https://www.livingdonorassistance.org/Get-Help/Who-can-Apply

Who can apply?

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A living organ donor and their recipient apply together for the Living Organ Donation Reimbursement Program.
While this program helps donors, a donor and their recipient will both need to:

• Be eligible to apply
• Fill out an application

An organ donor and recipient can apply if:

• The donor is planning to donate one of these organs:
  
  • Kidney
  • Liver
  • Uterus
  • Intestine
  • Lung
• The recipient meets the income guidelines or has financial hardship
• The donor and recipient are U.S. citizens or lawfully present residents
• The donor and recipient live in the U.S. or its territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands).

...

https://www.cureus.com/articles/389422-long-term-follow-up-of-kidney-donors-in-a-tertiary-care-hospital?score_article=true#!/

Long-Term Follow-Up of Kidney Donors in a Tertiary Care Hospital
A P, N S, Kaliaperumal T, et al. (December 04, 2025) 
Long-Term Follow-Up of Kidney Donors in a Tertiary Care Hospital. 
Cureus 17(12): e98478. doi:10.7759/cureus.98478

Abstract
Aim: To estimate the proportion of living kidney donors (completed one year post-donation) who have developed proteinuria, an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m², hypertension, or suboptimal renal compensation (defined as <70% of pre-donation glomerular filtration rate (GFR)) during post-donation follow-up. The study also aimed to evaluate the association between donor-related factors and clinical outcomes. To assess the emotional well-being and overall satisfaction of donors through structured, in-person interviews.
Patients and methods: A cross-sectional prospective study design was undertaken to contact all donors of recipients under regular review who had completed at least one year post-donation. Among approximately 250 living renal transplant recipients in active follow-up, about 200 corresponding donors had crossed the one-year post-donation period. Of these, 160 donors responded to the call for follow-up, and 140 completed a comprehensive clinical and laboratory assessment in accordance with the institutional follow-up protocol. Written informed consent was obtained from all participants, and pre-donation records were retrieved for comparative analysis. The emotional well-being and overall satisfaction of donors were assessed through structured, in-person (in formal) interviews. Results were analyzed with IBM SPSS Statistics Software, version 20.0 (IBM Corp., Armonk, New York, USA).
Results: The mean age at donation was 45.4 ± 9.4 years (range: 20-69 years), and the mean age at follow-up was 51.5 ± 9.9 years. The median duration of follow-up was 7 ± 4 years (interquartile range (IQR): 1-23 years), with 30% (n = 42) of donors followed for more than 10 years post-donation. Female donors predominated (77.2%; n = 108), yielding a female-to-male ratio of approximately 3.4:1. Mothers constituted the largest donor subgroup (52.8%; n = 74). Perioperative complications occurred in 8% (n = 7) of donors. Hypertension was noted in 34 (24.3%). Proteinuria (protein-to-creatinine ratio (PCR) > 0.2) was seen in 34 donors (24.3%). Mean eGFR pre- and post-donation was 91.6 ± 16.0 ml/min and 80.3 ± 18.5 ml/min, with a decline of 11 ml/min. One hundred twenty-two donors (87.1%) have eGFR >60 ml/min/1.73 m2. Overall, 84.3% (n = 118) achieved optimal and 15.7% (n = 22) showed suboptimal compensation. On multivariate analysis, only suboptimal renal compensation remained an independent predictor of eGFR < 60 ml/min (adjusted OR: 31.43; 95% CI: 7.19-137.2; p < 0.001). Neither donor age nor gender showed a significant association with outcomes such as proteinuria, hypertension, eGFR <60 mL/min/1.73 m2, and suboptimal compensation. A vast majority (91%, n = 127) expressed happiness and complete satisfaction with their decision to donate.
Conclusion: In this cohort, female predominance reflected persistent sociocultural patterns. The prevalence of hypertension was comparable to that of the general population. These findings reinforce that modest post-donation changes in proteinuria or eGFR should not discourage donation, given its profound benefits to recipients, donors, and society. Establishing dedicated renal donor clinics for structured, lifelong surveillance is vital to safeguard donor health.

Dear Karli,

  Welcome! We hope you find answers to questions here and the support other donors can provide as you walk this path. May I suggest you consider starting with your primary care physician, and in addition to asking their thoughts on your intentions, ask them which nearby facility would they suggest you start at? If you intend to make a donation and do not yet have a recipient in mind, any transplant center can help you become a non-directed donor to a person in need. Best wishes!

