Requirements for kidney donation vary by transplant center. At a minimum, you must be 18 years of age, in good health, with normal kidney function and no major physical or mental illnesses. There are a number of other factors to consider, all of which will be addressed during the evaluation process should you decide to become a living kidney donor. You can easily apply to become a kidney donor using the Donor Care Network online donor screening process to determine if you are qualified to donate.
Frequently Asked Questions
Find the answers to your questions about the process of living kidney donation.
For Kidney Donors:
If you are interested in becoming a living kidney donor, you can start the process by taking a short screening survey to see if you are medically qualified to donate. If you qualify, you will then be asked to complete a longer, more detailed medical history questionnaire and do routine labs including blood tests and a urine sample After this, you will be referred to a transplant center of your choosing. If you participate in an NKR swap you will automatically receive the NKR’s Donor Shield protections.
As a convenience, donors can also donate through the NKR’s Voucher Program, which allows the donor to donate to a stranger at a time that works best with the donor’s schedule and provide a voucher to an intended recipient in immediate need of a kidney. If you don’t have an intended recipient who is in imminent need of a kidney, you can take advantage of the Family Voucher Program, where you can donate and provide vouchers for up to five family members as a safeguard in case one of them ever needs a kidney transplant in the future.
Other options for donation include donating your kidney to a specific recipient (direct donation), donating to a stranger (Good Samaritan donation), or donating through traditional paired exchange, which works the same as the Voucher Program but you would donate on the same day that your recipient receives their kidney.
There is no official maximum age limit for becoming a living kidney donor. It is harder for an older donor to qualify for donation surgery but the National Kidney Registry (NKR) has had donors who were in their late-70s when they donated. The minimum age for donation is 18-25 depending on the transplant center.
If you are considering donating a kidney in the future, but are concerned your age may be an issue, the National Kidney Registry (NKR) Family Voucher Program lets potential donors donate a kidney now and give vouchers to up to five family members. If any of the voucher holders need a kidney in the future, they can activate their voucher to receive priority consideration for a well-matched kidney from a living donor through the NKR. Only one voucher can be redeemed per voucher donor.
Potential kidney donors with a Body Mass Index (BMI) over 35 are usually rejected as kidney donors. Those with a BMI of 30-35 may be encouraged to lose weight before surgery. If you are interested in becoming a kidney donor but are concerned that you will not be accepted because of your weight, we encourage you to complete a short initial screening to determine your eligibility. The online donor screening process quickly lets potential donors determine whether they are medically qualified to donate and identifies which centers will accept them as donor candidates.
You will be given a general anesthetic and will be asleep for the entire procedure. Most kidney removals (nephrectomies) are done using laparoscopic surgery, which is a minimally invasive surgery that uses small incisions and a special camera. In this case, the surgeon will make one or more incisions in your abdomen, carefully remove one kidney, then close the incision(s). Laparoscopic surgery typically results in a shorter hospital stay, less pain and scarring, faster recovery time, and fewer post-operative complications. In cases where laparoscopic surgery is not possible, you may have open surgery to remove your kidney. Your transplant center can give you the most current medical information about the specific surgery you will undergo.
If you become a living kidney donor through a National Kidney Registry (NKR) swap, you are covered by the support and protections offered by Donor Shield.
The recovery time after living kidney donation surgery will vary depending on several factors, including the type of surgery and the donor’s individual rate of recovery. Typically, a living kidney donor will be in the hospital for one to three days after donation, should not fly for a minimum of one week after donation and will need between two and four weeks of recovery time before returning to work. The more physical exertion the donor’s job requires, the longer the expected recovery time. For competitive athletes, we have heard some donors report that it took six to 12 months before they were back to their pre-surgery peak performance levels.
The voucher never expires and can be redeemed when that patient (voucher holder) is ready for transplant. However, if the voucher holder is part of a family voucher, Once the first voucher holder is activated to receive a kidney, all other vouchers related to that donor become void and cannot be redeemed.
For Kidney Donors & Kidney Patients:
Direct kidney donation is when a donor is found to be compatible with a recipient, they can donate their kidney directly to that recipient. This is, logistically, the least complex type of donation. However, except in the case of six-antigen matched siblings, the recipient can usually get a better-matched kidney, which usually means the transplanted kidney lasts longer, by participating in voucher donation or paired exchange.
Non-directed donors, often called Good Samaritan donors, are donors who donate their kidney to a stranger. This donation often starts a chain where several patients get transplanted. Donors who intend to be non-directed donors should investigate and understand their options about the Family Voucher Program, which allows the donor to donate to start a chain and name up to five family members to receive a voucher in the unlikely event one of them needs a transplant in the future.
