Human Tissue Authority

The regulator for human tissue and organs

Types of living organ donation

There are a number of different types of living organ donation, some of which involve a donor and recipient coming together either because of a pre-existing relationship or through a third party and others where the donor and recipient(s) are matched by NHS Blood and Transplant (NHSBT). The information below provides an overview of the types of living organ donation which you may wish to consider if you are thinking about becoming a living organ donor.

Cases where the donor and recipient come together either because of a pre-existing relationship or through a third party

Directed donation

This is a form of donation where a person donates an organ to a specific, identified recipient with whom they have a genetic or pre-existing emotional relationship for example parent to child, brother to sister or friend to friend.

Directed altruistic donation (DAD)

This is a form of donation where the organ is donated to a specific individual and there is no evidence of a qualifying genetic or pre-existing emotional relationship between the donor and recipient. These cases tend to be characterised by a third party - either a person or other mechanism such a social networking website - bringing the donor and recipient together for the purpose of transplantation, for example, a work colleague donating to a colleague’s child or an individual choosing to donate to a person they have seen in the local newspaper requiring a kidney. The HTA has produced guidance on matching websites and social media.

Cases where the donor and recipient(s) are matched by NHSBT

Non-directed altruistic donation (NDAD)

This is a form of donation where a person donates an organ to an unknown recipient, that is, someone they have never met and that is not known to them. 

A non-directed altruistic donor donates into the paired/pooled scheme to create a 'chain' of transplants. Please see below for further information.

Non-directed altruistic donor chains

This is a form of donation where a non-directed altruistic donor donates their organ into the paired/pooled scheme. Every three months NHSBT undertakes a matching run which matches pairs of donors and recipients together based on a range of factors. These include tissue type compatibility and blood group. By matching two or more donors and recipients, a chain of operations can be carried out. The remaining organ at the end of the chain is then donated to the best-matched recipient on the national waiting list.

How to get further information about becoming an altruistic donor

To find out more about becoming an altruistic donor, please contact your local transplant unit in order to be assessed. This assessment will include a number of medical tests and also a mental health assessment. These tests may take a number of months to be completed. Further information about becoming an altruistic donor can be found here.

If an individual is assessed as clinically suitable as a donor they will be referred to a Human Tissue Authority (HTA) Independent Assessor (IA). The IA will interview the potential donor to ensure the requirements of the Human Tissue Act (HT Act) 2004 have been met. The IA will submit a report of their interview to the HTA. The decision on the case is then made by a panel of HTA Board Members.

Following HTA approval, the donor’s name will be put forward to a national allocation scheme and matched to a suitable recipient. This works in the same way as a deceased donation, where a donor is matched to a patient on the national waiting list.

Further information can be found on the NHS Blood and Transplant website.

UK Living Kidney Sharing Schemes

This is a form of donation where a healthy donor is unable to (or chooses not to) donate because they are either incompatible with their recipient, or would prefer a better match. They may be matched with another donor and recipient in the same situation in the UK Living Kidney Sharing Scheme. The donor organs are then swapped between recipients. When two pairs are involved this is known as a paired donation. Sometimes, more than two donors and two recipients will be involved in the swap, known as a pooled donation.

Paired/pooled donations are currently only available for kidney transplants in the UK. Donor and recipient operations are usually planned to take place at the same time and the organs are transported between hospitals. Sometimes the donor and recipient operations can be staggered and may not take place at the same time.

Local transplant centres will assess whether a donor and recipient are suitable to be put forward for the national scheme. If so, their details will be put into the national register. Every three months NHS Blood and Transplant (NHSBT) undertake a matching run which matches pairs together based on a range of factors. These include tissue type compatibility and blood group.

Further information on becoming a living donor can be found here or on the NHS Blood and Transplant website.

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