To anyone reading this a loved one fighting kidney disease: I am ready to be tested to see if I can be their living kidney donor. My commitment is to a process that is 100% legal, ethical, and guided by medical professionals to ensure everyone's safety. If you have a mother, father, spouse, or friend in need, please have their transplant coordinator contact me. Let's see if I can help give them the future they deserve.

https://zenodo.org/records/17591291

The illicit Organ Trade: Biographical, Anatomical, Economic and Legal Aspects

JOURNAL
OF
ACADEMICS STAND AGAINST POVERTY
Volume 6, 2025: pages 86-102
Research Paper
Journal of Academics Stand Against Poverty, 2025, 6, 86-102
The Illicit Organ Trade:
Biographical, Anatomical, Economic and Legal Aspects
Nater Paul Akpen
College of Health Sciences, Benue State University, Makurdi, Nigeria. ORCID: 0009-0009-0446-1043
e-ISSN 2690-3458 ISSN 2690-3431

A kidney can cost up to USD 200,000. Humans have two kidneys but normally require just one to live. Individuals can donate one to relatives for altruistic reasons. But to pay USD 200,000 - or any other amount - to obtain a kidney, no country in the world allows that. Except for Iran. This global blanket ban has pushed the trade of organs underground and it now ranks as the fourth most lucrative illegal activity – behind only drugs, arms, and human trafficking. Rising incidence of end-stage kidney disease will increase demand for replacement kidneys, both gifted and bought. This essay studies this trade using two case studies, one of a Nigerian leading legislator arrested in the UK for getting a kidney for his daughter and another on kidney demand in Iran where trade in organs is permitted. The global value of the trade is studied, and literature gaps are discussed. The inadequacies of the current system are highlighted and improvements suggested, based on best practices around the world.

https://medicalxpress.com/news/2025-11-ai-donor-livers-viable-potentially.html

AI predicts when donor livers are viable, potentially slashing canceled transplants by 60%
by Stanford University Medical Center
edited by Sadie Harley, reviewed by Robert Egan

There are more candidates on the waitlist for a liver transplant than there are available organs, yet about half the time a match is found with a donor who dies after cardiac arrest following the removal of life support, the transplant must be canceled.

For this type of organ donation, called donation after circulatory death, the time between the removal of life support and death must not exceed 30 to 45 minutes, or the surgeons will often reject the liver because of the increased risk of complications to the recipient.
Now, Stanford Medicine researchers have developed a machine learning-based model that predicts whether a donor is likely to die within the time frame during which their organs are viable for transplantation. The model outperformed surgeon judgment and reduced the rate of futile procurements—which occur when transplant preparations have begun but death happens too late—by 60%.
"By identifying when an organ is likely to be useful before any preparations for surgery have started, this model could make the transplant process more efficient," said Kazunari Sasaki, MD, clinical professor of abdominal transplantation and senior author on the study. "It also has the potential to allow more candidates who need an organ transplant to receive one."
The work is published in Lancet Digital Health. The lead author of the study is Rintaro Yanagawa of Kyoto University.
Making liver donation more efficient
For people with end-stage liver disease, which consists of severe and irreversible damage to the organ, the best treatment option is a transplant.

