Living vs. Deceased Donor Transplants – Pros and Cons

February 24 09:40 2025 Print This Article

Summary

A Living donor transplant is a 2-part surgery in which a living organ or tissues are harvested from a live donor, and then transplanted to a patient in need. A Deceased donor transplant is a transplant surgery in which the organs and tissues are harvested from the donor after they are brain dead.

Living donor transplants are known to have better outcomes, as the transplant recipient usually receives an immediate donation from a family member, with whom they have high genetic compatibility. This is beneficial on 2 counts – The recipient patient’s health has not reached critical status yet (so they are stronger for recovery), and the donated organ has a significant genetic similarity (reducing the chances of rejection by the recipient’s immune system). Living donor transplants are easier to schedule, plan and execute efficiently, and hence makes paired donations and donation chains possible. There are, however, minor surgical risks and financial costs to the donor which cannot be fully eliminated.

Deceased donor transplants are a lifeline for terminal patients with rare blood types, helping us combat the major organ shortage as a society. It is a selfless act, to choose to save someone else’s life, even as the donor loses their own. The deceased donor also has the chance to save multiple lives, as they can donate organs such as the pancreas, heart and both lungs as well. However, deceased donor transplants must be timed correctly, and can become a logistical nightmare, especially if the family of the donor withdraws consent after they have passed.

What is a Living Donor Transplant?

A Living Donor Transplant is a surgical procedure in which living organs or tissues from a donor, who is still alive, are extracted and transplanted into a patient who needs it. According to the National Organ and Tissue Transplant Organization (NOTTO), which regulates organ transplantation in India, a record high of 12,791 living donor transplants were performed in the country in 2022. Living donor transplants have increased in the last decade, with the advancement of medical sciences, as the risks to the donor have significantly decreased.

A majority of the live donor transplants performed are liver or kidney transplants. The donor must possess 2 healthy kidneys in order to qualify for a live-kidney donation. The donor can comfortably donate one of their healthy kidneys to a patient in need, and live a perfectly healthy life while the remaining kidney performs the necessary functions in removing wastes from the body. During a live liver transplant, the donor donates only a lobe of their liver. The remainder of the liver regenerates and grows back to nearly its original size, without any compromise in function. According to transplant surgeons, living donor transplants are also possible with tissues which have the capacity to regenerate – such as skin, bone marrow, and blood-forming cells.

Live donor transplants are of 2 types – Directed donations and Non-directed donations. Directed donations are conditional, wherein the donor agrees to donate their organ or tissue to a specific recipient. This is usually someone they know, such as a parent, sibling, child, spouse or friend. Non-directed donations, or altruistic donations, are when the donor does not specify the recipient, and instead chooses to help out a stranger purely due to good will. The transplant match is made by the regulating authority based on organ compatibility and the status of the recipient. Of the 2 types, in the case of living donors, directed transplants are more common.

Advantages of a Living Donor Transplant 

• Better Outcomes – Statistically, living donor transplants have had a higher rate of positive long-term outcomes. Live donor transplants are associated with fewer complications during and after the transplant surgery, as well as longer survival of the donor organ in the recipient’s body. This is partially also due to the quality of live donor organs. Live donors are thoroughly screened for health issues, ensuring only those with very healthy organs are eligible to donate.
• Makes Paired Organ Donation and Organ Donation Chains Possible – When a living organ donor and their intended transplant recipient are not a match, paired donations or donation chains may be organized. In paired organ donation, two organ recipients trade donors consensually so that each recipient gets an organ which matches their blood type. This is crucial to ensure the transplanted organ doesn’t get rejected by the transplant recipient. An organ donation chain is created when more than 2 donor-recipient pairs are involved in the trade. It is difficult to organize the logistics of paired organ donations or organ donation chains in the case of deceased donor transplants, as the donated organ doesn’t stay viable for long once the organ donor has passed.
• Immediate function of the Organ – In live donor transplants, the donated kidney or liver begins to function in the recipient’s body almost immediately. Sometimes, deceased donor organs take time to start functioning, and the patient must be kept on dialysis, or continued medication during this time. Patients who receive transplants from live donors tend to recover faster, and start receiving the benefits of the transplant immediately, greatly improving their quality of life.
• Flexibility in Scheduling – With a live donor, the organ retrieval surgery can be scheduled at the same location as the transplant surgery, and with the required urgency, depending on the status of the patient. This improves co-ordination between the surgical teams performing the procedures and decreases the time the donated organ spends in transit. These factors have a marked impact on the final outcome. The surgery can also be performed with the required urgency through a directed donation, instead of waiting for a compatible deceased donor to appear on the transplant list.
• Greater Genetic Compatibility – Live donors making directed donations are usually close family members of the patient. They tend to have greater genetic compatibility. This reduces the chances of the donor organ being rejected by the recipient’s body.

