Organ Donation → Transplant Receiving

Skip anything

Every question is optional. No one has to retell painful events, name a diagnosis, or choose a religion or identity to begin.

Pause or stop

Stop at any point. Nothing is sent anywhere, and nothing is shared unless the person chooses it in the sharing review.

Whose words

Record who said each thing: the person, a caregiver or surrogate, or a professional. A caregiver's needs get their own field.

Support to take part

Extra time, a quieter place, pictures, an interpreter or a trusted person can help someone say what matters. Ask what helps.

Barriers are not preferences

Cost, travel, work, housing, caring for others and digital access are written down as barriers, not as what the person wants.

Meaning, religious or not

Hope, purpose, faith, relationships and identity can be part of the conversation if the person wants. None is assumed.

• Transplant physician or surgeon: Benefits, risks and the kinds of organs that may be offered.
• Transplant nurse coordinator: Listing, organ offers and what each step involves.
• Social worker: Costs, travel, work and family support.
• Pharmacist: Lifelong medicines and their side effects.
• Psychologist or counselor: Worry, stress and support before and after transplant.
• Chaplain or spiritual-care provider: Meaning, distress, hope and relationships, for people of any faith or none.
• Interpreter or communication specialist: Language and communication support so the person's own words come through.
• People the person chooses: Family, friends, or a community or faith contact, only if the person wants them. Never assumed safe, available or wanted.

Roles, titles and training differ by country and service. Not every role exists everywhere.

A small set of places chosen for contrast, not a ranking or a representative survey: Global, Japan, India, Turkey, South Africa, United States, Netherlands, Mexico, Iran, Multi-country, New Zealand. Each example states what its source establishes and what it does not. Policy on paper is not proof that a service is available.

Guidance, not outcomes:

Shows what is written or recommended. It does not show that it is followed or what results.

Abstract only:

Read from the abstract. The full paper may add or qualify this.

Service as described:

Describes a service when the source was written. Whether it still runs is not verified.

Place from authors:

The place is taken from the authors' affiliations, not from where data were collected.

• Global · Guidance · 2010

  WHO's Guiding Principles commentary says living donation, particularly by unrelated donors, needs a psychosocial evaluation to guard against donor coercion and paid donation.

  Limits: Guidance, not outcomes

  What others could learn: When a relative offers to donate, the team can explain that an independent psychosocial evaluation of the donor is part of the process, to check that the choice is voluntary and unpaid and to assess motivation and expectations about outcomes.

  Conditions, limits and source

  Conditions that matter:

  The commentary says the national health authority should ensure the evaluation is done by an appropriately qualified, independent party. Needs a legal framework for living donation and time before surgery for the evaluation and for withdrawal of consent.

  Cannot be inferred:

  Does not show that evaluations detect coercion in practice, that any country applies them as described, or how family expectations work in any community.

  Limits:

  Non-binding principles; the text says each jurisdiction determines how to implement them. The IRIS record dates the document only to 2010 (no day or month). Normative guidance, not an evaluation of any program. Later guidance, such as the 2018 Declaration of Istanbul, updates some points.

  Source: World Health Organization, WHO guiding principles on human cell, tissue and organ transplantation (Commentary on Guiding Principle 3, printed p. 4 (PDF p. 4)). Where: Global. Population: Living organ donors and the people who receive their organs. Published 2010; retrieved 2026-10-11.

• Global · Guidance · 2019

  An open-access companion article to the 2018 Declaration of Istanbul says transplants should not be performed without sufficient guarantee of follow-up care and access to immunosuppression.

  Limits: Guidance, not outcomes

  What others could learn: Before a transplant, the team and the person can ask who will pay for lifelong immunosuppression and follow-up, and how records and care will connect if surgery is in another city or country.

  Conditions, limits and source

  Conditions that matter:

  Per the article: professionals confirm funding or insurance for follow-up; when someone travels for a transplant, the transplant team coordinates with the physicians who will provide follow-up at home and the person receives the necessary medical records; outcome data go to registries.