The number of people who need a liver exceeds the number of donors, but the gap is starting to narrow due to devices that carry out normothermic machine perfusion, a technique that keeps organs at the ideal temperature and supplied with oxygen while they travel from the donor to the recipient. These devices have made it possible for organs from donation after circulatory death to be used for transplants.
While most liver donations come from donors who suffered brain death, the number of donations after circulatory death is growing.
"The number of liver transplants keeps going up because of donation after circulatory death, and the waitlist is getting smaller. In the future, it might be possible for everyone who needs a liver transplant to get one from a deceased donor," Sasaki said.
A third type of liver transplantation, living donation, involves removing part of a healthy person's liver to transplant—which is possible because the liver can regenerate. While "it's a beautiful story," Sasaki said of living donation, "any major surgery is not without risk to the healthy donor."
There is a challenge to donation after circulatory death, however: time.
While the donor is dying, the blood supply to organs throughout the body can vary and, in some cases, stop altogether, leading to liver damage. The liver contains a network of pipes called ducts that squeeze out bile, a fluid that helps us digest food, to the gallbladder and intestines.
A long time between the cessation of life support and the donor's time of death is associated with malfunctioning ducts and serious complications for transplant recipients. If the donor's time of death happens more than 30 minutes after blood flow starts to decrease to the body's organs, the liver might not be useful for transplantation.
About half of the possible donors die within the first 30 minutes after life support is removed. When death occurs later, between 30 and 60 minutes after life support ends, surgeons use their judgment to determine which donors are the best candidates by considering the donor's vital signs, blood work, and neurological information such as the pupil and gag reflex.
Still, about half of the transplantations need to be canceled because death occurred too late. Knowing where to allocate resources, such as normothermic machine perfusion devices, can save money and streamline the workload of transplant health care workers, Sasaki explained.
Competing machine-learning algorithms
To predict the time of death, the model uses an array of clinical information from the donor including gender, age, body mass index, blood pressure, heart rate, respiratory rate, urine output, blood work test results and cardiovascular health history.
The model also considers the ventilator settings, which indicate how much help someone needs to breathe, in addition to neurological assessments of how conscious the patient, as well as pupil, corneal, cough, gag and motor reflexes.
The research team pitted numerous machine-learning algorithms against each other to find the one that best predicted the time of death using the same information available to surgeons. The winning algorithm was more accurate than surgeons and other available computerized tools at predicting whether the donor's time of death would happen within the acceptable time frame for a successful transplant.
The model was trained and validated on more than 2,000 real-world cases from six U.S. transplant centers.
The model accurately predicts the donor's time of death 75% of the time, outperforming both existing tools and the average judgment of surgeons, who accurately predicted the time of death 65% of the time. It also makes accurate predictions for cases with information missing from the medical record.
The research team designed the model to be customizable so it can handle different surgeon preferences and hospital procedures. For example, the model can be set to calculate the time of death from when life support is removed or from when agonal breathing, a gasping breathing pattern that happens as a body is dying, begins.
The researchers have also developed a natural language interface, similar to ChatGPT, that pulls information from the donor medical record into the model.

Minimizing missed opportunities
Sometimes death unexpectedly occurs within the time frame when organs are suitable for transplantation, but because preparations must be underway before the donor dies, these cases do not result in a transplant. The rate of these missed opportunities was similar for the model and surgeon judgment: both were just over 15%.
Because artificial intelligence is rapidly advancing, the researchers expect that the model's accuracy in predicting time of death will improve and that it will catch more missed opportunities.
"We are now working on decreasing the missed opportunity rate because it is in the patients' best interest that those who need transplants receive them," Sasaki said.
"We continue to refine the model by having competition among available machine learning algorithms, and we recently found an algorithm that achieves the same accuracy in predicting the time of death but with a missed opportunity rate of about 10%."
The research team is also working on variations of the model for use in heart and lung transplants.
Researchers from the International University of Health and Welfare, Duke University School of Medicine, Cleveland Clinic, University of Rochester Medical Center, University of Florida College of Medicine, Virginia Commonwealth University Health, Columbia University Irving Medical Center, and Transmedics, Inc. contributed to this study.
More information: The Lancet Digital Health (2025). DOI: 10.1016/j.landig.2025.10091

https://www.renalandurologynews.com/news/could-pig-kidneys-end-the-transplant-shortage-first-u-s-trial-begins/

Could Pig Kidneys End the Transplant Shortage? First U.S. Trial Begins

A first-of-its-kind clinical trial is beginning in the United States to see if pig kidneys could help save the lives of people waiting for a human organ transplant.
United Therapeutics, the company that developed the genetically edited pig kidneys, said Monday that the first transplant in the trial has already taken place at NYU Langone Health.
The patient's identity and surgery date were not released for privacy reasons.
NYU surgeon Dr. Robert Montgomery, who led the transplant team, said the hospital already has more patients waiting to join the study.
The trial will begin with six participants and could grow to as many as 50 people if early results are safe and promising.
...

https://adage.com/events-awards/health-care-marketing-impact/aa-sanofi-badge-of-honor-pharmaceutical-gold/

Sanofi's AI-driven campaign boosts living kidney donor applications amid urgent need

