Organ procurement

Organ procurement is a surgical procedure that removes organs or tissues for reuse, typically for organ transplantation.

Procedures

If the organ donor is human, most countries require that the donor be legally dead for consideration of organ transplantation. For some organs, a living donor can be the source of the organ. For example, living donors can donate one kidney or part of their liver to a well-matched recipient.
Organs cannot be procured after the heart has stopped beating for a long time. Thus, donation after brain death is generally preferred because the organs are still receiving blood from the donor's heart until minutes before being removed from the body and placed on ice. To standardize brain death evaluation, the American Academy of Neurology updated guidelines in 2010, requiring coma with known cause, absent brain stem reflexes, and apnea; recent practices emphasize critical care coordination to optimize donor stability and increase procurement rates.
Donation after circulatory death, also called donation after cardiac death, refers to organ donation from patients in whom life-sustaining treatment is withdrawn and death is declared following irreversible cessation of circulatory and respiratory function; organs are procured after a short, defined no-touch observation period following circulatory arrest. DCD donors may have variable residual brain activity at the time of withdrawal of support, and protocols differ between jurisdictions. For example, UK guidance typically applies a 2–5 minute observation period in controlled DCD pathways, while other countries use different timings within their local protocols. This occurs in situations where, based on the patient's advanced directive or the family's wishes, the patient is going to be withdrawn from life support. After this decision has been made, the family is contacted for consideration for organ donation. Once life support has been withdrawn, there is a 2-5 minute waiting period to ensure that the potential donor's heart does not start beating again spontaneously. After this waiting period, the organ procurement surgery begins as quickly as possible to minimize time that the organs are not being perfused with blood. DCD had been the norm for organ donors until 'brain death' became a legal definition in the United States in 1981. Since then, most donors have been brain-dead.
After consent and clinical donor evaluation, donor-recipient matching is coordinated in the United States via the Organ Procurement and Transplantation Network, operated under contract by UNOS. The OPTN maintains the national matching algorithms and allocation policy documents.
Co-ordination between teams working on different organs is often necessary in case of multiple-organ procurement. For trauma patients, successful procurement requires extensive collaboration between trauma teams and organ procurement organizations to ensure viable organs amid physiological instability. Multiple-organ procurement models are also developed from slaughtered pigs to reduce the use of laboratory animals.
The quality of the organ then is certified. If the heart stopped beating for too long then the organ becomes unusable and cannot be used for transplant.

Preservation and transport

After organ procurement, the organs are often rushed to the site of the recipient for transplantation or preserved for later study. The faster the organ is transplanted into the recipient, the better the outcome. While the organ is being transported, it is either stored in an icy cold solution to help preserve it or it is connected to a miniature organ perfusion system which pumps an icy solution through the organ. This time during transport is called the "cold ischemia time". Cold ischemia time targets vary by organ. Historically, hearts and lungs have been transplanted within about six hours of procurement, and livers within a window up to ~24 hours, although shorter times generally improve outcomes. Advances in ex-vivo perfusion and normothermic preservation have extended safe preservation intervals in some settings and improved early graft assessment, allowing clinically successful transplantation of organs that would previously have exceeded conventional cold ischemia limits. For kidney transplants, as the cold ischemia time increases, the risk of delayed function of the kidney increases. Sometimes, the kidney function is delayed enough that the recipient requires temporary dialysis until the transplanted kidney begins to function.
Recent advancements include hypothermic or normothermic machine perfusion, widely used for kidneys and emerging for hearts/lungs/livers, potentially increasing viability and addressing shortages. In the case of DCD, the first technique established for organ procurement was super-rapid recovery. Hypothermic perfusion of kidneys is a relatively widespread practice. For the heart normothermic preservation has been used in which the heart is provided with warm oxygenated blood and so continues to beat ex-vivo during its preservation. This technique has also been applied to lungs and led to the emergence of donor lung reconditioning centres in North America. For the liver, hypothermic and normothermic techniques are being used with evidence to suggest that both may be beneficial.
There is ongoing research and development to improve machine perfusion and alternative approaches such as novel cryoprotectant solvents to improve organ viability and availability – such as by increasing preservation durations.

