Types of Kidney Donation

By donating through the Standard Voucher Program, you can donate according to your schedule while providing a voucher for your friend or family member who is in imminent need of a transplant. The voucher can be redeemed when your friend or family member is ready for transplant surgery.

When the voucher is redeemed, the voucher holder will be prioritized for a living donor kidney through the National Kidney Registry (NKR). The NKR’s Kidney for Life initiative, which utilizes the latest generation in DNA sequencing technology to assess the histologic, or eplet, mismatch between patients and donors, increases the odds of a better match for the person you are trying to help (unless they have a six-antigen match sibling donor) which usually means the transplanted kidney will last longer and the recipient will require less immune-suppressive medication.

Despite facilitating transplants for more difficult cases, NKR transplants have better outcomes compared to the typical living donor transplant in the United States.

All standard voucher donors are prioritized for a living donor transplant in the extremely rare case they ever need a kidney transplant in the future. Standard voucher donors are eligible for the support and protections covered by Donor Shield.

Finally, by donating through the Standard Voucher Program, donors are able to help more than one person in need of a transplant—the person who receives the voucher and the other person or people transplanted due to their kidney donation.

In KPD, a donor will donate their kidney to another recipient in exchange for a compatible kidney for their friend or family member.

KPD was originally created to overcome donor-recipient incompatibility; however, compatible pairs often participate in KPD to find a donor who is a better match to their paired recipient. A better match usually means the transplanted kidney will last longer and the recipient will require less immunosuppressive medication.

When a person (Recipient A) is in need of a kidney and has a willing donor (Donor A), but 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 donation, 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 the example above, the first pair, a mother and her son, are incompatible. The second pair, a husband and his wife, are also incompatible. In this exchange, the mother donates to the wife of the second pair and the husband donates to the son in the first pair; this is called a loop. A paired exchange chain begins with a Good Samaritan or voucher donor who donates to the son. The mother then donates to the wife and the husband will donate to someone else with a paired donor in a domino chain as shown in the diagram in the Start a Chain section below.

Typically, all of the surgeries in a KPD swap happen on the same day, which can cause scheduling issues. Because of that, in many cases traditional KPD is being replaced by the Standard Voucher Program, which also overcomes incompatibility issues but makes scheduling surgery more convenient and flexible for the donor.

All NKR KPD donors are prioritized for a living donor transplant in the extremely rare case they ever need a kidney transplant in the future. NKR KPD donors are eligible for the support and protections covered by Donor Shield.

Direct donation is the original form of kidney donation in which the donor knows the recipient and donates directly to them. This is generally the best option when the donor is a six-antigen matched sibling, otherwise, better donor-recipient matches can be found by participating in the Voucher Program or by participating in an NKR swap. A better match usually means the transplanted kidney will last longer and the recipient will require less immunosuppressive medication.

By donating through the Family Voucher Program, you can donate according to your schedule while providing up to five vouchers for your family members who are not in imminent need of a transplant. This will allow you to help one or more people who are in need of a kidney transplant now (by starting a chain or donating to someone on the deceased donor waitlist) while also looking out for your family in case one of them ever needs a kidney transplant. In the unlikely event that one of the people you named as a voucher holder needs a kidney transplant someday, they will be prioritized for a living donor kidney through the National Kidney Registry. Only one family voucher can be redeemed.

All family voucher donors are prioritized for a living donor transplant in the extremely rare case they ever need a kidney transplant in the future. Family voucher donors are eligible for the support and protections covered by Donor Shield.

Family voucher donors almost always start chains and are rapidly becoming the predominant form of chain starter donors. In a chain, a donor will donate to someone in need of a kidney who has someone willing to donate on their behalf but is incompatible or is a poor match. That paired donor will then donate to someone else in need of a kidney who has a donor willing to donate on their behalf and so on and so forth as exemplified in the diagram above. One chain can facilitate anywhere from two to 30 transplants. Historically, donors that started chains were simply Good Samaritan donors, however, with the innovation of the Family Voucher Program, donors that start chains are much more likely to be family voucher donors.

All donors that start NKR chains are prioritized for a living donor transplant in the extremely rare case they ever need a kidney transplant in the future. NKR donors are eligible for the support and protections covered by Donor Shield.

The original form of Good Samaritan donation is to a patient on the deceased donor waitlist. Most Good Samaritan donors choose to donate through the Voucher Program or start a chain so that they can help as many people as possible.