  Cannot be inferred:

  Does not measure how many programs meet this standard, outcomes of transplants abroad, or what happens to people who cannot show a guarantee of follow-up. Not legal advice about any country's law.

  Limits:

  Explanatory article, not the text of the Declaration itself (declarationofistanbul.org returned 403 and was not retrieved). Normative ('should'), prepared as part of the Declaration's update process, and not an evaluation of any program. It says diversity in policy and practice is not necessarily inconsistent with the Declaration.

  Source: Transplantation Direct (Martin DE, Van Assche K, Dominguez-Gil B, Lopez-Fraga M, Garcia Gallont R, Muller E, Capron AM); companion to the Declaration of Istanbul Custodian Group's 2018 edition, Strengthening Global Efforts to Combat Organ Trafficking and Transplant Tourism: Implications of the 2018 Edition of the Declaration of Istanbul (Discussion of Principle 2, 'The optimal care of organ donors and transplant recipients should be a primary goal of transplant policies and programs' (PMC full text, Principle 2 section)). Where: Global. Population: Living donors and transplant recipients, including those who travel for transplantation. Published 2019-02-22; retrieved 2026-10-11.

• Japan · Measured outcome · 2015

  In a nationwide survey of Japanese programs active in living-donor transplantation in 2013, many programs reported practices to support related living donors' decisions, including a right to withdraw consent and a set cooling-off period.

  Limits: Abstract only · Service as described

  What others could learn: Programs can build in a third-party interview, a stated right to withdraw and a cooling-off period, which may give a relative who hesitates a structured way to reconsider.

  Conditions, limits and source

  Conditions that matter:

  Per the abstract: third parties were most often psychiatrists; most donors were offered mental health specialist care (86% kidney, 93% liver); larger kidney programs designated third parties more often. Needs mental health staff attached to transplant programs.

  Cannot be inferred:

  Practice today (data are from programs active in 2013); programs that did not respond; unrelated donation; whether Japanese families experience less or more pressure than families elsewhere; recipient experience.

  Limits:

  Abstract only; the full text was not retrieved. Programs described their own practices. Donors were not asked about their experience, so the survey cannot show whether the practices reduced pressure. Practices varied by organ and program size, and the abstract says 70% of kidney and 90% of liver programs interviewed all donors with a third party to confirm voluntariness, so some did not.

  Source: American Journal of Transplantation (Nishimura K, Kobayashi S, Tsutsui J, et al.); abstract via PubMed, Practices for Supporting and Confirming Decision-Making Involved in Kidney and Liver Donation by Related Living Donors in Japan: A Nationwide Survey (Abstract, Results (percentages are kidney and liver programs, in that order)). Where: Japan. Population: Related living kidney and liver donor candidates (programs reported on their practices). Published 2015-11-10; retrieved 2026-10-11.

• India · Measured outcome · 2025

  A 2025 review of kidney transplantation in India reports that between 2019 and 2023 women were 30% of living-donor kidney recipients but 66.2% of living donors.

  What others could learn: Teams can record who in the family is asked to donate and who is offered a transplant, and ask the family openly how the donor was chosen, because the pattern is unequal even though the numbers do not explain it.

  Conditions, limits and source

  Conditions that matter:

  Per the review: the Transplantation of Human Organs and Tissues Act requires an Authorisation Committee for donation by distant relatives or unrelated people; the review recommends psychological evaluation of all donors to avert coercion; Gujarat reports bonus waitlist points for women on the deceased-donor kidney list.

  Cannot be inferred:

  Whether any donation was pressured; causes of the gender difference; the pattern in a specific region, community or center; figures after 2023.

  Limits:

  Review, not a primary study. The abstract does not name the data source for the 2019 to 2023 figures, and the review itself says India has no national registry tracking demographics and long-term outcomes. Counts show who donates and who receives, not why.

