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As transplant medicine matures into a mainstream, lifesaving set of specialties, the need for available organs remains considerably high, with the availability of organs being the principal rate-limiting factor in performing transplants. One of the modalities for increasing the number of needed organs is advancing the notion of “living donors” and encouraging individuals to donate an organ (e.g., kidney) or a segment (e.g., liver) in order to provide transplant candidates with life-sustaining organs or tissue that help regain much of the candidate’s premorbid functionality.

In 2019, the number of living organ donations rose to nearly 7500, almost one-fifth of all transplants done in that year. Like with transplant recipient candidates, the goal of the psychosocial evaluation of organ donors is to determine that cognitive and emotional integrity is sufficient to sustain the donor through the decision-making, harvesting, and postoperative recovery period.1

The goals of the psychiatric evaluation of prospective live organ donors can therefore be summarized as follows:

  • Determine the decisional capacity of the donor to consent to the donation process

  • Explore mental health factors, such as mental illness, substance use, or personality traits, that may influence the exercise of free will in donating, even in the presence of decisional capacity

  • Determine whether there is sufficient psychiatric and psychological strength along with financial and social stability to prevent harm from the burdens of donation

  • Rule out other psychosocial factors that may cause undue influence on the donor’s decision making, even in the absence of cognitive and mental health limitations

  • Provide donor with referrals and resources that can facilitate the process of organ donation or potentially remove obstacles to becoming one

There are several reasons why living donors play an increasing role in the organ donation process. One is that recipients of organs from living donors have better outcomes and better survival rates.2 The other is that living relatives of transplant candidates tend to match better, boosting chances for a favorable outcome. Finally, the number of potential donors among living donors by far exceeds the number of available cadaver donors, and as more people opt to donate their organs, it can lead to a considerable increase in the availability of organs for donation. There are nonprofit agencies, such as Renewal,3 that advocate for living kidney donation and help popularize this generous practice.

There are several reasons that motivate individuals to become living donors, and we classify living donors based on those reasons. Frequently, close family members or relatives are willing to give a kidney, for example, to help a relative; those are genetically related donors. Legally related donors are not genetically related to the recipient but have legal family ties (e.g., spousal). Another type of donors are those who are emotionally related to the recipient (e.g., close friends).

Completely unrelated donors are known as altruistic donors (or “Good Samaritans”), and they ...

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