As more organs are flown annually and are travelling further, more and more recipients are living longer and more fully thanks to the capabilities of specialised organ air transport providers. Alex Preston finds out more

This article first appeared in Low-Cost & Regional Airline Business in July/August 2025

Each year, more people are having their lives saved and extended thanks to organ donation and transplantation.
According to the most recent figures from the Organ Procurement and Transplantation Network (OPTN), a public-private partnership that links all professionals involved in the US donation and transplantation system, the number of organ transplants in the country reached an historic high of 48,149 transplants in 2024, made possible by the generous contributions of deceased donors providing one or more organs for transplantation and living donors donating either a whole kidney, a segment of their liver, or a uterus.
Closer to home, at the time of writing 1,068 people in the UK had received a transplant since April 2025.
Yet, despite this positive news, many more people await the opportunity for a transplant.
In the US, there are more than 103,000 individuals on the national transplant waiting list – a person is added every eight minutes. In the UK, the number of people on the active transplant waiting list reached 8,085 at the end of March, the highest number of people in need of a transplant in the past decade.
Organs qualifying for transport include kidneys, livers, hearts, lungs, corneas, blood reserves, plasma and frozen section samples from biopsies.

Time sensitivity
Once removed, organs remain viable only for a limited amount of time (the cold ischemic period). The time frame in which the transplantation must take place varies per organ.
Until recent times, the standard method of transporting the organs was to pack them in ice in a cooler which limited the travel time to keep an organ viable for transplantation. According to Duke University, for a heart, the window is about four hours, which severely limited the distance a donated organ could be retrieved and transported. Also, organs transported in cold storage could get ‘freezer burn’ since the temperature in the cooler was not regulated.
The rapid advances seen in organ preservation technologies means that organs can now travel further to reach those patients most in need of a transplant, facilitated by the growth in the use of jet aircraft as air transport for organ transplants over the past several years.

Handle with care
In some countries, the donation and transplant system relies on commercial airline cargo processes, which are often not designed for this purpose – an issue that has been highlighted by the US‑based non-profit United Network for Organ Sharing (UNOS).
They call attention to the fact that after the September 11 attacks in 2001, deceased donor organs in the US that hitherto travelled on commercial airlines unaccompanied were redesignated as cargo and thus no longer permitted to travel near the cockpit. This ended expedited on- and off-boarding at the gate and subjected organs, as well as related blood and tissue, to below-wing handling.
UNOS asserts that this designation introduced these “lifesaving gifts” to mishandling, delays and damage as baggage, and resulted in additional challenges navigating cargo hours and cargo lock-out times.

UNOS has led advocacy efforts which has seen the US Congress include a provision to the Securing Growth and Robust Leadership in American Aviation Act that requires the Department of Transport (DOT) and Federal Aviation Administration (FAA) to convene a working group to identify best practices and hindrances for the transportation of donated organs, primarily kidneys and livers, in the passenger cabin instead of in the cargo hold of an airplane.
The FAA held the first working group meeting in August 2024. Their work is expected to inform policy improvements that would not require going through the federal rulemaking process.
However, there are air operators that specialise in organ procurement transportation for surgical teams and organ-only trips.
Medical Air Service has long-standing experience in chartering emergency air ambulances and patient transportation vehicles, enabling it to equip ambulance aircraft with adequate organ care infrastructure within a lead time of 60 minutes almost anywhere in the world.
The organisation has a mixed fleet of rotor wing aircraft, including AS 365 Dauphin and EC135 and 145 helicopters amongst other models, and fixed wing medical jets.
To meet the needs of organ recovery efforts throughout the Northeast US and across the country as needed, Eagle Air Aviation is specialised in transportation for organ recovery teams and organ-only trips. The company currently has four Citation CJ2 light jets available round-the-clock.
As CEO Tyler Sigel explains, Eagle Air has averaged over 300 organ recovery trips each year, with those numbers growing as the size of the fleet increases. The typical organ procurement trip consists of two pilots and a specialty transplant surgical team that varies from two to four medics depending on the complexity of the recovery.
“While Eagle Air currently does have a mix of both fixed wing and rotor wing aircraft, we are currently providing organ recovery flights in our jet aircraft fleet,” says Sigel. “The FAA sets the requirements for air operators and aircraft to be able to perform MedEvac work, which includes organ procurement team and organ-only transports, and Eagle Air Aviation is finalising details with the FAA to assure that all regulations are met from an operational standpoint. We anticipate that our clients will be able to utilise our EC135 helicopter [acquired in April] very soon, if practical, for short-range transportation.”
Indeed, when announcing the new acquisition, Sigel confirmed the company had already received a lot of inquiries from both organ transportation entities and air charter brokers.

Organised procedures
Organ Procurement Organisation (OPO) coordinators work tirelessly to match donor organs with recipients. According to Sigel, sometimes the best match for an organ means a longer transport time so several things have been done to optimise the ability to get that organ from the donor to the recipient.
Eurotransplant is an international non-profit organisation involved in the allocation of donor organs within Austria, Belgium, Croatia, Germany, Hungary, Luxembourg, the Netherlands and Slovenia.
It explains that transport is generally the responsibility of the donor coordinator and the transplant centre; however, it has a consultative role in finding a suitable flight for transport of renal organs.
According to the organisation, in almost all cases the thoracic organs (heart and lungs) are procured by the centre that accepted the organs.
Organ preservation starts with an adequate donor management. Optimal donor management, based on the most recent scientific developments, should maintain and restore adequate perfusion and oxygenation of the organs and tissues to facilitate a successful organ preservation, recovery and transplantation.
Sigel says that special organ preservation devices are used to store and maintain the organ during air transport. “Some of these devices utilise cold storage of the organ while outside of a human body. However, there are now also some warm perfusion devices which circulate blood products through the organ during transport allowing for optimised viability of the organ.”
Even though Eagle Air specialises in medical-related transportation needs for organ recovery, the aircraft used for the purpose are not specifically outfitted in a singular medical configuration, in comparison to the helicopters and planes that are used to transport critically sick and injured patients.
Sigel explains the jets are normally in a typical executive interior layout without any medical equipment installed. The transplant teams typically bring their own equipment and specialised coolers or transport devices with them. Also known as organ transport boxes, these ensure that organs are kept in optimal preservation temperature during the transfer. These are stowed in the cargo areas of the plane for the flight to and from the recovery location.
“Eagle Air Aviation does have the ability to transport some of the larger organ preservation devices with a special FAA-approved mounting system designed to secure the equipment in the cabin of the plane with the medical staff allowing them to monitor the status of the organ throughout the flight,” he says. This can result in fewer complications in the recipient after the transplant.
Looking ahead to the future, advances in transportation technologies such as the so-called heart-in-a-box are pushing transport times further, helping reduce organ rejections and primary graft dysfunction (PGD).
As Sigel enthuses, “Eagle Air Aviation is committed to providing the best aircraft, pilots and processes for safe and efficient transport needs of organ recovery teams and organs. We constantly have our sights on the market and will grow with the needs
of the industry to make sure we remain the go to providers for organ recovery efforts.”