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Living Donors


You can make a difference by joining the ranks of over 50,000 living donors who have donated their kidneys to people facing kidney failure. Since 1954, when the first successful living donor transplant took place in Boston, living donors have been giving the gift of life and making a difference. This tradition has allowed thousands of people facing kidney failure to live longer, healthier lives, free from the challenging routine of dialysis. Donating a kidney not only helps the person who receives the kidney but also shortens the deceased donor wait list, helping others get a deceased donor kidney sooner. Also, all living donors are awarded points for their donation so if they ever need a kidney later in life, they will be given priority on the deceased donor list.

Types of Donation

There are four types of living kidney donation: direct donation, paired exchange donation, Good Samaritan donation, and advanced donation.

Direct Donation

With direct donation, the donor generally knows the recipient and donates directly to them. If the donor is compatible, the donor's kidney can be transplanted directly into the recipient. One problem with direct donation is that direct donors are often incompatible or poorly compatible with their intended recipients - this means they are not the right blood type or do not pass a cross match test with the intended recipient. However, a donor can still help their intended recipient get a transplant if they are incompatible by participating in a paired exchange. Below is an illustration of the three hurdles that direct donors must clear before they can donate their kidney in a direct donation.


Direct Kidney Donation - Hurdle #1: Healthy
Hurdle #1

Blood Compatible

Direct Kidney Donation - Hurdle #1: Healthy
Hurdle #2

Pass Cross Match

Direct Kidney Donation - Hurdle #1: Healthy
Hurdle #3
Paired Exchange Donation

In a paired exchange, a donor will donate their kidney to another recipient in exchange for a compatible kidney for their loved one. In the example to the right, 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. Often compatible pairs enter into a paired exchange to get a better match donor.

Paired Kidney Exchange click image to zoom
Good Samaritan Donation

With Good Samaritan donation, the donor is giving to a stranger which initiates a chain of transplants. Chains are a way for one Good Samaritan donor (aka Non Directed Donor) to help many patients get transplanted. Chains are also revolutionizing the paired exchange process by facilitating better donor-recipient matches including some six antigen matches, which is important because a great match allows the transplanted kidney to last longer.

Many Good Samaritan donors choose to start chains because it is a way to help more than one person suffering from kidney failure. One chain typically facilitates anywhere from 2 to 30 transplants. The NKR pays for donation insurance for all Good Samaritan donor who start chains through NKR.

To Become a
Good Samaritan Donor
Click Here
Donor Chain Graph click image to zoom


We've got your back

We have Donated
Two senior leaders in the NKR organization are living kidney donors who donated their kidneys and started chains. As such, we intimately understand the living donor process and are committed to ensuring a convenient and safe donation experience for all living kidney donors.

We are your Safety Net
The NKR currently provides 'kidney prioritization' to all NKR donors enabled by our Medical Board policy that states that should an NKR donor’s remaining kidney ever fail, they will be prioritized in the NKR program to receive a living donor kidney. This is in addition to the prioritization points that a living donor receives on the national deceased donor wait list. Research shows that Living donor kidney transplants can last approximately twice as long as a deceased donor kidney transplants. The NKR prioritization for a living donor kidney provides additional reassurance in the unlikely case that a donor will ever need a kidney transplant.

We Provide Financial Protection
If a kidney donor experiences post-surgical complications (e.g. hernia, etc.) related to kidney donation, these medical costs should be paid for by the recipient’s medical insurance. Sometimes insurance companies avoid paying these costs by limiting the time that they will pay for donor complications. Sometimes insurance companies ask the donor for an additional co-payment for donor complications. While these instances are rare, they do happen and they are morally wrong. Through the Donor Protection Program, the NKR ensures that any donor who participates in an NKR swap is never asked to pay (either directly or with their health insurance) for a post-surgical complication that is a result of their kidney donation. Member Centers that opt into NKR’s Donor Protection Program agree to waive all uncovered donor complications for any NKR donors that undergo donor surgery at the Member Center’s Hospital. Member Centers that do not agree to waive uncovered donor complications are charged a fee that is added to the NKR Donor Protection Fund. The NKR Donor Protection Fund is used to help pay for any such donor complications. If you have a complication related to your kidney donation, please speak to the transplant program that performed your surgery. Member Centers are responsible for seeking the assistance of the NKR Donor Protection Fund.

