Most organ transplants come from deceased donors, and the vast majority of these deceased donor organs are allocated by a regulated system of national waiting lists. That is, the organs of a deceased donor go to strangers in need. In contrast, most transplants from living donors (of kidneys and livers) are direct donations from someone healthy enough to donate to someone who they know.* Living donations are also different in that they can be planned well in advance, while deceased donations have to be hastily arranged following a death.
But it is legal, and sometimes possible, for the next of kin of a deceased potential donor to direct an organ donation to someone they know who needs a transplant. This will only take place if the potential recipient is available on short notice, and if the donor organ is compatible with the recipient. So it's a rare event: the next of kin need to know someone in need, and the transplant has to turn out to be feasible.
But rare events happen, and the NYT reports on just such a story:
A Man Who Shunned Cheap Sentiment Left a Gift for Others: Life By Dan Barry
"Informed that her 55-year-old brother would never regain consciousness, Darlene Costello made the heartbreaking decision to have him removed from his ventilator — only to learn, seconds before it was time, that Brendan was a registered organ donor.
"Once Ms. Costello calmed down — why wasn’t this known before? — she came to embrace the news of her brother’s final selfless act. She also knew someone who desperately needed a kidney. Calls were made, tests done, overwhelming odds overcome."
...
" His lungs went to a woman in Tennessee, his right kidney to a man in Pennsylvania. And his left kidney was received by Ms. Costello’s mentor and employer, Dr. Sylvio Burcescu, 62, whose ability to run his Westchester County clinic had been hampered by a rare kidney disease requiring dialysis."
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*Nondirected living donors can also start chains of kidney exchange.
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