The gift of life: why policy matters for organ donation
2 October 2025
Can governments and science ensure fair access to organ donation for all?
Organ donation is the act of giving one or more organs, or parts of organs, to someone else without compensation. A donor can be living – in fact, the first successful kidney transplant, in 1954, was between two brothers – or deceased, in which case multiple organs could save many lives. A single person can save eight lives through organ donation – and save or improve up to 100 lives by donating tissue.
More than 170,000 organs were transplanted globally in 2023, an increase of nearly 10% from 2022. However, the supply of organs falls far below the need, and no country has reached self-sufficiency.
Global challenges and disparities in organ donation
Worldwide, organ donation faces persistent challenges. The Global Observatory on Donation and Transplantation reported that, in 2023, around 45,000 organs were donated from deceased donors and 53,000 living transplants were performed – but this meets less than 10% of global demand.
Organ donation rates vary considerably by country. For example, Spain – considered to have a world-leading transplantation programme – has a comparatively high number of donors: 58.6 (living and deceased) per 1 million population. Other countries report far lower numbers, though; Moldova has 0.6 donors per 1 million. The World Health Organization (WHO) attributes this variation to many barriers, including limited public awareness about the value of organ donation and low awareness among healthcare professionals.
A single person can save eight lives through organ donation – and save or improve up to 100 lives by donating tissue.
Opt in or opt out?
Consent is central to organ donation policy. Most models of consent are either opt-in or opt-out; the main difference is that opt-in models require people to actively indicate that they wish to donate their organs, whereas opt-out models work under the assumption of consent.
Opt-in models often suffer from low participation – not necessarily due to opposition, but because of inertia or lack of awareness. People might have no objection to organ donation, but do not join registers due to ‘not getting round to it’.
Spain’s opt-out system has led to the highest deceased donor rate globally, and the rate has doubled in less than a decade. Spain’s model is supported by extensive awareness raising and assumes that everyone is a donor by default, with next of kin having the final say.
Addressing organ trafficking
Even with strong donation consent mechanisms, unethical practices such as organ trafficking remain a concern. The WHO estimates that organ trafficking accounts for 5–10% of all transplants, with many victims being from vulnerable backgrounds; traffickers often target unemployed people, migrants and refugees.
The World Health Assembly (WHA) has called for a paradigm shift to ensure national self-sufficiency in meeting the donation and transplantation needs of patients, which would help tackle one of the root causes of organ trafficking: insufficient access to transplantation. In its 2024 resolution, WHA calls for member states to better integrate transplantation into their health systems, increase donation rates and raise public awareness of organ donation. In response, many countries are implementing policies and strengthening their health systems to improve donation rates, institute high ethical standards and ensure that no donated organs are wasted.
Access to organs through social media
As countries aim to increase their self-sufficiency around the supply of organs, robust legal frameworks are essential to balance the rights of people donating with those receiving organs. These frameworks must govern the allocation, or ‘matching’, of donated organs – for example, balancing medical urgency with waiting times.
National waiting lists can facilitate this matching by using medical criteria, but many such lists rely on donors registering. The lack of donors can mean that many people die or become too ill to receive a transplant while on the waiting list. In Europe, waiting lists for a kidney are around 3–5 years, and it was reported that 12,000 people in the UK died or were removed from the transplant waiting list during the past decade.
In this context, it is perhaps not surprising that people are also using the internet – particularly social media – to try and find living donors. These platforms can reach huge numbers of people and raise awareness about donation. However, this direct approach is unregulated, and concerns have been raised that it circumnavigates a medically informed allocation process. Most European countries do not allow donations from donors who respond to a public request. However, in some countries, including the UK, it is legal to place an advert seeking a live donor as long as no payment is offered. And the UK’s NHS Blood and Transplant service offers guidance for both donors and potential recipients to ensure that these laws are adhered to if this route is taken.
Health system efficiency and infrastructure are vital to provide equitable access to care, avoid logistical delays, and ensure the responsible use of donated organs.
Health system infrastructure and efficiency
Organs can survive for a limited time outside of the body before they are no longer viable for transplantation; for heart and lungs, this window is only around 4–6 hours. So health system efficiency and infrastructure – particularly coordination between hospitals and other organisations involved in transplantation – are vital to provide equitable access to care, avoid logistical delays and ensure the responsible use of donated organs (in terms of both their physical procurement and their movement).
Spain is an exemplar in this respect. The country has strong leadership across the logistical system, including hospital transplant coordinators supported by regional coordinators and overseen by the National Transplant Organisation.
Technological advances in transport – including drones and systems that continually supply an organ with blood – are increasing the length of time that organs can be kept viable and broadening the geographical range of available donor organs. However, despite these advances, rural and underserved areas often have fewer hospitals equipped to facilitate organ donation and transplantation.
Looking ahead: innovation and artificial organs
Ever-expanding innovation in the creation of artificial organs could help bring about a future where donor shortages are no longer a problem.
Research into the use of stem cells to generate new organs or rebuild damaged organs and the expanding development of 3D-bioprinted structures hold great potential for mending or even creating organs, including the heart, kidneys and liver. But for these advances to truly transform the future of transplantation, further research and development will certainly be needed.
Alongside this, it will be important to continue to raise awareness of the vital importance of organ and tissue donation both to the public and healthcare professionals, while efforts are made to address the complex interplay between managing national-level waiting lists and the growing use of social media to facilitate donation. Combining this with technological, logistical and health system-level advancements could enable solutions that address inequities in access, and move us closer to a future where no one dies waiting for a second chance at life.