with my decision to donate, but I found out later that many other people were not — like my wife,” Logsdon adds.
At the end of the day, these are your organs, and you get to choose what to do with them. But it could well be the toughest decision of your life (and someone else’s).
You Must Be Both Physically and Mentally Fit
“Every donor has to undergo an extraordinarily thorough evaluation to ensure that they’re healthy enough to donate,” explains Jennifer Kozakowski, a woman who donated her kidney in 1993. “A lot of donors match with their intended recipient (which is based on medical compatibility), but they’re excluded due to their physical and psychological exam results.”
According to the Department of Health & Human Services, “Living donors should be physically fit, in good health, between the ages of 18 and 60, and should not have (or have had) diabetes, cancer, high blood pressure, kidney disease or heart disease.” They must also be financially stable — some donors are required to take more time off from work than expected while recovering (which typically isn’t covered by insurance). And as with any surgical procedure, there’s also a small risk of complications that may require additional financial coverage.
The Procedures Can Be Dangerous
The most common living donor procedure is called laparoscopic donor nephrectomy, which involves the removal of a kidney. The surgery is minimally invasive — small incisions are made, and the kidney is typically removed with the help of a camera. The recovery period is also relatively short: Donors who undergo laparoscopic surgery often return to work within three to four weeks after the procedure.
Donating a kidney wasn’t always this straightforward, though. “They performed a massive flank incision in my day,” Kozakowski says. “That typically includes the removal (or breakage) of a rib and the slicing of the surrounding muscles — all of which require six weeks to heal.”
But despite new advancements, recovering from a kidney donation is full of unpredictable (and outright strange) pains. “They inflate you full of air so they have room to work during the procedure,” Logsdon explains. “All of that air then settles in your shoulders when you sit down, because it wants to move up — it hurts like hell. That lasted for about four days before dissipating.”
There’s also the living donor lobectomy, which involves removing a portion of the lung. This procedure is certainly risky compared to laparoscopic surgery: Donors frequently become sick enough to require extended hospitalization, and research indicates that donors lose 10 to 20 percent of their pre-donation lung function, meaning it will be more difficult for your lungs to breathe in and hold air after the procedure.
You May Experience Issues Later in Life
While the long-term effects of donating an organ aren’t well-documented, follow-up reviews of living donors are generally optimistic — e.g., a long-term study of more than 80,000 live kidney donors found that their life expectancy remains unchanged.
A 2013 study of the long-term impact of donating a kidney, however, found slightly less positive results: “Kidney donation is projected to reduce LE [life expectancy] by 0.83 years and increase the absolute cumulative risk of ESRD [end stage renal disease] by 0.89 percent for a 40-year-old white male. White females were predicted to have slightly greater loss of life and less added ESRD risk. Conversely, Blacks have greater risks of ESRD after donation.”
The impact of other organ donations are even less well-known. There is, though, certainly some concern regarding the effects of stress on the remaining organ (say, you donate a single kidney). For this reason, the Department of Health & Human Services recommends thinking long and hard before becoming a living organ donor:
“The decision to be a living donor is very personal one. The potential donor must consider the possibility of adverse health effects after donation — as well as the potential to save the life of the recipient, who may be a loved one.”
“Because we don’t know what the short-term and long-term effects to the donor will be, the Federal government does not actively encourage anyone to be a living donor.”
That said, Kozakowski mentions that living donors are checked on throughout their lives, meaning you can expect extra medical attention if necessary.
The Recipient Might Experience a Personality Change
Since the dawn of organ transplants, there’s been what seems like a Frankenstein-inspired rumor suggesting that transplant recipients take on the personalities of their donors: A man may, for example, suddenly find himself in love with the widow of the man whose heart he now possesses.
While this might seem outlandish (and outright ridiculous), there’s some truth to it — at least anecdotally: A 1992 study of 47 heart-transplant patients found that while 79 percent didn’t feel that their personality had changed, 15 percent experienced a change in personality directly due to having experienced a life-threatening event, and six percent confirmed a drastic change in personality due to feelings stemming directly from their new heart.
But In the End, You’ll Probably Be Okay
“I honestly don’t really think about my donation,” Kozakowski says, nearly 25 years after donating her kidney. “They recommend that you don’t ride a motorcycle, skydive or do things that might put you at risk of blunt-force injury. They also recommend that you avoid nonsteroidal anti-inflammatory drugs when you can — I haven’t taken an Advil since the donation. But I gave birth to both of my children with one kidney; I played every sport I wanted to play; and I work full-time.”
And No, Doctors Won’t Let You Die So They Can Harvest Your Organs
Because of the massive demand for organs, internet rumor has it that paramedics and doctors are instructed to allow organ donors — the ones with that pink heart (or dot) on their driver’s licenses — to die in order to harvest their organs. It’s basic math, the theory goes: One person dies, multiple others get to live.
But like so much on the internet, this is nonsense: If you’re a registered organ donor, doctors and paramedics will work just as hard to save your life as they would any life. “A doctor’s first obligation is to treat patients to the best of their ability and the wishes of the patient and their family,” David Klassen, chief medical officer for the United Network for Organ Sharing, told VICE. “It is an absolute requirement that the OPO [organ procurement organization] is not involved at all.”
Finally: When They Do Harvest Your Organs, It’ll Be Surprisingly Chill
Once your heart officially stops beating, the transplant surgery team has approximately 90 minutes to remove your organs, since they begin to deteriorate during that time as they require blood and oxygen to remain suitable for donation. But don’t worry, it’s not a frantic hack-’n’-slash operation. According to the Center for Organ Recovery & Education, “The donor is taken to the operating room where the organs and tissues are recovered through a dignified surgical procedure. The appearance of the donor is not affected, and open-casket funerals are still possible.”
Once removed, the organ is packed in a sterile solution and ice, then taken straight to the hospital where the transplant will take place. This is also a relatively hasty process: Kidneys last up to 30 hours outside of the body; the pancreas and liver last up to 12 hours; and the heart and lungs last up to six hours. (These times may vary depending on how much the organs deteriorated while still in the body.)
Just be sure that all medical staff are aware that you require surgeons to blast Céline Dion’s “My Heart Will Go On” throughout the entire procedure (because come on, you totally should).