The context you need, when you need it

When news breaks, you need to understand what actually matters — and what to do about it. At Vox, our mission to help you make sense of the world has never been more vital. But we can’t do it on our own.

We rely on readers like you to fund our journalism. Will you support our work and become a Vox Member today?

This transplant surgery could save countless lives. Why aren’t we doing more of them?

You can give part of your liver away while you’re still alive, but we need better medical infrastructure if we’re going to make the most of them.

In an episode from the fifth season of Grey’s Anatomy, Miranda Bailey, played by Chandra Wilson, orchestrates an ambitious 12-person paired kidney transplant surgery. Six living donors each give one of their kidneys to a stranger and six recipients receive one in return. While the show, which is still on the air almost 18 years later, often blurs the line between fact and fiction, this particular form of kidney transplant, called a paired kidney exchange chain, has become increasingly common in the United States.

Kidneys and livers, two organs that a living donor can donate, account for more than 90 percent of the demand on the US organ waiting list.

More living liver donors could help close a critical gap, just as they did for kidneys.

We currently don’t have systems in place, such as a national registry, to implement a strong living donor liver transplant system.

New organ preservation technology, universal protections for living donors, and broader surgical training could help us change that.

Rewatching the show (sue me), I wondered if such donation chains are viable for other organs (or tissues) that can be donated by living donors. The liver, the only organ that can regenerate itself over a span of six to eight weeks, struck me as a particularly notable candidate. As with any surgical procedure, donating part of one carries some risk, but in most cases a person can safely continue to lead a healthy life afterward. And the need for them far exceeds what deceased donors can provide. Right now, there are more than 100,000 people on the waitlist for organs.

Over the past decade, using organs from living donors to meet organ demand has emerged as a particularly effective strategy.

In 2025, around 24 percent of kidney transplants used living donors, according to preliminary data from the Organ Procurement and Transplantation Network (OPTN), the public-private partnership responsible for maintaining equitable organ allocation policies. Infrastructural advances, such as the establishment of the National Kidney Registry (NKR) in 2007, have helped reduce wait time for kidneys, provided financial support for donors, and facilitated close to 11,000 paired exchange kidney transplants. In a paired exchange, two patients who each have a willing but incompatible organ donor simply swap donors — my donor gives to you, yours gives to me. Ultimately, both of us receive a kidney that our bodies are more likely to accept.

By contrast, only about 6 percent of the roughly 12,000 liver transplants performed in the US last year used living donors.

This is not the case around the world. Countries that face a shortage of deceased liver donors rely almost entirely on livers from living donors. In 2022, India placed third, behind the US and China, in terms of the overall number of liver transplants but performed the most living donor liver transplants in the world — 81 percent of all liver transplants there were from living donors.

While the number of living donor liver transplants has trended generally upwards over the last decade, the success of living kidney donation suggests that a similar path might be possible for the liver here, too. The US already has what it takes — a potentially lifesaving supply of living donor livers — but it lacks the infrastructure to turn willing liver donors into transplants at scale. That may actually be starting to change, as surgeons around the country are working to build out the interconnected systems and standards that they need to do their work.

Why parting with part of your liver makes all the difference

Organ access is a multifaceted problem in the US. While the country has largely drawn on organs from deceased donors to meet organ demand, living donors grow more important by the day. A patient’s position on the liver waitlist is determined by their Model for End-Stage Liver Disease (MELD) score. It is a number between 6 and 40 that helps doctors decide how soon the patient needs a new liver. Sometimes, if a patient gets too sick, surgery is unsafe, or if they have problems with substance abuse, they are no longer transplant eligible.

Living liver donors are especially important because transplantation is the only treatment for end-stage liver failure — there are no alternative options. For patients in end-stage kidney failure, a dialysis machine can artificially take over the function of a kidney, and temporarily help manage their condition as they wait for an organ match. But a person experiencing liver failure has no such interventions available to them. They continue to get........

© Vox