  Source: Kidney360 (Kute V, Abraham G, et al.); American Society of Nephrology, Current State of Live and Deceased Donor Kidney Transplantation in India: Challenges and Opportunities (Abstract; also the gender disparity section of the PMC full text). Where: India. Population: Living-donor kidney transplant donors and recipients, 2019 to 2023. Published 2025-10-28; retrieved 2026-10-11.

• Turkey · Measured outcome · 2025

  In a Turkish survey of 405 healthcare providers, kidney transplant recipients and dialysis patients, awareness of kidney xenotransplantation was limited, over 65% wanted to learn more, and immunologic rejection and infection were common concerns.

  Limits: Abstract only

  What others could learn: Over 65% of this sample wanted to learn more about animal-derived organs, so a team can ask what the person has heard, what worries them about rejection, infection or where the organ comes from, and offer to revisit it.

  Conditions, limits and source

  Conditions that matter:

  Per the abstract: acceptance was highest when outcomes were equivalent to human transplants and substantially lower when inferior; higher education and lower perceived risk predicted acceptance when outcomes were equal. The authors call for culturally sensitive communication, which needs staff time and clear information.

  Cannot be inferred:

  What patients would choose when offered a real xenograft; acceptance in other Turkish regions or languages; acceptance in any other country; what any faith tradition allows. The 32-item questionnaire was not reviewed and is not reproduced.

  Limits:

  Abstract only. Sampling and response rate are not stated in the abstract; author affiliations are Istanbul hospitals, so it may not represent all of Turkey. Hypothetical scenarios (equivalent or inferior outcomes), not real offers. The abstract reports religious appropriateness as the strongest independent predictor of acceptance and describes the sample as predominantly Muslim; it does not report what any religious authority holds. PubMed lists the issue as Nov-Dec 2025.

  Source: Xenotransplantation (Ozcan SG, Dincer MT, Erol E, et al.); abstract via PubMed, Attitudes Toward Kidney Xenotransplantation Among Turkish Healthcare Providers, Dialysis Patients, and Transplant Recipients (Abstract, Results). Where: Turkey. Population: 197 healthcare providers, 114 kidney transplant recipients, 94 dialysis patients. Published 2025-11; retrieved 2026-10-11.

• South Africa · Measured outcome · 2026

  Of 761 people referred for kidney replacement therapy at an Eastern Cape public hospital, 79% were untreated and presumed dead; accepted patients were younger, more stable and better off socioeconomically; 21% of those started on dialysis were transplanted.

  What others could learn: Where treatment is rationed, a person can ask the referral team which criteria applied, which are modifiable (for example blood pressure or diabetes control, social support), and what palliative support is offered if not accepted.

  Conditions, limits and source

  Conditions that matter:

  Per the full text: a committee of nephrologists, physicians, managers, a social worker, psychologist and nurses assesses eligibility; a peritoneal-dialysis-first policy; supportive palliative care for referred patients not accepted; patients with donors must travel more than 800 km to the Western Cape for transplant surgery; about 93% of the population is medically uninsured.

  Cannot be inferred:

  Practice in other South African provinces, in the private sector, or in other African countries; whether relaxing criteria would change outcomes; how patients experienced the committee decision.

  Limits:

  Single center, retrospective. Of 761 referred, 598 (79%) were untreated and presumed to have died, so deaths were not confirmed. The full text notes incomplete records for referred patients who were never presented to the committee. The survival comparison is observational and the transplanted group was selected on health and social criteria.

  Source: Transplantation Direct (Manning K, Freercks R, et al.), Transplantation Improves Patient Survival in a PD-first Program in South Africa (Abstract, Results; allocation and travel details from the PMC full text (Methods and Discussion)). Where: South Africa (Eastern Cape, one public-sector center). Population: Adults with kidney failure referred for kidney replacement therapy, 2012 to 2020, followed to 2023. Published 2026-03-17; retrieved 2026-10-11.

