The National Kidney Registry (NKR) Voucher Program allows a living kidney donor to choose the most convenient time frame for their kidney donation surgery and provide one or more vouchers to people who can then be prioritized to receive a living donor kidney through the NKR if/when they need a transplant. Voucher donation, which has been referred to in the medical literature as a paired exchange separated in time, allows donors to overcome chronological incompatibility.
The standard voucher is utilized when a family member or friend is in imminent need of a kidney transplant (within a year) and the donor would like to donate sooner rather than later. The person in imminent need will receive a voucher for a living donor kidney, which can be activated at any time. In addition to the voucher holder in imminent need, the donor can also name five family members as back-up voucher holders should the voucher holder in imminent need receive a deceased donor transplant.
The family voucher is utilized when a donor does not know someone in immediate need of a kidney transplant and wants to help others in need by starting a chain and donating their kidney to a stranger. The Family Voucher Program allows for up to five family members of the donor to receive vouchers that can be activated if one of the family members ever needs a kidney transplant. Once the first voucher is redeemed, all other vouchers related to that donor become void and cannot be redeemed.
The swap saver is used when there is a problem with a swap (e.g., the paired recipient becomes sick, etc.) and the paired donor decides to proceed with the scheduled surgery to keep the rest of the swap on schedule. The paired recipient is then prioritized for a transplant in a future swap when they are healthy enough to undergo transplant surgery.
Real-Time Swap Failure
A real-time swap failure occurs when there is a problem with a swap and the paired donor donates but the paired recipient does not get a kidney transplant. In these cases, the patient is prioritized for a transplant in a future swap.