I’ve done most of my writing about this process from the perspective of the kidney recipient and someone on the deceased donor transplant list.
If you’ve got a driver’s license you’ve been asked whether or not you want to be an organ donor. Your preference is listed on your driver’s license because not counting the current glut of donors deceased due to opiate overdoses, motor vehicle accidents are probably the #1 source of organs for people who need them.

(I’m tempted to pop in here with a joke about Invader Zim and more spleens meaning that you’re more human, but I’ll leave the low hanging fruit.)

Certainly if you don’t have any moral objection to it you should be an organ donor You’d be amazed at what can be transplanted, even from older people, in the event of your untimely death.

Untimely deaths aside, though, being a living organ donor is the most precious and most impactful gift you can ever give anyone.

When Andrew announced that he was going to eventually need a transplant he had offers from four friends, two family members and me. I don’t count Andrew’s brother’s as an “offer” because basically what David did was to pick us up at the Honolulu airport when we were visiting for Christmas one year and spend the entire trip from the airport along H3, over the Pali mountain range, and over to the windward side of the island explaining to Andrew how he *was* going to donate a kidney and Andrew *was* going to accept it. So it wasn’t really an offer in the classic sense of the word, but I’m not entirely certain what to call it besides incredibly sweet.

For one reason or another most of these very generous offers fell by the wayside. Andrew told me in no uncertain terms that I wasn’t allowed to put myself under consideration because he’d need me to be whole and mobile throughout the process and I wouldn’t be if I were recovering from surgery myself. This did not, of course, keep from contacting the donor registry service to start the process, but when Curt started looking like a more viable option, and when the donor registry people started disliking my family history of essential hypertension I dropped the matter.

Any transplant center that deals with living donors has two branches. The recipient’s medical/social/pharmacologic/social services and the donor’s, and never the twain shall meet. If you put yourself forward as a living donor first and foremost they look at you under a microscope to be sure that you’re neither being compensated nor are you donating under duress. Then the medical testing starts. Of course the transplant center is interested in having the best possible organ for the recipient, but they’re equally interested in having the best possible outcome for the donor. If there’s even a scrap of a predictable chance that you might have adverse complications from having an organ removed you don’t get to do it. I’m certain that there are sound medical and legal reasons for it, but I’m also impressed that, literally, the recipient’s medical team don’t know the donor and probably vice versa. I mean, certainly the physicians and surgeons on one side know the *name* of the person who’s on the other side of the process, but I know that Andrew’s medical team didn’t know Curt to look at and most of them didn’t even know the relationship between the two men.

Another interesting option for living donation, at least in the kidney transplant circle, is a chained donation. If person A needs a kidney and person B wants to oblige but isn’t an appropriate tissue match…. (Please don’t ask me the details on that. I have the barest understanding of the tissue matching process and if you want to know why I, as a medical professional, don’t understand this part of the medical process the answer is that the vast majority of my patients DON’T EVER HAVE organ transplants. That said, there is a feline kidney donor program at the veterinary school at U.Cal. Davis.) where was I?
Chained donations, right.
Anyway if A needs a kidney and B qualifies, but isn’t a match for A, the transplant center can reach out to other transplant centers to look for a match for B’s kidney. C gets B’s kidney and so long as D is a match for A then A gets D’s kidney. If D isn’t a match for A then the transplant center looks for E and F and so on. According to Swedish the longest chain donation to date is five kidneys. Just the thought of the logistics of that organization makes my head spin. 10 patients, probably at least three transplant centers, a couple dozen surgeons, thousands of support personnel, a centralized date book complex enough to need string theory to explain it, and all of it has to be coordinated and completed within the same 24 to 48 hour period.

Of all of the multitude of things that I’m grateful for with regards to this process, one of the largest is that Curt was not only an acceptable match for Andrew, but that we all live within a short (relatively) distance of all of the necessary services.