• United States · Reported experience · 2019

  Of 10 recipients in a pilot trial of hepatitis C-positive donor kidneys, 8 were interviewed; for many, hepatitis C risks seemed minimal compared with not receiving a transplant, and all recalled a thorough consent process.

  Limits: Place from authors

  What others could learn: For an organ with a known infection risk, a team can state the infection risk, the treatment that would follow and the alternative of waiting longer, and ask what the person understood, since the authors flag possible confusion between research and care.

  Conditions, limits and source

  Conditions that matter:

  Per the abstract: a trial protocol with formal informed consent; participants cited their understanding of HCV cure rates in the general population. The setting assumes effective hepatitis C treatment is available.

  Cannot be inferred:

  How people who declined the offer reasoned; acceptance of higher-risk organs outside trials, in settings without hepatitis C treatment, or in other countries; long-term outcomes. Single site.

  Limits:

  Eight people who had already chosen to join a trial, so people who declined are absent. All reported positive experiences. The authors flag a potential therapeutic misconception, meaning participants may have confused research with clinical care. Setting assumes access to effective hepatitis C treatment.

  Source: AJOB Empirical Bioethics (Van Pilsum Rasmussen SE, Seaman S, Brown D, et al.), Patient's Perspectives of Experimental HCV-Positive to HCV-Negative Renal Transplantation: Report from a Single Site (Abstract, Results). Where: United States (author affiliations; site not named in the text). Population: 8 of 10 kidney transplant recipients enrolled in a pilot trial of HCV-positive donor kidneys for HCV-negative recipients. Published 2019-10-16; retrieved 2026-10-11.

• Netherlands · Reported experience · 2022

  In 36 interviews (authors based in the Netherlands) with older adults with kidney failure, relatives and health professionals, older patients differed in how much they wanted to lead the choice between transplantation and dialysis and in the information they wanted.

  Limits: Abstract only · Place from authors

  What others could learn: Teams can ask early what the person values and how involved they want to be, in parallel with the eligibility assessment, rather than starting from eligibility alone.

  Conditions, limits and source

  Conditions that matter:

  Per the abstract: the authors suggest identifying older patients' values, needs and health outcome priorities early, before discussing treatment options, and using that information explicitly in later steps. Needs consultation time and some flexibility in how information is offered (evidence-based or experience-based).

  Cannot be inferred:

  Decisions of younger patients; practice outside the study centers or country; whether early values elicitation improves decisions or outcomes, since it was not tested.

  Limits:

  Abstract only. The abstract does not name the country; the Netherlands is inferred from every author's affiliation. Small sample; recruitment sites are not described in the abstract. Health professionals were more uniform than patients, which the authors note.

  Source: Age and Ageing (Schoot T, Perry M, Hilbrands LB, et al.), Kidney transplantation or dialysis in older adults-an interview study on the decision-making process (Abstract, Results). Where: Netherlands (author affiliations; country not named in the abstract). Population: 18 patients aged 65 or older with end-stage kidney disease, 5 relatives, 13 healthcare professionals. Published 2022-06; retrieved 2026-10-11.

• Mexico · Measured outcome · 2021

  Mexican national transplant data for 2007 to 2019 show an overall kidney transplant rate of 23.3 per million in 2019 but 9.3 per million among uninsured people (insurance status estimated). Of 34,931 transplants, 73.9% were in insured recipients.

  What others could learn: In Mexico, kidney transplant rates were far lower among uninsured people. A team could ask early who covers evaluation, surgery and lifelong anti-rejection medicines, involve a social worker, and document financial barriers separately from medical suitability.

  Conditions, limits and source

  Conditions that matter:

  Per the paper: access differs by health system; deceased-donor procurement and allocation are fragmented; 72.7% of transplants came from living donors; the authors call for a comprehensive kidney care program that treats transplantation as the therapy of choice.

  Cannot be inferred:

  Why any individual was or was not transplanted; whether uninsured people were offered and declined transplant; rates after 2019; patient experience; practice in other Latin American countries.

