🚨 Organ Donation

Today Korean Social News for Beginners | 2025.10.17

0️⃣ Expanding from Brain Death to Cardiac Death and System Improvements

📌 Organ Donation Previously Limited to Brain Death Now Expanding to 'Cardiac Death'

💬 The Ministry of Health and Welfare is pushing to expand organ donation, which was only possible for brain-dead patients, to include 'cardiac death' patients. The government is reviewing a law change to allow organ donation from patients who have a cardiac arrest after stopping life-sustaining treatment. This is expected to increase the number of annual donors from about 400 to up to 1.5 times more. The government plans to gradually implement this system starting in 2026, ensure transparent donation procedures, and strengthen benefits for families. Currently, about 40,000 people in Korea are waiting for organ transplants, but thousands of people miss their chance for transplants every year due to a shortage of donors.

💡 Summary

• Organ donation is the act of removing organs after brain death or cardiac death to transplant them to others who need them to survive.
• The government plans to expand organ donation from only brain-dead patients to include patients who have cardiac arrest after stopping life-sustaining treatment.
• The number of donors is expected to increase from 400 per year to up to 600, with implementation planned for 2026.

1️⃣ Definition

Organ donation means removing your organs after brain death or cardiac death to transplant them to others who need them to survive. This includes major organs like kidneys, liver, heart, lungs, pancreas, and small intestine, as well as tissues like corneas, bones, and skin.

Currently in Korea, under the "Act on Transplantation of Organs" only people who are declared brain-dead can donate organs. However, the government wants to expand donation to include 'cardiac death' patients to create more opportunities to save lives.

💡 Why is this important?

• About 40,000 people are waiting for organ transplants, but only 400 people donate each year, creating a serious shortage.
• Expanding donation will give more patients a chance at a new life.
• It's important to create a culture where the noble decision of donors and their families is respected by society.
• We need to build a trustworthy system that ensures medical ethics and transparent legal procedures.

2️⃣ Current Organ Donation System and Expansion Plans

📕 Current Organ Donation System and Its Limitations

• Currently only brain-dead patients can donate organs. The main situation is as follows:

  • Organ removal is only legally allowed when all brain functions have stopped (brain death).
  • Brain death determination requires strict examination and determination procedures by at least two specialists.
  • Donation can only proceed with the person's advance directive or family consent.
  • As of 2024, about 400 people donate organs through brain death annually.

• Many patients suffer due to donor shortage. The main problems are:

  • About 40,000 people are waiting for organ transplants, but only about 2,000 people receive transplants annually.
  • Kidney transplant patients especially must wait an average of 5-7 years, and some die without getting a chance for transplant.
  • The number of patients declared brain-dead is limited, making it difficult to increase donors.
  • The participation rate is lower than in developed countries due to cultural awareness and system limitations.

📕 Cardiac Death Donation (DCD) Introduction Plan

• A new donation system after circulatory arrest will be introduced. The main content is:

  • DCD (Donation after Circulatory Death) is a method where death is determined when the heart stops and doesn't recover for a certain time, then organs are donated.
  • Under the Life-Sustaining Treatment Decision Act, if a patient's heart doesn't beat for 5-10 minutes after cardiac arrest following treatment withdrawal, they are recognized as deceased.
  • Many countries including the UK, Spain, and the US already implement this, accounting for 30-50% of all donors.
  • If Korea introduces this system, annual donors are expected to increase from 400 to up to 600.

• Strict ethical standards and procedures will be established. The main principles are:

  • The decision to stop life-sustaining treatment and the decision to donate organs will be completely separated.
  • Clear guidelines will be provided so medical staff don't confuse patient treatment with organ donation.
  • Medical teams handling organ donation will be separated from patient care teams to prevent conflicts of interest.
  • The person's advance directive or clear family consent will be absolutely required.