We Provide Legal Representation
Generally most employers and insurance companies are very supportive of living kidney donation. Some employers (e.g. the Federal Government, the National Kidney Registry, etc.) offer additional paid leave to employees that donate a kidney. However, we have seen situations where employers are not so supportive, and in one case the NKR was instrumental winning a wrongful termination case when a donor involved in an NKR living paired exchange was fired for taking the time off to donate a kidney. We also understand that some donors, after they donate, lose their health insurance or see health insurance premium increases solely due to donating a kidney. This is very uncommon, but it is morally wrong. If you donate your kidney as a part of an NKR paired exchange or chain, and are wrongfully terminated from your employment, see a rise in insurance premiums or lose your health insurance as a result of your donation, the NKR will stand behind you and our legal counsel will do everything reasonably possible to advocate on your behalf.

We Listen to You
Have you ever noticed that organizations who routinely survey customer satisfaction generally provide better service? If you are referred to a transplant center from the NKR web site you will be given an opportunity to provide direct feedback to the center via the “Five Star Survey”. The survey is sent to the donor via email upon completion of the following key steps in the donation process: workup, pre-op testing, surgery + 3 days & surgery +30 days. The satisfaction survey is designed to take less than 5 minutes to complete and allows Members Centers to continuously improve the donation process.

We Make the Process Easier
Paper-based donor screening and medical history data collection is inconvenient for donors. To make matters worse, many donor candidates are required to provide medical history multiple times during the intake process. The NKR has eliminated this problem by providing online donor screening so that potential donors can determine in less than five minutes, if they are medically qualified to donate and which centers will accept them as donor candidates. Once the screening process is completed, the NKR collects your comprehensive medical history in an easy to use online format. Once the candidate completes the medical history, the data is electronically transferred to the transplant center.

We Minimize Donor Blood Draws
Tests to determine compatibility between a donor and a potential recipient can often lead to the donor having to return to the transplant center for frequent blood draws to support multiple cross match tests with potential swap recipients to determine compatibility. To avoid these multiple blood draws during the matching process, the NKR provides donor blood cryopreservation services which allow for the freezing and storage of the donor blood that can be used for up to seven cross match tests, reducing the number of times the donor has to return to the center or local lab for a blood draw.


Why the National Kidney Registry

If you want to donate to someone in need of a kidney, the NKR will give you the best opportunity of helping the most patients with your gift. The NKR provides patients the best chance of safely finding a well matched donor which increases graft survival and is correlated with more kidney life years. The NKR works with all the top transplant hospitals in the United States and has facilitated more exchange transplants than any other exchange program in the world. Additionally, the patient outcomes from transplants facilitated by the National Kidney Registry exceed the average U.S. living donor transplant outcomes. We believe this is driven by the improved donor - recipient matches available through the National Kidney Registry which is the largest living donor pool in the world.

There are some transplant centers that attempt to provide paired exchange services from a "single center." This approach may make the logistics easier (no need to ship kidneys or coordinate surgery dates with other centers) but this "single center" approach cannot equal the NKR's ability to improve HLA and donor age matching which improves transplant outcomes (i.e. the kidney lasts longer). This is because paired exchange is inherently a numbers game and the NKR is the largest paired exchange program in the world and the NKR has, by far, the biggest pool of donors. The larger the pool of donors, the better the matches. Single center programs have limited ability to "repair" a real-time swap failure (e.g. recipient experiences complications during surgery and cannot receive the kidney). If a single center program cannot "repair" a failed swap, the patient, whose paired donor has already donated, is left without a kidney. Single center programs do not have the volume to repair failed swaps quickly. The NKR has successfully repaired many real-time swap failures. The NKR’s solution for resolving real-time swap failures is outlined in our Medical Board Policies. Additionally, paired exchange presents unique challenges related to protecting donors from the financial exposure related to un-covered donor complications. The NKR has a Donor Protection Program which eliminates this exposure. If you are considering enrolling in a single center paired exchange program, you should request a written copy of the center’s 1) policy for repairing failed swaps and 2) policy for protecting donors against un-covered donor complications. If a written copy of these policies are not immediately available or if they are filled with legal language that protects the hospital, you should consider enrolling in the NKR program where these important risks are clearly addressed.

