Types of Organ Donation and Related Costs

Organ donation is the process by which a person can donate a healthy organ to replace the unhealthy organ of another person. Some organs are donated after the donor has died, other organ donations are made by healthy friends or relatives who make the decision to help a loved one who is experiencing organ failure.


The Costs

Declaration of organ donation on clipboard
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The decision to be an organ donor can save one life or many lives, depending on the type of organ donation and the health of the donor.

There are no medical expenses associated with being an organ donor of any type; insurance or the agency responsible for recovering the organs will pay for the costs of organ recovery. Living organ donors may have financial repercussions outside of medical expenses if they do not have sick time or disability pay during their recovery, but they are in no way charged to be a donor. In short, there are no costs to be an organ donor of any kind. All expenses are paid by the insurance company of the person you are donating to if you are a living donor, or by the organ procurement organization that recovers organs from a deceased donor.​


Organ Donation After Cardiac Death (DCD)

Organ donation after cardiac death (DCD), also known as donation after circulatory death, is the type of donation that was used in the early years of organ donation. Before brain death criteria were established, DCD and living related donation were the only options.

This type of donation occurs when a patient has an illness from which he or she cannot recover, and the patient is being kept alive by artificial means, including ventilators and supportive drugs. The patient is not brain dead but has no hope of recovery.

Once the family makes the decision to withdraw artificial support, the option to donate organs after cardiac death is presented by representatives of the local organ procurement organization if the patient meets age and medical criteria. The decision to withdraw support is made independently of the decision to donate. That way, if the donation falls through, the family has still made the correct decision for their loved one, without having the possibility of donation as a factor.

Consenting for donation on your driver's license or another donor registry is not consent for the DCD process. That consent is specifically for donation after brain death, which is another type of donation. For a DCD donation, the legal next of kin must consent to the process.

If the family is interested in donation and has made the decision to withdraw support, that process will occur in the operating room instead of the hospital room. The time from the family consenting to the process to the removal of support is typically no less than 8 hours, because of the blood tests and other arrangements that must be made.

Once in the OR, if the patient’s heart stops within the designated time frame for donation, the team then waits for several minutes to ensure that the heart does not function. At this time, a physician from the hospital, not the organ recovery team, will pronounce the patient dead. Then, the surgery to procure the organs for donation begins. There will be at least 2 minutes between heartbeats that circulate blood and making the surgical incision.​

While donation after cardiac death increases the number of organs available for transplant, this type of donation does not allow for organs other than the liver and kidneys to be procured in most cases. This is because the heart, lungs, pancreas, and intestine cannot tolerate being without blood flow, even during the short time between the cardiac arrest and the surgical procedure.

There are always exceptions, and in some cases, lungs and other organs can be procured, but that is the exception rather than the rule.


Organ Donation After Brain Death

Organ donation after brain death is the type of organ donation that most people are familiar with. The most common type of donation, donation after brain death is the type of donation is covered when you say yes to organ donation for a donor registry or at the bureau of motor vehicles.

A patient becomes eligible for this type of donation when they are declared brain dead, a medical condition that means that the brain is no longer receiving blood flow and has been irreversibly damaged. At the time the doctor determines that brain death has occurred, the patient becomes legally dead. In fact, the death certificate will be issued at the time of the brain death pronouncement at the time of death, rather than when the heart stops beating later during surgery.

When the donor is taken to the operating room, her heart is still beating and breathing is being supported by a ventilator. While the body is kept functioning with the help of machines and medications, the brain no longer functions in a meaningful way, and the surgery to recover the organs takes place. The supportive devices will be removed midway through recovery surgery, at which point breathing and cardiac activity cease.

Donation after brain death allows for many different organs to be transplanted, including heart, lungs, kidneys, pancreas, liver, and small intestine.


Living Related Organ Donation

This type of organ donation, which allows a family member or friend to donate an organ for a loved one, is becoming increasingly popular. The vast majority of these organ donations involve kidney transplants, as the human body can function normally with one healthy kidney. Relatives can be ideal kidney donors because the strong genetic match between recipient and donor can improve the lifespan of the transplanted organ.

Recipients of living donor organs typically have excellent outcomes, not just because of the genetic match, but because they do not wait for years for an organ, during which recipients often experience a decline in their health.


Altruistic Living Organ Donation

Altruistic donation is the same as living related organ donation in most ways, except the donor and the recipient are not related, nor are they friends. An altruistic donor is a person who decides to donate an organ, typically a kidney, to a complete stranger with no expectation of compensation or reward.

While an altruistic donor may at some point meet the recipient of his or her organ, both parties must agree to the meeting, otherwise, the parties remain anonymous.

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By Jennifer Whitlock, RN, MSN, FN
Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.