By
Joy R. Lee
November 10, 2025 06:00 AM

Sanofi, the global pharmaceutical company, responded to the urgent need for living kidney donation with an unorthodox approach. The "Badge of Honor" campaign, created in partnership with FCB Health New York, an IPG Health Company, focused on the only variable that could shift the outcome—the donor.
...

https://www.acpjournals.org/doi/10.7326/ANNALS-25-02257

Risk for Scrotal Surgery After Laparoscopic Donor Nephrectomy: A Population-Based Cohort Study
Authors: Amit X. Garg, MD, PhD et al
https://doi.org/10.7326/ANNALS-25-02257

Abstract
Background:
A potential long-term complication of living kidney donation in male donors is scrotal swelling on the same side as the nephrectomy, and some undergo surgery to relieve discomfort from the fluid collection. The long-term risk for this outcome attributable to donation is unknown.
Objective:
To evaluate long-term scrotal surgery rates after laparoscopic nephrectomy in male living kidney donors compared with non-donors.
Design:
Population-based cohort study (2002 to 2024). (ClinicalTrials.gov: NCT06716723)
Setting:
Linked administrative health care databases in Ontario, Canada.
Participants:
898 male living kidney donors who had a laparoscopic nephrectomy were matched in a 1:10 ratio with 8980 male non-donors from the general population. The matching characteristics were age, date of cohort entry, rural residence, income, prior vasectomy, and prior inguinal hernia repair. Participants were followed for a median of 9 years, up to 22 years.
Measurements:
The primary outcome was hospitalization for surgery to address a unilateral scrotal fluid collection.
Results:
Donors and matched non-donors had a median age of 45 years. The rate of scrotal surgery was higher in donors than non-donors (70 of 898 donors [7.8%] vs. 19 of 8980 non-donors [0.2%]; 8.3 vs. 0.2 events per 1000 person-years; hazard ratio, 38.8 [95% CI, 22.1 to 67.9]; P < 0.001). The median time from donation to scrotal surgery was 5.2 years (IQR, 3.3 to 8.4 years); more than 90% of the surgeries were hydrocelectomies and were performed under general anesthesia. Over 20 years, the cumulative incidence was 13.8% in donors versus 0.7% in non-donors.
Limitation:
The precise causal mechanism remains unknown.
Conclusion:
Laparoscopic nephrectomy is associated with a higher risk for subsequent scrotal surgery in male living kidney donors.
Primary Funding Source:
Canadian Institutes of Health Research.

https://journals.lww.com/transplantjournal/fulltext/2025/02000/organ_transplantation_in_india__not_for_the_common.9.aspx

COMMENTARIES
Organ Transplantation in India: NOT for the Common Good
Domínguez-Gil, Beatriz MD, PhD1; Delmonico, Francis L. MD2; Chapman, Jeremy R. MD3
Transplantation 109(2):p 240-242, February 2025. | DOI: 10.1097/TP.0000000000005116

India has demonstrated exceptional rates of growth in the number of kidney and liver transplants performed across the country (Figure 1).1 Over the 5 y from 2014 to 2019, India increased the number of transplants performed per annum, by adding approximately the total number of transplants performed in a year in France, Germany, Spain, or Turkey. This growth in capacity involved every aspect of specialized and trained surgical, medical, and nursing human resources, as well as hospital infrastructure in operating theaters and recovery wards. It is worthy of congratulations as a demonstration of the evolving power of this nation. However, with that growth has come a description of Indian organ transplant practices in the global and local media that is at once both alarming and reprehensible.2 The experience of human and organ trafficking in India today is seemingly recurrent and validated.3-5