Graft Survival - NKR Transplants vs. U.S. Living Donor Transplants as of 3/19/2014
click image to zoom

Paired Exchange donors participating in the NKR will be assured that:

  • You will be matched as quickly as possible so your paired recipient can be transplanted as soon as possible.
  • Your paired recipient will get the best matched donor possible because the NKR has the largest living donor pool in the world.
  • You will not be required to travel to the recipient center in order to participate in a swap.
  • We will minimize the risk of a real-time swap failure where the patient could be left without a kidney.

Good Samaritan donors participating in the NKR will be assured that:

  • You will be provided with a donation insurance policy at no cost.
  • You will be matched in accordance with your donation timeframe so that your surgery date and recovery period fit your schedule.
  • The patients that you help will get the best matched donor possible because the NKR has the largest living donor pool in the world.
  • We will work hard to maximize your donation by facilitating as many transplants as possible in your chain.
  • You may donate at any of our many Member Centers which will minimize your travel time and costs.


Recipient Benefits

Dialysis vs. Transplant

People facing kidney failure who are medically qualified for transplant surgery have two basic options: stay on dialysis or get a transplant. Transplantation is far superior to long-term dialysis. Transplant recipients generally live twice as long as those who stay on dialysis and transplant recipients are not restricted by the challenging routine of dialysis therapy. These factors and the quality of life improvements lead many people to seek transplants.

Deceased Donor vs. Living Donor Transplants

In pursuing a transplant, there are two options: a deceased donor transplant or a living donor transplant. Kidneys transplanted from living donors are superior because they last nearly twice as long as kidneys transplanted from deceased donors.

Living Donor Kidneys Last Longer
click image to zoom
Time Matters

Once a person has made the decision to pursue a transplant, time matters. Studies indicate that the less time the patient is on dialysis, the better the transplant outcome. Receiving a preemptive transplant and never going on dialysis leads to higher transplant success rates.

Ten year overall adjusted graft survival - Pre-emptive Living Donor Transplant vs. Dialysis
click image to zoom
The Match Matters

Not only does time matter but the donor - recipient match also matters. The most significant matching variable that can be improved via paired exchange is the HLA match. The donor age is less significant but can also be improved via paired exchange. Below are charts that show the impact of the HLA match and donor age on transplant outcomes.

Antigen Match Between Donor and Recipient Matters
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Donor Age Matters
click image to zoom


Donor Risks

Life Expectancy

Donating a kidney is major surgery but has not been shown to reduce the donor's life expectancy. Interestingly, people who have donated a kidney outlive the average person. (Reference: Fehrman-Ekholm, Ingela 2,3; Transplantation, 64(7): 976-978, October 15, 1997.) This fact has fueled an ongoing debate over why kidney donors live longer than expected. Some experts believe that it is simply a selection bias since only healthy people can be selected to be living donors. Others argue that the altruistic act of giving the gift of life and the happiness and satisfaction that follows has a positive impact and leads to a healthier and longer life.


Donors face the possibility of post-operative complications such as bleeding, wound infection, fever, etc. Most of the post-operative complications are generally short-term and can be addressed with quality medical care.

Recovery Time

The two types of kidney removal procedures, laparoscopic and non-laparoscopic, have very different recovery times. Laparoscopic kidney removal is less invasive and allows the donor to be discharged 1-2 days after surgery, allowing the donor to return to work in one to four weeks depending on the donor's occupation. Non-laparoscopic surgery has a longer recovery time. NKR member centers generally utilize the laparoscopic procedure.

Mortality Rate

Although more than 5,000 living donors in the United States donate their kidneys every year, the procedure is not without risks. The donor surgery has a .03% mortality rate (i.e., 3 in 10,000). As a point comparison, according to the U.S. Census Bureau, the 2007 infant mortality rate in the United States is .64% (e.g., 64 in 10,000) indicating that it is about 20 times riskier to be born in the United States than to donate a kidney.

