AST Position Statement on Directed and Non-Directed Donation

The field of solid organ transplantation is dependent on the availability of donor organs. The American Society of Transplantation (AST) recognizes the decision to donate an organ(s) or a portion thereof, as a truly selfless act, focused on the potential to save the life of another. Moreover, this decision may come at a particularly difficult time for family members of a loved one with impending death, while a live organ donor must consider the balance between the potential beneficial outcome to the recipient, as well as the potential risk to themselves.

A “directed donation” occurs when a donor family or a live donor directs the organ to a specific recipient. In most cases of live organ donation, the designated recipient is a family member, friend, or colleague. Thus, “directed” donation is the rule, rather than the exception, for live organ donation, as the emotional ties to the recipient are the basis for the donation. Directed donation is much less common for deceased donors, although it has occasionally led to successful organ transplantation in recipients designated by the deceased's family, based on family ties or friendships.

“Non-directed” donation occurs when a donor family or a live donor has no direct say so as to where an organ is allocated. The organ is then allocated according to the rules of UNOS for deceased organs and according to local arrangements for living altruistic donors. The altruistic donor gives to someone that they do not know and this may be to someone on the transplant waiting list or may be in the context of “paired donor exchanges.” In the later situation the donor donates to the recipient in a pair where the donor and recipient are not compatible. The original intended donor then donates to another recipient in an incompatible pair and so on.

The AST supports efforts to increase organ donation, including directed donations, based on principles of ethics, equality, fairness, and sound medical judgment. The circumstances surrounding a directed donation should be carefully assessed by the transplant team. Evidence of coercion, whether emotional, financial, or material, should lead the transplant team to refuse the donation.

The AST also supports the equitable distribution of organs based on current principles of allocation for all solid organs. If a donation is not directed to a specific recipient, based on a pre-existing relationship, the AST supports the allocation of the organ(s) as would normally occur with a non-directed donation. (See other statement)

In summary, the AST supports efforts to increase organ donation, as long as the donation is fair, equitable, and based on sound medical principles. However:

• The transplant center should refuse to transplant the organ(s), if there is any evidence of emotional, financial, or material coercion.
• Organ donations not directed to a specific recipient on the basis of a pre-existing relationship, should be distributed based on current standards and practice of allocation.

Approved by the AST Executive Committee on June 22, 2005
Revised and approved by the AST Board of Directors on April 13, 2009.