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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 three types of living kidney donation; direct donation, paired exchange donation and Good Samaritan 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.

Donor Chain Graph click image to zoom


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Why the National Kidney Registry

If you want to donate to someone in need of a kidney, the NKR will give you the best chance of helping the most patients with your gift. 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 NKR patient outcomes are superior to the average U.S. living donor transplant outcomes. We suspect these better outcomes are driven by the improved donor - recipient matches available through the NKR program.

Graft Survival - NKR Transplants vs. U.S. Living Donor Transplants as of 3/19/2014
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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 donor pool in the world
  • You will not be required to travel in order to participate in a swap

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 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

Single center exchange programs - CAUTION

There are some transplant centers in the United States that attempt to provide paired exchange services from a "single center". Although this approach will lower the Hospital’s cost and make the logistics easier (no need to ship kidneys or coordinate surgery dates with other centers) this "single center" approach can delay or even prevent a successful paired exchange transplant. Paired Exchange is inherently a numbers game - the larger the exchange program the greater the probability that the patient will be quickly matched and transplanted. Also, a large exchange program like the NKR facilitates better donor-recipient matches. These better matches will allow the transplanted kidney to last longer. The NKR is the largest paired exchange program in the world and provides the best chance for patients to find best match as quickly as possible.

Additionally the NKR has the policies in place and the volume to protect pairs in the remote event that your swap is impacted by a real time swap failure where a swap participant is left without a kidney (e.g. patient gets sick right before surgery). If you are considering using a single center swap program, ask them how they prioritize patients in the event of a real time swap failure.


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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
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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
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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
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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

For more details on the long term outcomes of kidney donation, read the article published in the New England Journal of Medicine.


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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.


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