The field of organ transplantation has evolved very differently across the world under the influence of different national healthcare financing systems. Healthcare is, in most countries, financed by taxation and thus through governmental budgets, in combination with private funds, mostly through contributory health insurance systems (eg, Australia, Canada, Europe, New Zealand, South America, and the United States). But across much of Asia, tertiary healthcare services, such as transplantation, are almost entirely dependent on the private finances of individuals. The impressive growth in Indian organ transplantation has been accomplished in for-profit hospitals, which have expanded Indian transplantation into 807 facilities, mostly associated with the major corporate hospital chains.6 Organ transplantation, in a part of the world where one-fifth of all people live, is thus largely not for the common good, but a treatment available for those with ample monetary resources.
In India, organ transplantation has become of such a high monetary value, that a population of foreign patients also undergo transplantation in that jurisdiction, swept up in the general development of medical tourism. In 2023, the Government of India's Ministry of Home Affairs announced the creation of the Ayush Visa category for foreign nationals, promoting travel for healthcare in India.7 Approximately 2 million patients from 78 countries go to India for all forms of medical care, generating $6 billion for the health industry of India and expected to reach $13 billion by 2026.8 Many transplant patients are thus coming to India from elsewhere in the Indian subcontinent, the Middle East, Southeast and Central Asia, and Africa with the expectation of receiving medical care. Medical tourism is a badge of excellence and national pride, but transplant tourism and commercialization have seemingly breached India's commitments to the 63rd World Health Assembly (WHA) in 2010, driving "preferential allotment of organs to foreigners" and the repetitive media reports of trafficked poor from neighboring countries as paid living donors.2
NOT ALL TRANSPLANT PROFESSIONALS IN INDIA ARE DRIVEN BY ECONOMIC INTERESTS
There is certainly a variation across the 28 states of India. There are states where all transplants are undertaken by large dedicated public hospitals and are free to the recipient. There are states where courts apparently determine whether living unrelated transplants proceed or not, and there are states where the approval process for unrelated transplants, especially from overseas donors, is seemingly waved through in the name of economic development.
THE SOURCE OF THE LIVING DONORS IN INDIA. WHAT IS THEIR NATIONALITY AND RELATIONSHIP TO THE RECIPIENT?
The reported number of deceased donors per million population in India was 0.67 in 2022; for every deceased organ donor in India, there were 13 living kidney or liver donors.1 The contrast to the equivalent ratios in North America or Europe could not be starker. What remains unknown is whether the organs donated by deceased Indians are preferentially allocated to foreign nationals, as proposed in media reports.2,9 Nor is it visible whether the 13 000 living donors that in 2022 provided a kidney (10 000) or a part of their liver (3000) were of Indian or foreign origin, nor is their relationship to the recipients known. The absence of transparency has enabled a repetitive experience of organ trafficking throughout the Indian Subcontinent of Asia.3-5 Alleged by media report in 2022: over the last 2 decades, for example, dozens of men from villages in Nepal were trafficked for their kidneys, with some duped with false promises of employment in Delhi. Nepal investigative officials told the "NewsHour" report that each new victim led them to the same hospital in Kolkata that has been in the headlines for illegal kidney transplants in the past, but has not been prosecuted despite the buying and selling of organs being illegal in India.
NOTTO SEEKS TO FULFILL THE LAW OF INDIA AND THE RESOLUTIONS OF THE WHA
It is time to support the Indian Government's earnest intent to fulfill the ethical principles they adopted in 2010 at the WHA. A memorandum was widely distributed in Indian transplant circles recently from Dr Anil Kumar, the Director of the National Organ Transplant And Tissue Organization of the Ministry of Health of India that defines the requirement for all centers to fulfill the law of India. The memorandum requires the record and reporting of every organ transplant "whether from a living donor or deceased donor." National Organ Transplant And Tissue Organization has emphatically expressed its concern regarding unethical practices of "commercial dealings in organs involving foreign citizens." The transplant professionals of India must now use this opportunity to cooperate to fulfill the promise and benefit of organ transplantation for the good of the communities of India and in doing so separate the ethical majority from the unethical minority.10,11
Member States of the Assembly have now an opportunity to consider a new Resolution in the 77th WHA in Geneva in May 2024. That resolution: "Increasing Availability, Ethical Access and Oversight of Transplantation of Human Cells, Tissues and Organs" calls for transparency and oversight of practices that should identify the nationality and relationship of the living donor to the organ transplant recipient. These data should be reported annually to the regulatory agency within the jurisdiction that authorizes the center to perform organ transplants.
FOR THE COMMON GOOD
The Transplantation Society, founded nearly 60 y ago, selected a sculpture by Auguste Rodin entitled "the Cathedral," to be its logo. Two right hands symbolize the right hand of an organ donor and the right hand of a recipient, with both needed to achieve a successful transplant. Two people doing extraordinary things to save lives, irrespective of ethnicity, sex, social status, or affluence.
National and international professional societies of transplantation exist to advance science, provide information and education but as well illuminate policies that span all cultures in ethical propriety. The support of India for the WHA Resolution will be a testimony of many right hands for the common good.

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