Living donor transplants offer superior patient and graft survival compared to deceased donor transplantation. The shortage of deceased donors has led to expanded indications for donation known as marginal donors. According to GODT data of 2023, 172,409 solid organ transplants were performed globally, and 31% of these were from living donors⁽¹⁾. The number of living donor transplants for the kidney was 43,101, liver was 10,081, and lung was 10. Considering transplants in WHO regions, living donors contributed 20% in the Americas, 27% in Europe, 32% in the Western Pacific Region, 82% in South-East Asia, 88% in the Eastern Mediterranean region, and 100% in Africa⁽¹⁾.

Given this major contribution, ensuring the health of living donors is essential to sustain and encourage donation. International guidance, including the Amsterdam Forum consensus and KDIGO recommendations, emphasizes the importance of long-term donor follow-up⁽²⁾. In the United States, UNOS requires transplant centers to follow donors for at least two years⁽³⁾ and several high-income countries (HICs), including the USA, Canada, the UK, Australia, and New Zealand, have established donor registries to monitor outcomes. Most published reports on donor follow-up originate from HICs. Earlier studies published before 2010 often found no significant long-term consequences of donation. However, more recent research incorporating larger cohorts, longer follow-up (exceeding 10–15 years), and better-matched control groups has shown increased risks of hypertension, cardiovascular disease, end-stage renal disease (ESRD), and mortality⁽⁴⁾. Risk of ESRD appears to rise with the donor’s age, duration since donation, and baseline glomerular filtration rate⁽⁵⁾.

Data from low-and middle-income countries (LMICs) remain limited. Reports from Sri Lanka and Bangladesh describe increased rates of chronic kidney disease and hypertension even in relatively short follow-up intervals. In Pakistan, a cohort of 2,696 donors followed for up to 27 years demonstrated an incidence of end-stage renal disease in 0.2%, hypertension in 13.7%, and diabetes in 3.6%. When compared with age- and sex-matched non-donors, hypertension, diabetes, and renal function were similar⁽⁶⁾.

Despite structured programs, donor follow-up is frequently irregular. Reported non-adherence ranges from 16–20% in the first two years, increasing to 50–60% by years 5–10⁽⁷⁾. The main barriers in HICs include logistical and financial constraints, while in LMICs these are compounded by social challenges and lack of infrastructure. Solutions in HICs have included closer integration of transplant centers with primary care providers, as well as use of telemedicine and mobile outreach⁽⁸⁾. Some LMIC programs address barriers by offering free follow-up care⁽⁹⁾.

Globally, the reliance on living donors continues to grow. These individuals provide not only the “Gift of Life” to recipients but also vital support to transplant systems. Ensuring their long-term health is therefore both an ethical obligation and a public health priority. Regular donor follow-up enables early detection of complications and timely interventions, protecting the well-being of the extraordinary individuals who make transplantation possible.

In May 2024, the Seventy-Seventh World Health Assembly adopted Resolution WHA77.4, calling on Member States to strengthen workforce capacity⁽¹⁾. The resolution emphasized the importance of robust education strategies and empowering health professionals at all levels. In LMICs, where resources are limited, digital platforms and targeted in-hospital training are critical tools for implementing these recommendations.

Professionalized training programs have demonstrably increased organ donation in various contexts^(2–4). The Australian Organ and Tissue Donation and Transplantation Annual Report 2023–24, issued by the Organ and Tissue Authority (OTA), describes initiatives to improve donor identification and family communication through targeted training programs for healthcare professionals⁽⁵⁾. The United Arab Emirates (UAE) has similarly demonstrated rapid progress in deceased organ donation. Through the UAE Hayat National Program, capacity building has been institutionalized as a central pillar, integrating donation training into healthcare conferences and certified workshops. In 2023 alone, more than 5,000 professionals across intensive care, neurology, anesthesiology, pediatrics, nursing, and transplant coordination participated^(6,7).

Digital platforms offer scalable avenues for LMICs to overcome training barriers. The ISODP Educational Watch (E-W) site, developed by the International Society for Organ Donation Professionals, exemplifies how scientific societies can facilitate healthcare professional education. ISODP E-W consolidates information regarding global available resources, including webinars, lectures, and certified organ donation courses, and provides video examples illustrating key competencies. E-W site guides the users towards the different steps of the organ donation process providing insights regarding the importance of each subject as well as the learning objectives. Through this global directory users can thus select materials appropriate to their needs and local context⁽⁸⁾.

Looking forward, the transplantation community must continue to invest in educational equity. Partnerships among international societies, national programs, and academic institutions are essential to expand access, adapt curricula to local contexts, and evaluate outcomes. Training should remain sensitive to cultural, infrastructural, and epidemiological realities while promoting adherence to international best practices. Strengthening the role of allied health professionals through accessible training represents one of the most effective strategies to expand donation capacity in LMICs and reduce the global burden of organ failure.

In conclusion, capacity building in organ donation requires accessible, multidisciplinary training tailored to LMIC realities. The ISODP Educational Watch site illustrates the potential of collaborative, innovative educational initiatives. By implementing the WHO resolution’s recommendations through practical, scalable programs, the global transplantation community can advance equitable access to life-saving transplantation.