​​​​​​​​​​​​​​​​​​​In NSW the donation, retrieval and use of human tissues, such as solid organs (e.g. heart, liver, lungs, kidneys and pancreas) and tissue (e.g. eyes, bones, tendons and heart valves) for transplantation from both living and deceased donors is regulated by the Human Tissue Act 1983.

Increasing Organ Donation in NSW: Government Plan 2012 provides the strategic framework for donation in NSW. Implementation of the Plan is overseen by an Implementation Advisory Committee chaired by the Chief Health Officer.

The NSW Ministry of Health is responsible for ensuring that the best possible organ and tissue donation services are provided in NSW. This includes maintaining policy and legislative frameworks to ensure that human tissue is used safely, ethically, and effectively; and monitoring organ and tissue donation performance.

The NSW Organ and Tissue Donation Service (OTDS) provides clinical and operational leadership for organ and tissue donation in NSW. Detailed information on organ and tissue donation in NSW, including facts and statistics, is available from the OTDS.

Two types of donation for transplantation are carried out in NSW:

  • deceased organ and tissue donation (after death)
  • living organ and tissue donation
Ante-mortem interventions (or procedures) are treatments which may be administered before a patient's death, for the purpose of organ donation, which are of no medical benefit to the patient. From 26 July 2024, certain ante-mortem interventions are now allowed in NSW.

Frequently asked questions

Deceased organ and tissue donation (after death)

Where can I find information to help me decide about becoming an organ and tissue donor after I die?

The DonateLife website has information to help you make a decision about organ and tissue donation. It also has information on talking with your family about organ and tissue donation.

How do I register to be an organ and tissue donor?

You can register as an organ and tissue donor on the Australian Organ Donor Register.

I do not want to donate my organs or tissues when I die. How do I register my objection?

You can register your objection to being an organ and tissue donor on the Australian Organ Donor Register

I am registered on the Australian Organ Donor Register as an organ and tissue donor. Can anyone override my decision when I die?

In Australia, families are asked to consent to organ and tissue donation, even if a person has registered their decision to be a donor. When you die your senior available next of kin may be asked if they consent to donate your organs and tissues for transplantation. S/He can decide not to donate your organs and tissues, even if you wanted to be a donor.

It is important that you discuss your decision to be an organ and tissue donor with your family. Families who know each other's donation decisions are more likely to uphold them.

I do not want to be an organ and tissue donor. Can anyone override that decision when I die?

No. Under the Human Tissue Act 1983 if you objected to organ and tissue donation during your lifetime and there is no evidence that you changed your mind, no one can consent to the donation of organs or tissues from your body.

Can I be an organ donor if I die outside hospital?

It is not possible to donate organs if you die outside a hospital, however it may be possible to become a tissue donor.

The reason people cannot donate organs if they die outside hospital is because they have to be artificially ventilated in order for death to occur in a way which makes organ donation possible. This usually happens in hospital intensive care units or emergency departments.

When can I donate my organs and tissues?

There are two pathways to deceased donation (after death):

  1. donation following brain death (irreversible cessation of all function of the person’s brain) and
  2. donation following circulatory death, (irreversible cessation of circulation of blood in the person’s body, also known as DCD).

Brain death is when a person dies because the blood and oxygen supply to their brain stops. The brain stops working and dies with no possibility of recovery. This is usually as a result of severe injury to the brain or bleeding in the brain (i.e.​ a stroke).

Donation after circulatory death occurs when a person is not expected to survive a severe illness or injury. If the person is being treated in an intensive care unit or emergency department, a medical decision is made to withdraw life sustaining treatment. Organ donation can only go ahead if the person dies within 90 minutes after withdrawal of life sustaining treatment. Once the heart and circulation stop, 5 minutes must elapse to establish that the circulation has permanently stopped. Death can then be declared. Tissue donation is possible after circulation standstill.

What organs and tissues can I donate after my death?

It may be possible for you to donate kidneys, lungs, liver, pancreas, heart, intestine, eyes, bone, tendons and heart valves.

Living org​an and tissue donation

Which organs can be donated by a living donor?

In NSW kidneys and partial livers can be donated by living donors.

I would like to donate a kidney to a family member. Can I do this?

It is possible for a living donor to donate an organ for transplantation into an identified recipient, usually a spouse /partner, family member, or close friend.

You must meet certain criteria to be a donor. These are outlined in PD2022_036 Living Kidney Donation and Transplantation.

NSW also participates in the Australian Paired Kidney Exchange (AKX) Programme. The AKX Programme identifies matches for patients who are eligible for a kidney transplant, and have a living donor who is willing but unable to donate because of an incompatible blood type or tissue type. This option is known as paired kidney exchange or paired kidney donation.

The AKX Programme uses a computer program to search the entire available database of registered recipient/donor pairs to look for combinations where the donor in an incompatible pair can be matched to a recipient in another pair. If the computer finds a compatible match, two or more simultaneous transplants can occur by exchanging donors.

Can I be a living donor for someone I do not know?

Yes. Non-directed (altruistic) kidney donation is where a person donates a single kidney to any suitable stranger on the waiting list. You must meet certain criteria to be a non-directed kidney donor. These are outlined in PD2022_036 Living Kidney Donation and Transplantation.

