While sastra does not refer to the specific issue of organ donation, Lord Krsna says that
“great personalities have attained immortal fame simply by sacrificing this temporary and perishable body.”
(Krsna Book, ‘The Liberation of King Jarasandha’).
The Srimad-Bhagavatam describes Maharaja Sibi, who was known as the greatest protector of surrendered souls and donor of charity. He selflessly gave his own flesh to Indra and Agni, who disguised themselves to test him, and was thus glorified by Narada Muni. When Maharaja Pariksit was born, it was foretold that he would be “a second Maharaja Sibi in charity and protection.”
While such personalities and behavior are exemplary, and while the issue of organ donation is considered to be an individual choice, devotees remain discerning with their charity: both in giving and in receiving, and thus are advised to take caution and confine their dealings in this regard to the community of devotees. In terms of donating an organ, Srila Prabhupada explains in Bhagavad-gita As It Is:
“Charity should be given to the right receiver…[and] should be given only to propagate Krsna consciousness all over the world. That is charity in the mode of goodness.” (Bg, 16:1-3, purport)
We should be willing to give anything to a devotee to extend their life, and in this way the giver and receiver engage in an exchange that is of transcendental benefit to them both. However, while this seemingly supports the act of receiving an organ from a random donor, as it would be charity in the mode of goodness for the purpose of propagating Krsna consciousness, it raises the question of the degree of karmic exchange involved. Devotees therefore remain selective in receiving as well as giving.