💡 Main Issues in Introducing Cardiac Death Donation

1. Death determination criteria: How many minutes after cardiac arrest should death be recognized
2. Medical ethics: Clearly separating life-sustaining treatment withdrawal from organ donation decisions
3. Legal responsibility: Establishing legal protections for medical staff's judgments and procedures
4. Family consent: The burden on families who must make quick decisions while grieving
5. Social consensus: Need for public understanding and agreement on new death criteria

3️⃣ Expected Effects and International Cases

✅ Positive Effects of System Introduction

• More opportunities to save lives will increase. The main expected effects are:

  • If annual donors increase by 1.5 times, over 200 additional patients can receive transplants.
  • Kidney transplant waiting times will be shortened, improving quality of life for dialysis patients.
  • Patients waiting for other organs like liver and lungs will also get more opportunities.
  • Medical cost savings are also expected through earlier transplants.

• Donation culture will spread and social awareness will improve. The main changes are:

  • Social interest and participation in organ donation will increase.
  • A culture of respect and gratitude toward donors and their families will take root.
  • The value of sharing life will spread throughout society.
  • Transparent and trustworthy system operation will increase public willingness to participate.

✅ Cardiac Death Donation Operations in Major Countries

• The UK operates DCD most actively in the world. The main features are:

  • About 40% of all organ donors are cardiac death donors.
  • Strict ethical guidelines and independent medical team separation principles are applied.
  • Sufficient time and counseling are provided to families to help them make careful decisions.
  • Post-donation family support programs are operated to help with psychological stability.

• Spain is recognized as the world's best organ donation country. The main achievements are:

  • With 48 donors per million population, it's the world's highest level.
  • Cardiac death donation is actively used, accounting for over 30% of all donors.
  • A nationwide donation coordinator network is established for efficient operation.
  • Positive awareness of donation has been raised through public education and promotion.

4️⃣ Related Terms

🔎 Act on Transplantation of Organs

• This is the core law that regulates organ donation and transplantation procedures.
  • The Act on Transplantation of Organs regulates the protection of organ donors' rights, brain death determination criteria, organ removal and transplantation procedures, and designation of organ transplant medical institutions. It was enacted in 1999 to provide the legal basis for organ donation and transplantation.
  • The main contents of the law include: First, it clearly defines brain death determination criteria and procedures. Second, it establishes donation procedures through the person's advance directive or family consent. Third, it strictly prohibits organ trafficking and includes punishment provisions. Fourth, it specifies the qualifications and obligations of organ transplant medical institutions. Fifth, it ensures fairness in organ distribution through the Korean Network for Organ Sharing.
  • Amending this law is essential for introducing cardiac death donation. Currently, it only recognizes brain death as the death determination criterion, so a new clause including cardiac death must be added. The government plans to submit a bill amendment to the National Assembly in the second half of 2025.

🔎 Life-Sustaining Treatment Decision Act

• This is an end-of-life medical law that respects patients' self-determination.
  • The Life-Sustaining Treatment Decision Act (Act on Hospice and Palliative Care and Decisions on Life-Sustaining Treatment for Patients at the End of Life) was implemented in 2018 and guarantees that patients in the dying process with no chance of recovery can refuse or stop life-sustaining treatment.
  • The main contents include: First, it recognizes patients' advance directives on life-sustaining treatment. Second, when patients cannot express their wishes, family agreement can determine life-sustaining treatment withdrawal. Third, life-sustaining treatment withdrawal is conducted through review by the medical institution's ethics committee. Fourth, it activates hospice and palliative care to help comfortable dying.
  • Cardiac death donation occurs when a patient who stopped life-sustaining treatment under this law is declared dead after cardiac arrest. The important thing is that the decision to stop life-sustaining treatment and the decision to donate organs must be completely separated. After the patient or family decides to stop life-sustaining treatment, organ donation intention must be confirmed and consent obtained through a separate, independent process.

🔎 Donation after Circulatory Death (DCD)

• This is a method of donating organs after determining death when the heart stops.
  • DCD (Donation after Circulatory Death), also called cardiac death donation or donation after circulatory arrest, is a method where death is determined when an irreversible circulatory arrest state occurs after the heart stops for a certain time, then organs are donated. It's a concept distinct from brain death donation (DBD: Donation after Brain Death).
  • The DCD procedure is as follows: First, a decision to stop life-sustaining treatment is made. Second, patients and families are informed about organ donation possibility and separate consent is obtained. Third, life-sustaining treatment is stopped and the patient naturally reaches cardiac arrest. Fourth, death is determined if the heart doesn't beat for 5-10 minutes after cardiac arrest. Fifth, organ removal surgery is immediately performed to minimize organ damage.
  • DCD has a longer ischemic time (blood supply interruption time) compared to brain death donation, so organ function may be somewhat reduced. Therefore, mainly kidneys, liver, and lungs are donated, while heart donation is limited. However, with advances in medical technology, DCD organ transplant outcomes are gradually improving, and many countries are actively using it.