Long Term Outcomes

Although kidney donation does not appear to impact life expectancy, research indicates that donating a kidney increases the risk of ESRD over time. In a 2015 paper published in the Journal of the American Society of Nephrology; lifetime risk for the average person of ESRD was 326/10,000 (about 1 in 30), 90/10,000 (about 1 in 110) for those who donated a kidney and 14/10,000 (about 1 in 700) for healthy non-donors. The reason that kidney donors have a lower risk of ESRD compared to the general population is that kidney donors are typically healthier than the average person due to the donor screening process. When donors and healthy non-donors are compared, there is an implied ESRD risk increase of 76/10,000 (90 - 14) from donating a kidney. The following are informative papers related to long term risks of donating a kidney:

Journal of the American Society of Nephrology - 2015
Reassessing Medical Risk in Living Kidney Donors

Journal of the American Medical Association - 2014
Risk of End-Stage Renal Disease Following Live Kidney Donation

New England Journal of Medicine - 2009
Long-Term Consequences of Kidney Donation


Advanced Donation

The Advanced Donation Program (ADP) is a kidney paired exchange separated in time. There are two types of ADP cases 1) Short term cases, where the intended recipient is on dialysis or is in imminent need of a kidney transplant and 2) Voucher cases, where the intended recipient is currently not in need of a kidney transplant and may never need a transplant. Both types of ADP cases allow donors to donate their kidney before their intended recipient receives a kidney. Some ADP donors have donated just a few months before their intended recipient was transplanted (short term cases). Some ADP donors have donated 20+ years before their intended recipient is expected to need a transplant (voucher cases) with the hope that their intended recipient will never need a transplant.

Below are some of the key requirements and disclosures related to this program:

  1. There is no guarantee that the patient can be matched and transplanted.
  2. The ADP donor and recipient must complete and return the consent forms to apply for ADP participation.
  3. We encourage you to read the published short term ADP case reports.
  4. We encourage you to read the published voucher ADP case reports (coming soon).
  5. An ADP Donor may identify one intended recipient.
  6. An ADP Recipient may have up to five ADP Donors
  7. The ADP donor and intended recipient can be at different centers but those centers must both be ADP participating centers.
  8. The intended recipients must be a kidney transplant recipient or currently have, or be expected to have, some form of renal function impairment.

Click here for a list of transplant centers participating in the Advanced Donation Program.


Myths about Living Donation

By Ilana Silver Levine, LMSW and Marian Charlton, RN, CCTC

The purpose of kidney transplantation is to give a healthy kidney to a person who has kidney disease. A successful kidney transplant may prevent the need for dialysis and the complications associated with kidney failure. For many years, the kidney that was transplanted had to come from a person who had died, from a "deceased donor." But there are not enough deceased donors for the number of people who need kidney transplants. Although living donor kidney transplantation is more common, there are still many myths associated with living donor kidney transplantation.

Myth #1: A kidney donor will have to take medications for the rest of their life

Fact #1: A kidney donor will be given prescriptions for pain medication and stool softeners at discharge from the hospital. These are only for the immediate post-operative period, after that time, a donor does not have to take medication.

Myth #2: A kidney donor will have debilitating pain for an extended period of time.

Fact #2: A kidney donor will have some pain after surgery from both the incisions and related to gas and bloating. This pain will diminish in the days following surgery and can be controlled with pain medication if necessary.

Myth #3: A kidney donor will be on bed rest following surgery.

Fact #3: A kidney donor will be out of bed and walking independently before discharge from the hospital.

Myth #4: A kidney donor will be in the hospital for an extended period of time after surgery.

Fact #4: A kidney donor will be hospitalized for two nights (i.e. if surgery is on a Tuesday, the donor will typically be discharged on Thursday).

Myth #5: A kidney donor can no longer participate in sports or exercise.

Fact #5: A kidney donor should be able to return to regular activities and exercise at approximately 4-6 weeks following surgery.

Myth #6: A kidney donor will have to follow a new diet plan following donation.

Fact #6: A kidney donor should eat a healthy, well balanced diet. There are no dietary restrictions following donation.

Myth #7: A kidney donor can no longer consume alcohol following donation.

Fact #7: While excessive alcohol use is always dangerous, a kidney donor can consume alcohol in moderation.

Myth #8: A female kidney donor should not get pregnant after donation.

Fact #8: A female kidney donor should wait 3-6 months' time after donation to become pregnant. The body requires time to recover from the surgery and to adjust to living with one kidney prior to pregnancy.

Myth #9: A kidney donor's sex life will be negatively affected by donation.

Fact #9: A kidney donor may engage in sexual activity when they feel well enough to do so.


Next Steps

Click here to get a referral to participating Kidney Transplant Centers.