Disadvantages of a Living Donor Transplant 

• Surgical risks for the Donor – While medical science has advanced by leaps and bounds in the last decade, transplant surgeons believe that surgery is still not completely risk-free. Donating an organ is considered major surgery and has certain associated risks, such as post-operative infections, internal bleeding, blood clots, allergic reactions, pain and complications from anaesthesia.
• Financial Costs – The recovery period can be painful for the donor, and restrict their mobility and capacity to work. This could result in financial losses.
• Ethical Considerations – There are strict ethical guidelines in place to ensure that the organ is donated 100% voluntarily, and not under coercion, emotional blackmail or promise of any financial incentives. These guidelines can be difficult to navigate for the donor, and put them under a lot of emotional and psychological stress.

What is a Deceased Donor Transplant?

Deceased organ donation is the process of donation an organ or tissues for the purpose of transplant, after the donor’s death. The donor must consent to the organ donation while they are still alive, and of sound mind, by registering with the NOTTO. You can visit the NOTTO website and register yourself online, if you wish to be a deceased organ donor. The donor receives an organ donor card after registering, which they must keep carefully, and inform their next of kin about. Even if a deceased person has registered with NOTTO and has an organ donor card, their next of kin must consent at the time of donation for it to be legal. When the donor’s time comes, they must be admitted to a hospital, and after brain death is declared, they need to be kept on a ventilator to keep the organs viable for harvesting. A potential organ donor who has passed away at home, or anywhere outside the hospital, may not be eligible to donate their organs.

Deceased organ donation is initiated only once the donor is declared brain dead. Since the donor is brain dead, they can donate organs such as the heart, lungs, liver, kidneys, pancreas, intestines, eyes, heart valves, skin, bones and blood vessels. In case of deceased organ transplants, it is crucial to act quickly, as the organs must be transplanted into the recipient while they are still viable. The donor tissue must be matched to a potential recipient, and is given to the compatible candidate highest on the transplant list maintained by NOTTO. The location of the recipient is also taken into account, as the organ cannot be transported long distances before being transplanted.

Deceased organ donations are usually non-directed organ donations, done purely out of the desire to do good deeds even once one has transcended this world.

Advantages of a Deceased Donor Transplant 

• Opportunity to save multiple lives – A single deceased donor has the opportunity to save upto 8 lives, by donating all of their vital organs after brain death, including the heart, both lungs, liver, both kidneys, pancreas and intestines. The donor could also potentially donate their skin, eyes, tendons and heart valves, giving them the opportunity to improve the quality of life of many more patients. Many people find the prospect of doing good even after they face their end to be a very comforting thought that lends meaning and fulfilment to their lives. It also fosters a culture of social responsibility and helping people without any expectations in return.
• No risks to the donor – Unlike living donor transplants, there is no risk for the deceased donor.
• Reducing organ shortages – Deceased donor organs help address the critical organ shortage and reduces the time that critical patients spend on the transplant list. Deceased donation also increases the likelihood of patients with rare blood types or specific medical conditions finding a compatible organ.

Disadvantages of a Deceased Donor Transplant 

• Specific conditions for donation – The donor’s death must happen under very specific circumstances for them to successfully donate their organs, even if they have consented during their life. They must be given their end-of-life care in an appropriately equipped hospital, and their next of kin must uphold their wishes to be a donor despite great personal grief, offering consent to harvest the organs. Depending on the cause of the donor’s death, all of the organs they intended to donate may not be good for donation after all. If a potential donor has died from an infection, cancer or any major disease that puts them into multi-system organ failure, they will probably not qualify to donate their organs.
• Logistical Challenges – The organs must be kept viable until they are ready to be harvested. Once harvested, the transplant must be done quickly, to ensure that the organ stays viable. This is a task that requires sophisticated medical equipment and staff, which not all hospitals, especially in a country like India, are equipped to handle. After all the time, effort and resources put into this process, the transplant could still fail because of delays.
• Potential Organ Rejection – Deceased donor transplants have higher rates of rejection than live donor transplants. This could be because deceased donor transplant recipients, on average, tend to spend longer on the transplant list, and tend to have a more critical status. It could also be due to the logistical challenges mentioned above, which make the deceased donor’s organ less viable.

At Kauvery Hospital, with branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, we are committed to providing exceptional care for both living and deceased donor transplants. Our skilled medical team and state-of-the-art facilities ensure optimal outcomes for transplant patients. Trust us to guide you through every step of the transplant process with compassion and expertise.

Frequently Asked Questions

What is a living donor transplant?
A living donor transplant uses a healthy organ or tissue from a living person, often a family member, to help someone in need.

What are the benefits of living donor transplant?
Living donor transplants offer better outcomes, immediate organ function, easier scheduling, and higher genetic compatibility.

What risks are associated with living donor transplants?
The donor may face surgical risks, potential financial costs during recovery, and emotional or ethical challenges.

What is a deceased donor transplant?
A deceased donor transplant involves using organs from a donor after they have been declared brain dead, following family consent.

How do deceased donor transplants help patients?
They can save multiple lives at once, address organ shortages, and provide options for patients with rare blood types.

What challenges do decease donor transplants face?
They require precise timing, quick logistical coordination, and have a higher risk of organ rejection compared to living donor transplants.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai Alwarpet – 044 4000 6000 •  Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801