When a person is in need of a kidney (Recipient A) and has a willing donor (Donor A), but that Donor A is either a poor match to Recipient A or not a match at all, the NKR can find a recipient who is in need of a kidney (Recipient B) and has a donor (Donor B) who is willing to donate, but is either a poor match or not a match at all to Recipient B, but is a match to Recipient A and have them swap. In traditional kidney paired exchange (KPD), Donor A is a match and gives to Recipient B and Donor B is a match and gives to Recipient A. This is a “swap.” In a paired exchange chain—the most common form of NKR paired exchange—a Good Samaritan donor (Donor A), most likely a family voucher donor, gives to Recipient B, Donor B gives to Recipient C and Donor C gives to someone else in a similar situation to Donor and Recipient B and C. Many donor-recipient pairs are choosing to participate in the Voucher Program instead of the traditional paired exchange process because it is more convenient, especially when the donor will be the recipient’s caretaker after the transplant.
Because of the large number of potential donors that a recipient can be matched with in a multi-center paired exchange program, paired exchange is almost always the best option for finding the best match, which is correlated with a longer lasting kidney transplant. The only exception is six-antigen matched siblings—these are the best possible matches and cannot be improved upon by participating in paired exchange.
80% of the patients who enter paired exchange through the National Kidney Registry (NKR) are transplanted in under 90 days. Single center paired exchange programs have much longer wait times, especially for highly sensitized patients.
Advanced donation is kidney paired exchange separated in time; the Voucher Program is based on this. In the Voucher Program, the donor donates first, to a stranger. That donation then provides a voucher for the recipient, which can be redeemed when that recipient is ready for transplant. Voucher donation allows the donor to donate when they are ready. Voucher donors typically start a paired exchange chain, which helps other patients in need of a transplant.
Finding the best match for a kidney transplant is important because the better the match, the more likely it is that the kidney will last longer. The National Kidney Registry uses the latest generation in DNA sequencing technology to assess the match between patients and donors. Traditionally, kidney transplant matches were measured by an HLA match score of zero to six. This score was based on antigens. Behind antigens are eplets, which are essential components of HLA epitopes recognized by antibodies. Eplet mismatch analysis has been proven to be a more precise measure of a donor-recipient match compared to antigen matching, and can potentially lower the probability of rejection and graft failure, as well as enable the recipient to safely reduce the immune-suppression medications they must take after the transplant is complete.
The National Kidney Registry holds the Guinness World Record for the longest kidney transplant chain in the world. “Chain 357” was facilitated by the NKR from January 6 to March 26, 2015 and included 35 kidney transplants, 70 surgeries, and the combined efforts of 25 transplant centers.
For Kidney Patients:
The cost of a kidney transplant depends on a number of factors, including the transplant center, location, and your level and type of insurance coverage. According to a 2017 report, the average estimated billed charges for a kidney transplant, including all pre- and post-transplant care, is $414,800. Depending on your insurance, most, or all, of these costs will be covered. Consult your insurance company and your healthcare provider regarding your specific case.
You will generally be in the hospital for two to seven days. Most kidney transplant recipients can return to normal activities within four to eight weeks after surgery.
Before the transplant, the patient will be put under general anesthesia—they will be asleep for the entire procedure. The surgeon then makes an incision in the recipient’s abdomen and places the donated kidney inside. The new kidney is then connected to the recipient’s blood vessels and bladder. Once this is done, the surgeon closes the incision. The patient’s original kidneys are usually left in place unless there is a medical reason to remove them. The operation typically takes three to five hours.
Kidney transplantation is a fairly common surgical procedure, with over 20,000 performed in the United States every year. This type of surgery generally has a high success rate and a low rate of complications. Kidney transplants from living donors generally last two to three times as long as those from deceased donors. Furthermore, those facilitated by the National Kidney Registry (NKR) have superior outcomes at three, five and seven years compared to average U.S. living donor transplant outcomes. Having the largest donor pool allows the NKR to find better matches for recipients.
If you find a donor willing to donate on your behalf, that donor may be able to donate directly to you, but it is often more beneficial for you and the donor to enter the Voucher Program. By entering this program, your donor can donate when it is convenient for them and you can get the best match possible. The Voucher Program also protects the donor because all voucher donors are covered by Donor Shield.
If you need a living kidney donor, you can sometimes find a donor by asking friends and family members. If you are unable to find a donor among people you know, we recommend finding a transplant center that participates in our microsite program, which is a free service that helps kidney patients build a simple website to tell their story and find a donor. The site is sharable via social media and comes with 250 free business cards with the patient’s name and microsite URL that can be given out by the patient.
If you have advanced kidney disease, you may be eligible for a transplant. You will need to be evaluated by a transplant center, which will do a number of tests to determine whether you are a good candidate for a kidney transplant. In general, qualifications for kidney transplant include having chronic irreversible kidney disease, being on dialysis now or being close to needing dialysis. You may be ineligible for a kidney transplant if you have an additional life-threatening disease, a history of chronic drug or alcohol abuse, or a serious psychiatric disorder.
To get on the list for a deceased donor kidney, your name must be added to the national waiting list for organs from deceased donors, which is managed by the United Network for Organ Sharing (UNOS). There are approximately 100,000 people in the United States on the waiting list to receive a kidney from a deceased donor, with an average wait time of three to 10 years. If you are able to find a donor willing to donate on your behalf, you will likely have a much shorter wait time and a better outcome.