  Limits:

  Unadjusted rates. The Methods say insurance status was estimated from census data, not recorded per recipient. There is no national dialysis registry, so waiting time runs only from listing to transplant and the number needing a transplant is unknown. No patient or graft survival data. The Background cites about 13 per million for uninsured people from earlier sources; the abstract and the 2019 table give 9.3. The authors attribute the gap to public policy and sociocultural factors; the data do not test causes.

  Source: BMC Nephrology (Garcia-Garcia G, Tonelli M, et al.), Access to kidney transplantation in Mexico, 2007-2019: a call to end disparities in transplant care (Abstract, Results; 2019 figures from Table 2 in the PMC full text). Where: Mexico. Population: People receiving or waiting for a kidney transplant in Mexico, 2007 to 2019, by insurance status, gender and health system. Published 2021-03-19; retrieved 2026-10-11.

• Iran · Service described in 2012

  A 2012 Kidney International review of Iran's government-involved living-unrelated kidney donation model names the lack of a donor registration system and of long-term donor follow-up as its operational weaknesses.

  Limits: Abstract only · Service as described

  What others could learn: A care team can ask any living-donor program what donor registration and long-term follow-up exist, and document the answer, since this review names their absence as a weakness of the program.

  Conditions, limits and source

  Conditions that matter:

  Per the abstract: government funding of hospitals and staff, charity foundations, a separate brain-death donation program, and procedures the author says should be ethically reviewed (including donor-recipient confrontation and financial interactions).

  Cannot be inferred:

  How many donors are followed today; whether donors or recipients were pressured or treated equitably; whether the model could be transferred; how the program operates in 2026. Not an endorsement or criticism of any country's law; not a statement of what any religion permits.

  Limits:

  Abstract only; 2012, so not current. The abstract also says the model gave most Iranian transplant candidates access irrespective of socioeconomic class; the abstract does not test that, and it is contested. A 2023 commentary (Taheri, World J Transplant, PMC10514748, CC BY-NC 4.0; full text read) describes the program's design as government matching, state-funded costs and compensation, and no role for brokers. It reports large practical departures, including shrinking state compensation and recipients paying most of the cost. A 2013 Shiraz survey (Fallahzadeh, Am J Transplant; abstract read) found lower general health and social functioning measures in paid unrelated donors than related donors. Only 52 of 347 paid donors took part, against 92 of 233 related donors. Paid donation also differs from WHO's position on commercialism cited in ot-01.

  Source: Kidney International (Mahdavi-Mazdeh M), The Iranian model of living renal transplantation (Abstract). Where: Iran. Population: Living-unrelated kidney donors and recipients in Iran's regulated program. Published 2012-06-06; retrieved 2026-10-11.

• Global · Guidance · 2010

  WHO's Guiding Principles commentary says transplant costs, including follow-up and immunosuppressive treatment, should be affordable to all patients concerned, so that no recipient is excluded solely for financial reasons.

  Limits: Guidance, not outcomes

  What others could learn: Financial barriers can sit behind a transplant decision. A team can ask early who covers evaluation, surgery and lifelong anti-rejection medicines, bring in a social worker, and document financial barriers separately from medical suitability. ot-09 shows one setting where insurance status tracked transplant rates.

  Conditions, limits and source

  Conditions that matter:

  The commentary says allocation criteria should be set by a committee with medical, bioethics and public health expertise, and should not rest on a recipient's economic condition. Meeting the affordability aim needs financing for follow-up and immunosuppressive medicines, not only the operation.

  Cannot be inferred:

  Does not show that any country meets the principle, what affordable means in practice, or how often people are excluded for cost. Not a statement about any person's eligibility.

  Limits:

  Non-binding principles; the preamble leaves implementation to each jurisdiction. The affordability sentence is the commentary's reading of what Principle 9 on allocation implies, not the text of the principle itself. It does not define affordable or say who pays. The IRIS record dates the document only to 2010. Later guidance may update it.