🔎 Korean Network for Organ Sharing (KONOS)

• This is the national agency that manages organ donation and transplantation.
  • The Korean Network for Organ Sharing (KONOS) is a public institution under the Ministry of Health and Welfare that handles organ donor recruitment, organ distribution, transplant medical institution management, and donation promotion. It was established in 2000 and oversees Korea's organ transplant system.
  • Main tasks include: First, managing organ donation procedures for brain-dead and cardiac-dead patients. Second, operating a fair and transparent organ distribution system. Third, handling organ transplant patient registration and management. Fourth, managing organ donation wish registration and advance directives. Fifth, conducting organ donation promotion and education campaigns.
  • When cardiac death donation is introduced, KONOS will build a management system suitable for the new donation type and perform roles in medical institution education, coordinator training, and data management. It also plans to expand and operate enhanced benefit programs for donors and their families.

5️⃣ Frequently Asked Questions (FAQ)

Q: If cardiac death donation is introduced, won't the decision to stop life-sustaining treatment be influenced by organ donation?

A: The two decisions will be completely separated, with life-sustaining treatment withdrawal decided first, then organ donation intention confirmed separately.

• The most important ethical principle in the cardiac death donation system is thorough separation of the life-sustaining treatment withdrawal decision and the organ donation decision. First, patients and families must decide to stop life-sustaining treatment first, and this decision must be purely for the patient's best interests. Second, after life-sustaining treatment withdrawal is decided, organ donation intention is confirmed through a separate, independent process. Third, medical teams handling organ donation are completely separated from patient care teams to prevent conflicts of interest. Fourth, sufficient time and information are provided to families to help them make voluntary decisions.
• The government plans to clearly stipulate these principles in laws and guidelines to prevent system abuse. Also, strict review by medical institution ethics committees will confirm that all procedures are conducted legally. If there's any suspicion that the life-sustaining treatment withdrawal decision was influenced by organ donation, the donation will not proceed.

Q: Do organs from cardiac death donation show results as good as brain death donation organs?

A: With technological advances, cardiac death donation organ transplant outcomes have greatly improved to reach similar levels as brain death donation.

• In the past, cardiac death donation organs had longer ischemic time (blood supply interruption time) than brain death donation organs, sometimes resulting in reduced function after transplant. However, recent advances in medical technology have greatly reduced this difference. First, using ECMO (extracorporeal membrane oxygenation) to resume blood supply to organs immediately after cardiac arrest minimizes ischemic damage. Second, advances in organ preservation solutions and perfusion techniques allow organs to be kept healthy longer. Third, improvements in transplant surgical techniques enable successful transplantation of cardiac death donation organs.
• Looking at overseas research results, for kidneys, there's almost no difference in long-term survival rates between cardiac death donation and brain death donation, and liver transplants show similar results. For lung transplants too, cardiac death donation has been proven safe and effective. Korea also plans to introduce these advanced technologies to maximize the quality of cardiac death donation organs.

Q: What benefits do families receive when they donate organs?

A: The government operates various benefit systems including funeral support, memorial projects, and certificates of appreciation, and plans to strengthen them further.

• Current benefit systems for organ donors and their families include: First, funeral expense support of up to 10 million won. Second, national cemetery burial eligibility, providing treatment equivalent to national merit. Third, certificates of appreciation and donation certificates to honor the donor's noble decision. Fourth, memorial parks and memorial homes are operated where families can honor the deceased. Fifth, medical expense support for living donors includes post-surgery checkup costs and complication treatment costs.
• The government plans to further strengthen the benefit system along with cardiac death donation introduction. Family psychological counseling support will be expanded, memorial events will be held regularly, and campaigns to share donors' stories with society will be conducted. Practical benefits such as scholarships for donors' children or employment preferences are also being considered. Most importantly, creating a culture where the sacrifice of donors and their families is socially respected and appreciated.

Table of Contents

• Go to Guide