What is involved in being a living donor?

You have to be willing to donate to a friend or relative, or an unrelated stranger as an altruistic act (for no personal benefit). You also have to complete a series of medical and psychological tests, and meet medical and surgical requirements to be a donor. Contact your doctor for more detailed information about the process, including the surgery to remove the organ for transplantation.

Is there any support available for living donors?

Yes. There is an Australian Government program which provides financial support for living donors. See Supporting Leave for Living Donors Scheme.

Transplant units also provide emotional and social support for living donors.

Can I donate other tissues as ​​a living donor?

Living tissue donation for transplantation includes blood, bone marrow, cord blood and femoral heads from patients who are undergoing hip replacement. Femoral heads can be made into bone grafts. For more information on these programs visit the Australian Red Cross Blood Service, the Australian Bone Marrow Donor Registry and the Sydney Cord Blood Bank or talk to your doctor if you are having a hip replacement.

​​​​​​​​​Ante-mortem interventions

​​​What are ante-mortem interventions?​​​

​Ante-mortem interventions (or procedures) are treatments which may be administered before a patient’s death, for the purpose of organ donation. The treatments are of no medical benefit to the patient but may help to assess if the organs considered for donation are healthy. The treatments are usually required to make the donated organs healthier and work better, for the benefit of the person or people who will receive the organs when they are transplanted.
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Are ante-mortem interventions allowed in NSW?

Yes, from 26 July 2024 changes to the Human Tissue Act 1983 (NSW) will allow ante-mortem interventions in NSW for potential tissue donors who lack capacity, where there is:

  1.  senior available next of kin or 
  2. where a senior available next of kin cannot be located, a designated officer who provides authorisation. 

In both cases, there are important safeguards that must be adhered to. These are explained below. 

The designated officer is a specific person within a hospital who has undergone special training on the functions of the role. In both these cases the potential tissue donor, during their lifetime, must have not expressed objections to the carrying out of ante-mortem procedures on themselves. 

First person consent continues to be permitted.

​​​​What type of ante-mortem interventions are allowed in NSW?​​

In NSW, the following ante-mortem procedures are allowed:
 
  • the administration of medication, such as antibiotics, vasopressors (drugs to support the patient to maintain blood flow) and heparin (a drug that prevents the blood from clotting), 
  • the removal of blood and tissue for testing,
  • medical imaging (such as CT scans and x-rays) and other diagnostic procedures (such as bronchoscopy, where a thin tube is passed into the windpipe to view the airway and lungs, coronary angiogram, a test that measures flow in the heart’s blood vessels), and
  • blood transfusions for the purpose of improving organ viability. 

All proposed interventions need to be explained to family members in advance as part of the usual organ donation consent process.

​Who makes decisions about whether ante-mortem interventions can be undertaken on me, if I am unable to?

Where there is a known senior available next of kin, they can provide consent, where they are satisfied that there is no reason to believe the potential tissue donor has expressed an objection to the carrying out of ante-mortem interventions. Following the senior available next of kin’s consent, the designated officer can authorise the ante-mortem interventions. 

Where there are no known senior available next of kin, the designated officer is able to authorise ante-mortem interventions provided they are satisfied that:

  1. the potential tissue donor has, during their lifetime, provided consent in writing to the removal of tissue for a relevant purpose, and 
  2. the consent has not been revoked, and 
  3. they did not express an objection to the carrying out of ante-mortem procedures.

What are the safeguards for carrying out ante-mortem interventions?

Prior to a designated officer authorising ante-mortem interventions on a potential tissue donor, additional safeguards must be met. These safeguards require a senior doctor (prescribed practitioner) to certify in writing that they are reasonably satisfied: 

  1. the death of the potential tissue donor is imminently expected, and 
  2. the carrying out of ante-mortem procedures on the potential tissue donor will not: 
    •  hasten the death of the potential tissue donor, or
    • cause more than minimal harm to the potential tissue donor, or
    • cause undue risk to the potential tissue donor.

Like the designated officer, the prescribed practitioner must not be involved in the care of the patient. The prescribed practitioner must also not be involved in the care of a potential transplant recipient or transplantation generally.

I wish to be an organ donor, but I would only support certain or no ante-mortem interventions. What should I do?

It is really important that you write down and discuss your wishes about organ donation with your family, so they are very clear about your preferences.

​This way, if they are asked to consent to organ donation and any ante-mortem interventions on your behalf (because you do not have capacity to make decisions yourself), they will be able to make decisions that reflect your wishes.

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With the changes to the Human Tissue Act to include ante-mortem interventions, will I need to re-register to be an organ donor?

No. Your existing registration on the ​Australian Organ Donor Register​​ remains in place. 

​​What happens if I haven't registered to be an organ donor?​

Anyone who wishes to become an organ donor can register on the Australian Organ Donor Register.

If a family member (next of kin) is asked to consider organ donation and ante-mortem interventions for a dying loved one who has not previously registered to be an organ donor, the family member should think about what their loved one would want, based on their knowledge of that person's wishes and values.

​Hospitals have specially trained staff to answer any questions and support family members while they make their decision.


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Current as at: Thursday 25 July 2024