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Overview
You gave an organ, and the system gives something back. If you ever need a transplant yourself, you move higher on the waiting list. Extra priority points are added to your score, ahead of people with the same blood type and tissue match who have not donated.
This protection is built into national transplant policy. It applies whether you donated to someone you knew or to a stranger. It applies to kidney, liver, and other living organ donors. Biological relatives of non-directed donors also get priority points. Make sure your donation is on file at the registry so the protection works if you ever need it.
What is the priority guarantee?
You gave an organ. In return, you receive a benefit: if you ever need an organ transplant yourself, you become a priority on the waiting list. This guarantee recognizes your sacrifice and encourages living donation by protecting donors from future health risks.
The priority guarantee provides several benefits to living donors:
- Bonus points on the waiting list if you ever need a transplant
- Protection that ensures donors are prioritized over non-donors with similar blood type and tissue match
- Biological relatives of non-directed donors also receive priority protection
- Comprehensive coverage for all living organ donors regardless of organ type
- State protections in some areas to prevent insurance discrimination
This article explains the priority policy and what you need to do to ensure you're registered.
What is the priority guarantee?
The priority guarantee is an OPTN policy designed to incentivize living donation by offering protection to living donors. If you donate and later need a transplant, you're prioritized over people of similar blood type and tissue match who haven't donated. This protection reflects the value of living donation and ensures donors are protected if they later become recipients.
Who is covered
The policy applies to all living organ donors including kidney, liver, lung, and pancreas donors. Biological relatives of non-directed donors also receive priority points. This comprehensive protection covers most living donors regardless of how they donated or to whom.
How priority points work
The priority guarantee works through the OPTN system. If you ever need a transplant, your donor status is flagged in the system and additional priority points are added to your waiting list score. These points move you higher on the waiting list compared to people with similar blood type and tissue match who haven't donated.
When you need a transplant, your waiting list position is calculated based on blood type compatibility, tissue match (HLA), time waiting, age, and other factors. If you're a living donor, additional priority points are added to your score, moving you higher on the waiting list.
Consider this example: Person A (not a donor) and Person B (living kidney donor) both need a kidney with identical blood type and tissue match. Without priority points, they'd rank similarly by waiting time. With priority points, Person B moves ahead on the waiting list.
If you ever need a transplant
If you develop kidney failure, liver disease, or another condition requiring transplant, your donor status protects you. The process is straightforward but important to understand. You're evaluated and listed for transplant through the standard process, just like any other patient.
The steps are:
- You're evaluated and listed for transplant (standard process)
- Your donor status is flagged in the OPTN system
- Priority points are added to your waiting list score
- When a compatible organ becomes available, you're considered based on your priority-adjusted position
- If you're the best match, you're offered the organ
Blood type compatibility matters significantly. Type O donors have the broadest compatibility with other blood types and benefit significantly from priority points. Type B and A donors also benefit substantially. Even type AB donors receive priority protection, though their compatibility is more limited.
How to make sure you're registered
Verifying your registration
The responsibility for registering yourself as a priority donor falls on both you and your transplant center. At the time of your donation, your center should register you with OPTN. However, you should verify this registration yourself rather than assuming it happened.
Steps to ensure you're registered:
- Ask your transplant center directly: "Am I registered in OPTN's donor priority system?"
- Request documentation that you're registered (you may receive a card or letter)
- Keep your donor registry documentation for future reference
- If you move or change contact information, notify your transplant center so OPTN records are updated
- If you later change transplant centers, inform them of your donor status
If unsure whether you're registered, contact your original transplant center's donor program coordinator and ask them to verify your registration status.
Additional protections for donors
Beyond the priority guarantee, other protections exist for living donors. Living donors are never classified as ECD (expanded criteria donors, which typically means age >60 or other risk factors). Your organ is considered standard criteria, which is desirable for recipients.
Key donor protections include:
- No expanded criteria donor classification based on your age or risk factors
- Deceased donor organs don't disadvantage you in waiting list priority
- If you were a non-directed donor, your biological relatives also receive priority points
- Some states have insurance protections preventing discrimination against donors
- These "donor bill of rights" protections vary by state
Even though you're a living donor, you're never below a deceased donor in waiting list priority due to your donation status. Deceased donor organs are considered first for highest-priority matches, ensuring you're not disadvantaged by your generosity. Check your state's laws to see if specific donor protections exist in your jurisdiction.
Questions to ask your transplant center
After donation, you should ask your transplant center specific questions about your priority registration and protection. Having clear answers ensures you understand your rights and protections.
Important questions to ask include:
- Am I registered in OPTN's priority system?
- What is my priority point score if I ever need a transplant?
- If I move to a different state, how are my priority points maintained?
- How long does priority registration last?
- Are my biological relatives (if I was a non-directed donor) protected?
Get answers in writing and keep documentation for your records.
Long-term implications
The priority guarantee means you've given yourself protection. If you ever need a transplant, you benefit from your prior donation. You shouldn't fear that donation leaves you unprotected. This matters psychologically as well as practically. Knowing you've secured priority if you ever need help may reduce anxiety about long-term donation risks and provides security for your future.
Additional Detailed Information
Additional Information
OPTN priority point system
Point calculation. Living donors receive additional priority points (typically 4 points) added to their waiting list score. Blood type compatibility, HLA matching, time waiting, age, and sensitization also factor into the final score.
Blood type advantage. Type O and B donors receive greater benefit from priority points (broader compatibility). Type AB donors benefit less but still receive priority protection.
Waiting time accrual. Once registered, donor waiting time accrues immediately for priority point purposes, even if they haven't formally listed for transplant. This is advantageous if they list later.
Non-directed donor relatives
Biological relative protection. Biological relatives (first-degree: parent, sibling, child) of non-directed donors receive priority points equal to the donor's priority. This encourages non-directed donation by extending protection to the donor's family.
Definition of "biological relative." Typically includes genetic parents, siblings, and children. Adoptive relatives and spouses are not included.
State-level protections
Living Donor Bill of Rights. Some states have enacted legislation protecting living donors from insurance discrimination. These laws typically prevent life, disability, and long-term care insurance from denying coverage or charging higher premiums based on donor status.
State variations. As of 2024, approximately 30 states have living donor protection laws. Protections vary by state. Donors should check their state's status.
International considerations
Priority abroad. The U.S. priority guarantee applies within the U.S. OPTN system. If you're a U.S. donor and need a transplant internationally, protections vary by country. Conversely, international donors in the U.S. receive priority based on OPTN policy, not their country of origin.
Written By:
Transplants.org Staff
Last Reviewed: February 26, 2026
Informed By:
Transplants.org, with participation from 23 leading U.S. transplant centers, led the largest comparative analysis of patient educational materials in transplant history. We recognize the participating centers who helped inform and inspire our direction with initial patient-centered educational content:
- Mayo Clinic (Co-Author)
- Vanderbilt University Medical Center (Co-Author)
- Johns Hopkins Hospital (Co-Author)
- UCLA Medical Center (Co-Author)
- UCSF Medical Center (Co-Author)
Transplants.org is an independent nonprofit organization and participation is not an endorsement by these organizations.
