Donate Life California: Registry, Living Donors, and Protections

To become an organ donor in California, say yes to the donor registry when you apply for or renew a driver’s license or ID at the DMV, or sign up directly at donatelifecalifornia.org. Either path adds your name to the Donate Life California Organ and Tissue Donor Registry, and that registration carries real legal weight: once you’ve made the decision, no family member can override it after your death.¹

Nearly 20,000 Californians are currently on the transplant waiting list.² Registering takes a few seconds. What follows explains how the process works, who can do it, and what protections and obligations come with the decision.

The Three Ways to Register

The DMV is the most common entry point. Every driver’s license and ID application and renewal asks whether you want to join the registry. Check yes and you’re enrolled.¹

If you aren’t planning a DMV visit, go to donatelifecalifornia.org and register online. The registry is the same either way.

California’s Uniform Anatomical Gift Act also recognizes other methods. You can make the gift through a will, a signed donor card, or a verbal statement made during a terminal illness, provided the statement is communicated to at least two adults, one of whom has no stake in the donation, and later memorialized in writing.³ These alternatives exist for people who can’t register through the standard channels, but the DMV and online options cover the vast majority of registrations.

Who Can Register

Any adult 18 or older can sign up independently. Minors between 15 and 17 can also register with written consent from a parent or guardian, and emancipated minors can decide on their own regardless of age.⁴ If a registered minor dies before turning 18, a parent can still revoke or change the registration.⁵

There is no upper age limit. Medical teams evaluate the condition of individual organs at the time of death, so a 70-year-old with healthy kidneys can be a better candidate than a younger person with underlying conditions. Age by itself doesn’t disqualify anyone.

Registration also doesn’t guarantee every organ will be used. When a registered donor dies, the organ procurement organization conducts a medical assessment organ by organ. Certain cancers, active infections, or damage to a specific organ may rule out that organ while leaving others viable. A single donor can save up to eight lives through organ donation and improve many more through tissue and cornea gifts.⁶

What Your Registration Actually Does

Under California law, if you made an anatomical gift during your lifetime, no one else can override, amend, or revoke it after your death.⁵ Your family cannot veto the decision. That is one of the strongest donor protections in the law, and it’s the reason registering matters more than simply telling relatives how you feel.

You can change your mind at any point while you’re alive. Removing your name from the registry, destroying your donor card, or signing a new document that contradicts the earlier one all revoke the gift.⁷ Once death occurs, the decision locks in.

If you die without registering or recording a preference, California law lets certain family members and agents decide for you. That’s why the conversation with family matters even after you register. If you haven’t registered, loved ones are left guessing under time pressure, and that often leads to no donation at all.

Registry information is tightly restricted. Procurement organizations can access the Donate Life California registry only to check whether someone at or near death registered as a donor, and they cannot use or sell that information for any other purpose.⁶

Donating While You’re Alive

Not all organ donation happens after death. Living donors can give a kidney or a portion of their liver. Living kidney donation is the most common form, and donors can live full, healthy lives with one kidney.

The evaluation is more intensive than most people expect. A prospective living donor goes through a multi-day workup at a transplant center that typically includes:

Medical screening: blood tests, urine analysis, chest X-rays, an electrocardiogram, and a CT scan of the kidneys. Donors over 50 typically undergo additional cardiac stress testing and a colonoscopy to rule out heart disease and colon cancer.
A psychosocial interview with a clinical social worker to confirm the donor is free from pressure, understands the risks, has support for recovery, and knows that federal law prohibits receiving anything of value in exchange for an organ.
An education session with a nurse coordinator covering every stage of the process and the short- and long-term risks for donor and recipient.

Living donors must have their own health insurance and an established relationship with a primary care doctor, because follow-up care at 6, 12, and 24 months after surgery is required. If the evaluation surfaces any history of depression, anxiety, or similar conditions, a transplant psychiatrist may conduct a separate assessment.

Paid Leave for Living Donors

California employers with 15 or more employees must provide paid leave to workers who donate an organ or bone marrow. Organ donors receive up to 30 business days of paid leave per year, plus an additional 30 business days of unpaid leave if needed. Bone marrow donors get up to five paid business days. Your employer must maintain your group health insurance for the entire leave, and the time off cannot count as a break in service for seniority, vacation accrual, or sick leave.⁸

One condition: your employer can require you to use up to two weeks of accrued sick leave, vacation, or PTO before organ donation leave kicks in, or up to five days before bone marrow donation leave begins.⁸ You’ll need written verification confirming you’re a donor and that the donation is medically necessary.

Federal employees have a separate entitlement: up to 30 days of paid leave per year for organ donation and seven days for bone marrow donation, on top of regular annual and sick leave.⁹

What It Costs and What It Doesn’t

The donor’s family pays nothing for the donation itself. All costs tied directly to organ recovery are covered by the recipient’s insurance or the organ procurement organization. Hospital bills from efforts to save the donor’s life before donation was ever considered remain the family’s responsibility, as do funeral expenses.¹⁰

Donation also doesn’t disrupt funeral plans. An open casket service is still possible, and the process does not delay funeral arrangements.¹⁰

Federal law makes it a crime to buy or sell human organs for transplant. Anyone who knowingly acquires or transfers an organ for something of value faces up to five years in prison and a $50,000 fine.¹¹ The prohibition does not apply to paired kidney exchanges, in which two incompatible donor-recipient pairs swap kidneys so each recipient receives a compatible organ.

Protections Against Discrimination

California law prohibits hospitals, surgeons, procurement organizations, and anyone else involved in the transplant process from basing recipient decisions on a person’s physical or mental disability. The only exception is when a physician determines, through a case-by-case evaluation, that the disability is medically significant to the transplant itself. A person with a disability cannot be required to demonstrate the ability to live independently after surgery as a condition for receiving an organ, as long as they have adequate support in place.³ Courts are required to prioritize any enforcement action brought under this provision.

On the allocation side, the federal Organ Procurement and Transplantation Network runs the national waitlist and matching system.¹² Only medical and logistical factors drive a match. Income, celebrity status, insurance type, and personal connections play no role.¹³

If you’re ready, the registry is at donatelifecalifornia.org, and the question will appear automatically the next time you deal with the DMV. After you sign up, tell your family. The law makes your decision binding, but a short conversation now spares them from having to guess later.

1
Donate Life California. Everything You Need to Know About the Organ Donation Process
2
Donate Life California. The Organ Transplant Waiting List
3
California Legislative Information. California Health and Safety Code Chapter 3.5 – Uniform Anatomical Gift Act
4
California Legislative Information. California Health and Safety Code 7150.15
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California Legislative Information. California Health and Safety Code 7150.35
6
Justia. California Health and Safety Code 7150-7151.40 – Uniform Anatomical Gift Act
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California Legislative Information. California Health and Safety Code 7150.30
8
California Legislative Information. California Labor Code 1510
9
U.S. Office of Personnel Management. Bone Marrow or Organ Donor Leave
10
Donate Life California. Organ and Tissue Donation Myths
11
Office of the Law Revision Counsel. 42 USC 274e – Prohibition of Organ Purchases
12
GovInfo. 42 USC 274 – Organ Procurement and Transplantation Network
13
UNOS. How We Match Organs