Living organ donation is the donation of a paired or divisible organ by a living person to another person. In contrast to postmortem donation — whether after brain death or after circulatory arrest — the donating person remains alive during and after the donation.
This makes living donation the structurally less problematic path of organ donation: the question of the Dead Donor Rule does not arise, because the donor is alive.
Which organs?
The possibility of living donation depends on the anatomical classification of the organ:
Paired organs:
- Kidney — the most common form of living donation worldwide. Donor mortality risk about 0.03 percent. One kidney suffices for the donating person.
- Lung — one lung lobe (lobus) can be donated without the donor dying; the removed portion does not regenerate but is compensated for by the remaining lung.
Divisible organs:
- Liver — partial liver donation (usually the left liver lobe). Donor mortality risk about 0.28 percent — higher than with the kidney, because the operation is more extensive. The liver regenerates in the donor.
- Pancreas — a partial segment is possible.
- Small intestine — a partial segment is possible.
Strictly unpaired organs (no living donation possible):
- Heart — only postmortem donation is possible. This is the decisive point for the aggravation of the donation-after-circulatory-arrest problem (cf. below).
- Complete lung or complete liver — only post mortem.
Principle of totality
The moral permissibility of living donation rests on the principle of totality, which Pius XII formulated in 1956 before the Italian Society of Anesthesiology: the part of the body is ordered toward the whole, yet the person may sacrifice a part for the benefit of another person, provided no serious impairment of function follows. A kidney can be donated — the second suffices to live on. The heart cannot — because its removal would mean the death of the donor.
Living donation as a personal-ontological act
John Paul II formulated the personal-ontological depth of living donation in his address to the XVIII International Congress of the Transplantation Society (Rome, 29 August 2000):
„Every organ transplant has its source in a decision of great ethical value: the decision to offer without reward a part of one’s own body for the health and well-being of another person. … Above all, this is a gesture which is a genuine act of love. It is not just a matter of giving away something that belongs to us but of giving something of ourselves.”
Living donation is thus a concrete realization of the personalist norm: an act of affirmation of the other for his own sake. It is self-transcendence in a bodily-concrete form.
Structural asymmetry to donation after circulatory arrest
From the differentiation paired/unpaired follows an ethical asymmetry that is central for the assessment of the practice of donation after circulatory arrest:
| Organ type | Living donation possible? | Donation-after-circulatory-arrest assessment under the precautionary principle |
|---|---|---|
| Kidney, lung (paired) | Yes | Donation after circulatory arrest is avoidable — living donation is the ethically less problematic alternative |
| Liver, pancreas (divisible) | Yes, with higher risk | Donation after circulatory arrest is partly avoidable |
| Heart (strictly unpaired) | No | Donation after circulatory arrest is unavoidable — the DDR-permanence tension becomes structurally maximal |
This asymmetry explains why the donation-after-circulatory-arrest heart transplant (Switzerland 2023, 9 countries worldwide) is the sharpest point of the entire donation-after-circulatory-arrest discussion: there is no fallback path via living donation, so the whole ethical burden falls on the permanence-setting of the postmortem donation.
Ontological classification
Superordinate concepts: state of affairs (donation type)
Ontological relations:
- compatible with (restricted): principle of totality, Dead Donor Rule, personalist norm
- disjoint with: postmortem donation (donation after circulatory arrest / donation after brain death)
- permitted for: paired organs (kidney, lung), divisible organs (partial liver, partial pancreas)
- not possible for: strictly unpaired organs (heart)
- grounded by: Pius XII (1956), John Paul II (2000)
Chapter assignment: Chapter 4: What Is Human Personhood? (German)
Sources
Magisterial sources
- Pius XII (1956): Anesthesia: Three Moral Questions — address to the Italian Society of Anesthesiology. Georgetown University Library Repository. https://repository.library.georgetown.edu/handle/10822/762162
- John Paul II (2000): Address to the XVIII International Congress of the Transplantation Society, Rome, 29 August 2000. https://www.vatican.va/content/john-paul-ii/en/speeches/2000/jul-sep/documents/hf_jp-ii_spe_20000829_transplants.html
- John Paul II (1995): Evangelium Vitae, no. 86 — organ donation as a way of nourishing a culture of life.
- Congregation for the Doctrine of the Faith (1987): Donum Vitae. — The body as a constitutive part of the person; what is technically possible is not, for that reason alone, morally permissible.
- Catechism of the Catholic Church (1997), no. 2296: on organ donation as an act of charity and its ethical conditions.
Medical-ethical literature
- United Network for Organ Sharing (UNOS): Living Donation Facts. https://unos.org/transplant/living-donation/
- HRSA / organdonor.gov: Living Organ Donation. https://www.organdonor.gov/learn/process/living-donation
- HRSA / OPTN: Living Donation FAQs. https://www.hrsa.gov/optn/patients/organ-donation/living-donation/living-donation-faqs
- Reese, Peter P.; Boudville, Neil; Garg, Amit X. (2015): Living kidney donation: outcomes, ethics, and uncertainty. The Lancet 385(9981): 2003—2013. — Standard article on risks and ethical conditions.
- Capron, Alexander Morgan (2008): Ethical issues in organ transplantation. PMC.
- OPTN/SRTR Annual Data Report — annual statistics, including living donation.
Statistics and epidemiology
- Changes in Organ Donation after Circulatory Death in the United States (2025), PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC12947068/ — asymmetry of donation-after-circulatory-arrest shares per organ.