If you are considering donating one of your kidneys, the information below can help you understand the process, the benefits, and the risks.

The first successful kidney transplant took place in the mid-1950s, between identical twin brothers. Since then, living kidney donation has expanded well beyond close relatives to include extended family, friends, and even strangers.

Living donor kidneys have a higher success rate than kidneys from deceased donors (people who have been declared brain-dead), and a healthy person can donate a kidney and continue to live a full, healthy life.

If you want to donate to a loved one but are not a match, you may still be able to help them receive a living donor kidney through paired donation, described below. As with any donor, you must first be found eligible by the transplant team.

Types of Living Donation

• Directed donation — the donor chooses the recipient, usually a spouse, family member, or friend.
• Non-directed donation — the donor gives anonymously to a stranger on the transplant waiting list.
• Paired kidney donation — if a donor and intended recipient are not a match, they can swap with another incompatible pair. Multiple pairs can form a “chain” of donations.
• Voucher donation — a donor gives a kidney now and receives a voucher a designated recipient can redeem for a kidney later. This is often used when someone will likely need a transplant in the future but the donor may not be eligible to donate at that time, due to age.

Benefits of a Living Donor Kidney

• Receiving a kidney from a living donor offers several advantages over a deceased donor kidney:
  • Shorter wait, better health at transplant. The national average wait for a deceased donor kidney is five to ten years, depending on blood type and transplant center location. A living donor shortens that wait significantly, and the longer a patient is on dialysis, the greater the risk of other health complications.
  • Planned surgery. Transplant surgery can be scheduled in advance rather than performed on an emergency basis, as is often the case with deceased donor kidneys, allowing the patient to be better prepared medically.
  • Minimal “cold time.” Cold time is the period a donor kidney spends on ice before being transplanted. A deceased donor kidney may sit on ice for hours; a living donor kidney is transplanted almost immediately. Kidneys with less cold time tend to function right away and fare better long-term.
  • Better function and longevity. Kidneys from living donors generally work better and last longer than deceased donor kidneys.

Evaluating the Potential Donor

Every potential donor undergoes a complete medical evaluation. It begins with blood tests to check compatibility, including blood typing (A, B, AB, or O) and human leukocyte antigen (HLA) typing, which confirms that you and the recipient share most or all of six key antigens (proteins on the surface of kidney cells).

If you are found to be a potential match, the transplant team will take a complete medical history and perform a physical exam to confirm you are healthy enough to donate. If you are not a match, ask the team about paired donation.

The evaluation typically includes:

• EKG and echocardiogram, to assess heart condition and strength.
• Chest X-ray, to check lung health.
• Abdominal ultrasound, to image the abdominal area.
• Extensive blood and urine tests.
• Psychological evaluation, to assess your understanding of and motivation for donating.

Depending on your age, sex, and health history, additional tests such as a colonoscopy, mammogram, or Pap smear may be ordered.

Donors must be in very good health — free of diabetes, high blood pressure, kidney stones, cancer, and any history of mental illness — with both kidneys functioning normally and no significant excess weight. The full evaluation process can take several months to a year.

Most important, you must be certain you want to donate. Many people find it helpful to talk through their feelings and concerns with a spiritual advisor, counselor, or other trusted source before deciding.

If you decide to proceed and are cleared to donate, you will undergo a CT angiogram of the abdomen before surgery. This imaging shows the transplant team the anatomy and condition of the veins and arteries in your kidneys.

Types of Kidney Removal (Nephrectomy) Surgery

There are three surgical approaches to donor nephrectomy:

Laparoscopic Donor Nephrectomy

Leaves a three- to four-inch scar below the bikini line and three small punctures that heal quickly. Because muscles are generally not cut, recovery is more comfortable. The average hospital stay is about two days, with a return to work in two to three weeks. Due to its faster recovery, most transplant centers now favor this approach over open surgery. It may not be an option for donors who are significantly overweight or very thin, have had multiple prior abdominal surgeries, or have abnormal blood vessels around the kidneys.

Minimally Invasive Donor Nephrectomy

Also leaves a three- to four-inch scar. The muscles are separated but no rib is removed. The procedure takes about half an hour longer than open surgery, causes no damage to the kidney, and offers a faster recovery than the open approach.

Open Donor Nephrectomy

Involves an eight- to nine-inch incision through or below the twelfth rib, usually with removal of a portion of the rib. This approach is very safe and yields a kidney in excellent condition. It requires about three days in the hospital and six to eight weeks of recovery, during which you will be unable to work. The scar will fade over time.

Advantages of Laparoscopic Surgery

• Less blood loss.
• Less post-surgical pain.
• Shorter hospital stay.
• Faster recovery — a return to daily activities within two to three weeks.
• A smaller, less noticeable scar.

Disadvantages of Laparoscopic Surgery

• The surgery takes longer and is technically more difficult.
• Unexpected complications may require converting to an open procedure.
• Not every donor is a suitable candidate for this approach.

Risks of Donation

Kidney donation is a relatively safe procedure, but it is major surgery and carries risk. Possible complications include allergic reaction to anesthesia, infection, bleeding or the need for a blood transfusion, vascular complications (such as blood clots, hernia, bowel obstruction, or abnormal scarring), a temporarily collapsed lung, or unexpected complications requiring a longer hospital stay.

A person can live a healthy life with one kidney, but longer-term risks after donation may include protein in the urine, high blood pressure, kidney disease, tumor development, or injury to the remaining kidney from trauma. In rare cases, donors have gone on to develop kidney failure — which is why careful screening is essential to confirm a donor is a suitable candidate.

Pregnancy After Donation

Women can have children after donating a kidney but should wait at least six months to allow the body to recover. If you are considering donation and hope to become pregnant in the future, discuss timing with the transplant team.

Financial Costs

Medicare or the recipient’s private insurance covers the donor’s evaluation, surgery, and post-operative care. It does not cover:

• Time off work.
• Child care.
• Travel costs.
• Meals
• Other out-of-pocket expenses.

Donating a kidney may also affect eligibility for affordable health, disability, and life insurance, and can raise complications for donors pursuing careers in the military, law enforcement, firefighting, or aviation.

Deciding to Donate

Donating a kidney is a major decision. Talk openly with the transplant team, ask about the risks, and share any medical concerns or conditions. Gather all the information you need before deciding.

At any point during the evaluation process — even up to the day of surgery — you may withdraw as a donor simply by telling your transplant coordinator or any member of the transplant team. Your decision will be kept confidential.

It is illegal in the United States to exchange money for a donated organ; a kidney donation must be a true gift. For many donors, giving the “gift of life” becomes one of the most meaningful experiences of their lives. If it would help, ask the transplant team to connect you with someone who has donated a kidney.