Ethical issues

The World Health Organization defines and condemns commercial trade in human organs for transplantation and promotes national regulatory frameworks to prevent trafficking, transplant tourism and unethical commercialisation. Estimates of the scale of illicit organ trade vary widely by method and region. WHO reports, regional surveillance, and independent analyses document ongoing illegal or coerced organ procurement in some countries and estimate that illicit activity comprises a non-negligible but variably quantified proportion of global transplantation. These countries include, but are not limited to:

Although the procedure of organ transplantation has become widely accepted, there are still a number of ethical debates around related issues. The debates center around illegal, forced or compensated transplantation like organ theft or organ trade, fair organ distribution, and to a lesser degree, animal rights and religious prohibition on consuming some animals such as pork.
There is a global shortage of transplantable organs relative to need. In the United States, recent official data and independent analyses estimate that roughly 15–20 people die each day while waiting for a transplant. OPTN/HRSA and related analyses provide the day-to-day waiting-list and removal-for-death statistics used to compute these estimates. In the US, organ procurement is a $1 billion annual industry managed by organ procurement organizations, with over 60% of costs as overhead and average profits of $2.3 million per organization. When an organ donor does arise, the transplant governing bodies must determine who receives the organ. The UNOS computer matching system finds a match for the organ based on a number of factors including blood type and other immune factors, size of the organ, medical urgency of the recipient, distance between donor and recipient, and time the recipient has been waiting on the waitlist.
Because of the significant need for organs for transplantation, there is ethical debate around where the organs can be obtained from and whether some organs are obtained illegally or through coercion.
In 2009, the Swedish tabloid Aftonbladet triggered international controversy by claiming that Israeli troops killed Palestinians in order to harvest their organs – the Israeli government condemned the allegations as an antisemitic libel. During the controversy, it emerged that there had been a practice in Israel of harvesting tissues from the deceased without the knowledge and consent of their families, but that practice ended in the 1990s.

China

In 2005, China admitted to using the organs of executed prisoners for transplant. Due to religious tradition of many Chinese people who value leaving the body whole after death, the availability of organs for transplant is much more limited. Almost all the organs transplanted from deceased donors came from executed prisoners. Since then, China has repeatedly been found to have a rampant black market for organs for transplant, including continued use of organs from executed prisoners without their consent and targeting young army conscripts for their organs. In 2014, China promised that by January 1, 2015, only voluntary organ donors would be accepted. China has worked to increase the number of voluntary organ donors as well as to convince the international community that they have changed their organ procurement practices after many prior failed attempts to do so. According to the former vice-minister of health, Dr. Huang Jiefu, the number of voluntary organ transplants increased by 50% from 2015 to 2016. Many of the organs harvested are sold to overseas buyers who fly to China for the transplantation procedure. It is possible to schedule these surgeries in advance which is not possible in systems which rely on voluntary organ donation. In the year 2020, allegations were made that Muslim customers from the Middle East, including Saudi Arabia, reportedly request Halal organs, those which come from a Muslim person from Xinjiang.
In 2022, the International Society for Heart and Lung Transplantation issued a policy statement to exclude transplant-related research involving human donors from China from its publications and scientific meetings due to the amount of evidence showing that the Chinese government stands alone in systematically supporting organ or tissue procurement from executed prisoners, a practice that the ISHLT identifies as a violation of fundamental human rights and the principle of voluntary donation.
In August 2024, media outlets reported on the first known survivor of China’s forced organ harvesting. The Diplomat reported its interview with Cheng Pei Ming, a Falun Gong practitioner, who recounted how he was subjected to repeated blood tests and a subsequent forced surgery while imprisoned in China and later discovered during medical exams in the U.S. that segments of his liver and a portion of his lung had been surgically removed.
According to recent claims in July 2025, the Xinjiang Health Commission—an agency under China's National Health Commission—intends to establish six additional medical facilities in the Xinjiang region by 2030, raising the total number to nine. Experts have expressed concern that these centers may be used to expand the practice of forced organ harvesting, particularly involving detained Uyghur individuals. The proposed expansion has heightened international scrutiny and alarm over ongoing human rights abuses in the region.