What it really means to be an organ and bone marrow donor

Do you want to give the gift of life?

Every day, lives are saved through organ and bone marrow donation – but the decision to become a donor is personal.

WRAL News spoke with Carrie Simpkins, chair of the board of directors at Donate Life NC, to dive deeper into commonly asked questions about donation.

From myths and misconceptions to the impact one donor can have, here’s what you need to know.

How do I sign up to be an organ donor?

Donate Life estimates more than 90% of donor registrations nationally come through the DMV. You can register to become an organ, eye and tissue donor easily when applying for a license or having your license renewed.

People who agree to become an organ donor upon death will have a heart symbol on their license. New North Carolina REAL IDs display the symbol on the bottom right.

Simpkins shared Donate Life has seen a decrease in people signing up through the DMV post pandemic.

“The DMV in partnership does a great job talking to people and asking people if they want to register, but unfortunately not everyone goes into the DMV now for renewal so it can be missed,” said Simpkins. “In North Carolina, there are approximately 5.8 million people signed up in the donor registry.”

You can also join the Donate Life registry online or log in at any time to check your registration status.

Simpkins shared people signing up to be a donor should notify family, to eliminate painful decisions they would need to make in the event of an untimely death.

What does it mean to be a living donor?

While alive, you can donate one of your kidneys, or part of your liver or other organs. The process for living organ donation differs from deceased organ donation because a living donor can decide who to donate their organ to.

Simpkins explained living donations can help people on waitlists receive life-saving transplants faster.

“In order to do living donation, you would reach out to a transplant center and ask to speak to their living donor team,” explained Simpkins. “They would start the process usually by sending a questionnaire for you to share your interest in being a living donor.”

How many people are waiting for a kidney transplant?

As of April 16, 2025, there were 4,461 people waiting for an organ transplant in North Carolina, according to Donate Life NC.

The breakdown is as follows:
-3,986 are waiting for a kidney
-135 are waiting for a heart
-130 are waiting for a liver
-71 are awaiting for a pancreas
-117 are waiting for a kidney and pancreas
-12 are waiting for a lung
-7 intestinal candidates
-2 patients are waiting for a heart-lung transplant
-1 candidate waiting for an abdominal wall transplant

How do living donors impact the number of people on organ donation waitlists?

Simpkins said increasing the number of people who sign up to be living donors would greatly reduce the number of people waiting for organs. She shared it would also increase the chance someone who is unable to find a living donor would be chosen off the waitlist for deceased donor organs.

“I think it would mean joy and an overwhelming sense of ‘Wow, somebody has reached out and wants to give me the gift of life,” said Simpkins. “It’s very emotional both for the donor, and the patient themselves who isn’t expecting a call from the transplant center who can then say, ‘Hey, we actually have a living donor for you even though you are on the waitlist.”

The American Transplant Foundation reports transplant candidates with living donors typically have better results than with deceased donors as the organs often have greater longevity.

The foundation also reports living donor organs function almost immediately, whereas deceased organs may require a recipient to undergo dialysis for something like a kidney donation to get the organ to restart.

What are the steps to donate a kidney, liver or tissue?

The evaluation process for living donors is extremely extensive to ensure donor and recipient safety. Thorough medical evaluations and blood tests are completed to establish a donor is compatible with the intended recipient and the organ or tissue is suitable for transplantation.

The National Kidney Foundation added patients also undergo an EKG to assess heart function, chest x-rays to assess lung function, and psychological evaluations prior to donating.

“For a living kidney donor, you can live your whole life with one healthy kidney,” said Simpkins. “I think we were given two so that we could share our spare.”

She continued, “Your liver regenerates, so you’re donating part of your liver. It’s an amazing thing.”

Simpkins shared regardless of if someone is signing up to be a living or deceased donor, a team of medical professionals ultimately make the call for if organs are a good match.

“Many times, people say, ‘Oh I don’t qualify, nobody would want what I have’ – and that is not true,” said Simpkins. “One deceased organ donor can save up to eight lives and effect 57 others through tissue transplantation.”

Simpkins noted recipients will take immunosuppressants after surgery, but donors themselves usually won’t be required to take any long-term medication.

What is the difference between organ donation and bone marrow donation?

Both processes take place in medical settings, such as hospitals, but organ donation and bone marrow donation are very different.

Organ donation requires surgery to transplant a healthy organ directly from a donor into a recipient with a failing organ. Bone marrow or blood donations involve blood stem cells and often do not require surgery.

Peripheral blood stem cell (PBSC) donation is a non-invasive method which uses an IV to collect cells for a live-saving transplant. The National Marrow Donor Program reports 90% of donations now occur using PBSC, with only about 10% requiring surgery.

People who donate through PBSC are usually discharged to go home the same day. Most people can return to work and school within 1-7 days. Close genetic matches for both organ and bone marrow donations have been shown to lessen the risk of rejection.

Is it painful to donate a kidney or liver?

Most kidney donors will stay in the hospital for 1-2 days after surgery.

The National Kidney Foundation reports that the most common types of surgery (laparoscopic and robotic) allow surgeons to remove your kidney with minimal incisions and scaring.

“Typically for living kidney donation you’re in the hospital for 48 hours,” shared Simpkins. “Your pain is managed by the anesthesia team in the operating room and by the surgical team post donation.”

Simpkins shared surgeons may use different kinds of implantable pain pumps for short-term relief, with donors taking routine pain medications in the days following surgery.

“A lot of the pain is different than that of the transplant recipient. The biggest thing and best help for the living kidney donors in general is to get up and get moving around,” said Simpkins.

Liver donors can expect some pain and discomfort from your incision immediately after surgery, according to Johns Hopkins Medicine. The institution added patients are not advised to life anything heavier than 10 pounds for six weeks. A donor’s liver starts to regenerate immediately and should grow back to its normal size within 12 weeks.

How long will an organ donor be in the hospital?

“After living kidney donation, you might be in the hospital for 48 hours and back to normal activities usually within 2-6 weeks.  With liver donation it’s a little different. You’d need to stay closer to the center so they could do more frequent checkups,” explained Simpkins.

As mentioned, PBSC donation for bone marrow transplants usually allow donors to return home the same day and resume normal activities within a week.

How much does it cost to become an organ donor?

“There is no cost to the living donor at all,” explained Simpkins. “The cost is covered by the recipient’s insurance.”

Those who donate either PBSC or bone marrow through the National Marrow Donor Program can also have all travel-related costs covered, as well as things like lost wages, childcare and pet boarding. The program will also pay for a family member to travel with you.

What do people need to know about organ donation?

“There are a lot of myths out there and concerns about if you’re going to be an organ donor, nobody is going to save your life – that is not true,” said Simpkins. “We want the organs to be as healthy as possible and working for the recipient. I think there’s a lot of myths that need to be addressed.”

Simpkins shared the biggest effort is around increasing awareness that living donation is an option at all.

“For those not as fortunate to have a living donor that are on the waitlist, we can help that – every one of us – by signing up to be an organ donor,” said Simpkins.