Who Can Donate an Organ, by Law and by Country

Families arranging a transplant abroad usually work through the questions in the order they feel urgent: is there a donor, are they compatible, can we afford it, which hospital. The legal question tends to arrive last, often after deposits have been paid.

That order is backwards, because the legal question is the only one that can invalidate everything else at a stroke. A compatible, healthy, willing donor in a relationship the destination does not recognise is not a transplant that costs more or takes longer. It is not a transplant.

What happens in practice is that a case reaches the hospital, the hospital submits it to the authority that must approve it, and the authority refuses. By then the family has travelled, paid, and in many cases given up a place on a waiting list at home. The refusal is correct and the loss is total.

The other reason to settle it first is that the alternative pathways only exist while you still have time. A different relative may be permitted. A different country may take a different view of the same relationship. A paired exchange may be possible. None of those are available to somebody who is already in a hospital in another country being told no.

The details differ everywhere, but most transplant laws are built from the same few ideas, and knowing them makes any particular country's rules easier to read.

Degree of relationship. Nearly every jurisdiction treats close blood relatives — parents, children, siblings — as the least problematic case, on the reasoning that the motive to donate is self-evident and the risk of coercion or payment is lower. Many laws express this as a degree of kinship, and set a boundary at second, third or fourth degree, beyond which extra scrutiny applies.

Marriage and relationships by marriage. A spouse is very commonly permitted, sometimes with a minimum duration of marriage written into the rule specifically to prevent a marriage arranged in order to enable a donation. Relationships by marriage — a brother-in-law, a parent-in-law — are treated inconsistently: permitted freely in some countries, treated as unrelated in others.

Emotional relationship without a family tie. A friend, a colleague, a member of the same community. Where this is permitted at all, it is almost always subject to approval of the individual case by an independent body, whose job is to establish that the relationship is genuine, that the donation is voluntary and that no payment has been made or promised.

Altruistic donation to a stranger. Permitted in a minority of countries, usually through a formal national programme rather than a private arrangement, and very rarely available to somebody who has travelled in specifically to do it.

Paired exchange. Where two incompatible pairs swap donors. This needs an organised programme and a legal framework that permits it; it is not something two families can arrange privately.

Non-residents and foreign nationals. Separately from all of the above, some countries restrict living donation involving people who are not residents or citizens, or require additional approvals when the donor and recipient come from different countries. This catches families who have checked the relationship rule and assumed it was the only one.

Where ethics committee approval is required, families often assume it is a paperwork step. It is not. Its function is to establish three things, and it has seen every attempt to misrepresent them.

That the relationship is what you say it is. This is where proof of relationship matters, and where families are most often caught out. Birth certificates, marriage certificates, family registers and identity documents may all be required, frequently translated by a sworn translator and legalised or apostilled. Documents that satisfy one country routinely fail another. Gather them before travelling; obtaining a legalised document from your home country while sitting in a hotel abroad is slow and sometimes impossible.

That the donation is voluntary. The donor is normally interviewed alone, without the recipient or the family present, and often more than once. The committee is looking for pressure — family, financial, religious — and a donor who has been coached tends to be visible to people who do this every week. A donor is entitled to withdraw at any point, for any reason or none, and a good centre will make that explicit and will give a donor a face-saving way to take it.

That no payment has been made or promised. This is the reason the whole apparatus exists. The committee will ask about it directly, and will look at how the parties came to know each other, who introduced them, and who is paying for what. An arrangement brokered by an agency that found the donor is exactly the pattern the system is built to detect.

Approval takes time, and how much varies by country and by how complete the file is when it arrives. Where we hold a verified figure, the tool shows it. Where we do not, do not assume: ask the centre what they have seen recently, and do not book non-refundable travel against a number nobody has given you in writing.