Fit for Donation: Health Requirements to Be a Living Organ Donor

When living organ donors need to improve their health, Keck Medicine of USC’s Donate Well Program helps them shape up.

Living organ donors give a very special gift: By donating a kidney or part of their liver while they’re still alive, these donors “provide recipients the opportunity to get a transplant sooner and, oftentimes, when they’re healthier,” says Susan C. Kim, MS, RDN, program manager of living-organ-donor nutrition and wellness for the USC Transplant Institute, part of Keck Medicine of USC.  

But “healthy” is the operative word here, for if a living donor isn’t themselves healthy, neither they nor their organ recipient has the best chance at long-term success. 

Fortunately, helping donors optimize their health is the goal of Keck Medicine’s Donate Well Program. And as Kim explains, the results pay dividends for all. She has seen it firsthand in her work with the USC Living-Donor Kidney Transplant Program and the USC Living-Donor Liver Program. (Kim is also a clinical instructor at the Keck School of Medicine of USC.) 

How does poor health impact organ donation? 

Nearly 75% of the U.S. population is overweight or obese, Kim says. That’s making it increasingly common for donor programs to encounter what she describes as “marginally healthy donors.” 

And their marginal health hampers donation, as evidenced by the much lower rate of living-donor transplantation compared to deceased-donor transplantation. “For context,” Kim explains, “more than 104,000 people — 90,000 kidney and 9,100 liver — are on a transplant waiting list, and yet there were 16,988 deceased donors enabling 41,100 transplants and 7,030 living-donor transplants in 2024, according to the United Network for Organ Sharing.” 

Why metabolic wellness matters for organ donation 

The problem is that overweight and obesity contribute to metabolic conditions like uncontrolled high blood pressure, prediabetes, fatty liver disease, high cholesterol and heart disease. These conditions can pose both short- and long-term health risks to the donor, who undergoes a routine but serious surgery to make their gift a reality. 

Because of this, Keck Medicine’s living-donor programs take extra care in evaluating potential donors for wellness. “With kidney donors,” Kim explains, “our nephrologists carefully assess kidney function to check that it’s adequate for the recipient and, importantly, for the living donor, as well as metabolic risk factors which are a concern for the donor’s health in the future.” 

For liver donations, doctors check the donor’s percentage of liver fat to see if it’s fit for donation. “And while most centers, including ours, accept liver donors with some excess liver fat above normal,” Kim says, “we know that if the donor improves their metabolic health, they can further improve the quality of the liver and their own health at the same time. Wins all around!” 

Helping living organ donors make healthy lifestyle changes 

Unfortunately, improving metabolic health can be an uphill battle in our busy lives. After all, if it were easy, current health statistics wouldn’t be so alarming. 

The good news, Kim reiterates, is that most metabolic diseases are preventable and reversible with help from weight loss and lifestyle changes. “People can become better living donors and healthier overall by adhering to healthy dietary patterns and regular physical activity,” she says. 

Keck Medicine’s Donate Well Program 

That’s what Keck Medicine’s Donate Well Program, the first of its kind in the country, was built to do. A personalized wellness plan, it gets donors healthy enough for organ donation, enhances their recovery and keeps them well for the long term. 

“We pair a registered dietitian with donors to provide nutrition and healthy-lifestyle education, personalized meal plans and dietary recommendations,” Kim says. The plan also monitors participants’ body composition and offers Lifestyle Redesign coaching for donors who need help with time and stress management, she adds. 

“My goal is for donors to mentally and physically be at their best for surgery,” Kim concludes. “Improving health can be a confidence booster, and we want donors to go into surgery feeling strong. We’re here to support and help donors for an optimal experience.” 

Second chance at donation 

“Once donors have met their weight-loss or health goals and demonstrated healthy lifestyle changes,” Kim continues, “they can be reevaluated by the team. We’ve essentially created another pathway for marginal donors that’s supported to increase their chances of success the second time around.” 

And Donate Well isn’t open solely to marginal donors. “When living donors meet our donation criteria at the start, I still work with them to reach peak health for surgery and recovery,” Kim says. “There’s always room to improve one’s health, and we want to help all donors reach their full potential for an optimal outcome and experience.” 

A real win-win for living-donor organ transplants 

That helps everyone — both the donors and the transplant patients. “That’s exactly the feedback we get from donors,” Kim adds. “They’re able to help someone in need while at the same time improving their own health — something that, in many cases, they’ve always wanted to do.” 

And by arming donors with the tools and knowledge to maintain their newfound health, the program sets them up for a fitter future. “This is our gift to them: the gift of good health for being selfless and amazing,” Kim says. 

How to become a living organ donor 

Those interested in becoming a living donor can start by completing this application on the USC Transplant Institute website. From there, an intake team will review the information and reach out for next steps. And remember: Living donors must be over 18 years old, should be in good physical and mental health, and cannot be pregnant, have malignant cancer or be active substance users.  

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