  Source: World Health Organization, WHO guiding principles on human cell, tissue and organ transplantation (Commentary on Guiding Principle 9, printed p. 8 (PDF p. 8)). Where: Global. Population: People who need or have received an organ, cell or tissue transplant. Published 2010; retrieved 2026-10-11.

• Multi-country · Reported experience · 2021

  A 2021 systematic review of 119 qualitative studies (2,901 adult solid organ transplant recipients) found that depending on medicines to preserve the graft jeopardized recipients' sense of normality.

  Limits: Abstract only

  What others could learn: A team can ask recipients how the medicine regimen fits daily life, work and costs, whether they feel alone in decisions about it, and what would help, and can record the answers. The authors suggest that interventions addressing treatment burdens may improve satisfaction and outcomes.

  Conditions, limits and source

  Conditions that matter:

  Per the abstract: themes included loss of financial independence, isolation in decision-making, being unprepared for side effects, establishing routines, and reassurance through collective experiences.

  Cannot be inferred:

  Does not show how common any theme is, how it varies by country, organ or age, or that any intervention works. Not a measure of adherence. Not a statement about any group's values.

  Limits:

  Abstract only; the full text was not retrieved. The abstract names six themes but not the countries, organs or ages of participants, or how the studies were appraised. Findings are thematic syntheses of what participants reported, not measures of adherence or outcomes. Searches ended July 2020.

  Source: American Journal of Transplantation (Tang J, Kerklaan J, Wong G, et al.), Perspectives of solid organ transplant recipients on medicine-taking: Systematic review of qualitative studies (Abstract, conclusion). Where: Multi-country (119 studies; countries not named in the abstract). Population: Adult solid organ transplant recipients in the included qualitative studies. Published 2021-06-15; retrieved 2026-10-11.

• New Zealand · Reported experience · 2022

  In a 2022 interview study of 40 Indigenous Māori, participants were highly motivated to seek kidney transplantation but reported barriers including social determinants, racism and lack of information.

  Limits: Abstract only

  What others could learn: A transplant team could ask people and their families what they have been told about listing and donor assessment, where information was missing, and where racism or social circumstances shaped access, and could document those barriers apart from medical suitability.

  Conditions, limits and source

  Conditions that matter:

  Per the abstract: the paper treats inequitable delivery of kidney transplantation to Māori, despite higher rates of kidney failure, as its context. Its five themes were actively seeking a transplant, evolving attitudes toward traditional values and practices, racism, poor information and communication, and social determinants of health.

  Cannot be inferred:

  Not representative of all Māori or of every kidney service in New Zealand; does not measure waitlisting or transplant rates; does not show how often any barrier occurs or what causes inequity; not a statement of any traditional value or practice.

  Limits:

  Abstract only; the full text was not retrieved. Participants came through patient advocacy organizations and one regional service, and the abstract says people unrelated to them could not be included. It gives no fieldwork dates (a companion paper, PMID 35018578, reports 40 Māori interviewed in September to December 2020 in a wider kidney transplantation study; whether it is the same dataset was not confirmed). Experiences reported, not waitlisting or outcome data.

  Source: American Journal of Kidney Diseases (Walker RC, Abel S, et al.), Values, Perspectives, and Experiences of Indigenous Māori Regarding Kidney Transplantation: A Qualitative Interview Study in Aotearoa/New Zealand (Abstract, conclusion). Where: New Zealand (Aotearoa). Population: Māori with kidney disease or a transplant, living kidney donors and family members. Published 2022-02-11; retrieved 2026-10-11.

• The sourced examples include guidance, measured outcome, reported experience, service description. Each quote was matched to the source text; that is not independent expert review.
• The prompts and fictional case are original. They have not been tested with patients, caregivers or clinicians.
• Whether this workflow helps anyone is an open research question.
• Content is in English. Interface translations are not reviewed for this topic.