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Kidney Patients - National Kidney Registry - Facilitating Living Donor Transplants   Skip navigation
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Kidney Patients


There are over 150,000 people in the United States living full and active lives with transplanted kidneys. Kidney transplants are truly a miracle of modern medicine. If you are facing kidney failure and are medically qualified for a transplant, we want you to have the miracle of a kidney transplant. We have even written a book for you called "Finding a Kidney" that will help you navigate this complex process. You can download the book by clicking HERE or you can buy it on The National Kidney Registry is committed to helping you get a transplant - If you have an incompatible donor or a poorly matched donor -you have come to the right place. We can help you.

Patient Benefits

90 Day Kidney Replacement Policy

Patients who are transplanted via the NKR and experience graft failure within 90 days of the transplant may be eligible for prioritization for a replacement kidney subject to review/approval of the NKR Medical Board.

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 on all fronts. Transplant patients generally live twice as long as those who stay on dialysis and transplant patients 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.

Time Matters

Once a person has made the decision to get 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.

Living Donor Kidneys Last Longer
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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 matters too. 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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Why the National Kidney Registry

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 NKR exceed the average U.S. living donor transplant outcomes. We believe this is driven by the improved donor - recipient matches available through the NKR 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
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Patients enrolled with the NKR will:

  • Increase the chance of a "clean cross-match" eliminating the need for desensitization.
  • Reduce the chance of not getting a match or waiting a long time for a match.
  • Increase the chance of finding a great HLA match which is correlated with more kidney life years.
  • Increase the chance of finding an age compatible donor match which is correlated with more kidney life years.
  • Minimize the risk of a real-time swap failure where the patient could be left without a kidney.
  • Are eligible for a replacement kidney should a donor surgery issue cause a transplanted kidney to not function within the first 90 days from transplant.
  • Ensure their paired donor receives the NKR donor protections.
NKR Facilitated Kidney Donation Programs Other
Paired Kidney Exchange through NKR swap at DCN Center of Excellence or Donor Shield Center Paired Kidney Exchange through NKR swap In-center Donation at Donor Shield Center In-center Donation at DCN Center Most Other Transplant Centers
Additional prioritization points on the Deceased Kidney Donor List if a living donor ever needs a kidney.
Prioritization for a living donor kidney if an NKR donor ever needs a kidney. Living donor kidneys typically list twice as long as deceased donor kidneys.
Any kidney donation related complications (e.g. hernia, etc.) not covered by the recipient's insurance, will be covered.
Donors are eligible for up to 4 weeks of lost wage reimbursement with a maximum reimbursement of $1,500 per week. Lost wages are earnings that a donor lost due to the time missed at work as a result of kidney donation.
Donors are eligibile for reimbursement of up to $2,000 of travel and lodging expenses related to their kidney donation for them and a traveling companion.
The donation life insurance policy includes a $500,000 principal sum covering a period of 365 days post donation.
The donation disability insurance policy covers up to $1,500 in weekly income for up to 52 weeks after surgery.

Voucher Donation

The Voucher Program, also referred to as Voucher Donation, is a kidney paired exchange separated in time. When a donor donates as part of the voucher program, either a Standard Voucher or Family Voucher(s) will be provided based on the situation:

  • When a donor donates for an intended recipient who will likely need a transplant within the next year, a Standard Voucher will be provided for that one recipient. Standard Vouchers can also be provided when a chain breaks and a donor continues with their donation to keep a portion of their chain on schedule, even though their paired recipient has been removed from that chain.
  • When a donor donates for intended recipient(s) who will not likely need a transplant within the next year, Family Voucher(s) will be provided for up to five intended recipient(s).

Both types of vouchers allow donors to donate their kidney before an intended recipient receives, or even needs, a kidney transplant.

Key requirements and stipulations of the Voucher program
  1. There is no guarantee that the intended recipient(s) can be matched or transplanted.
  2. The voucher donor and intended recipient(s) must complete and return the consent forms to apply for voucher participation.
  3. We encourage you to read the published Standard Voucher case reports.
  4. We encourage you to read the published Family Voucher case reports.
  5. An Voucher donor may identify one intended recipient for a Standard Voucher or up to five intended recipients in their immediate family for Family Vouchers.
  6. Regardless of the number of vouchers provided, only one voucher can be redeemed per donation. After the first voucher is redeemed, all other vouchers from the same donation are void.
  7. Up to five Voucher donors can identify the same intended recipient.
  8. The Voucher donor and intended recipient can be at different transplant centers but both centers must be Voucher participating centers.

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

Click here if you are a holder of a Voucher.

Patients without Living Donors

If you do not have a donor, several of our member centers utilize our Microsite Program. The Microsite Program is designed to aid those looking to find a living kidney donor by setting up a free website explaining that they need a kidney with links to educational resources and their transplant center's automated donor screening system. There are two types of sites – starter and custom. A starter site is automatically generated when a patient signs up for the Microsite Program and is a basic website displaying the patient's name, age and form text saying:

Hello! My name is ________ and I need a kidney transplant. Please consider being tested to determine if you are healthy enough to donate on my behalf. To see if you are medically able to donate, click the "Register to donate for ______" button or, to learn more about living donation, click the "Learn About Living Donation" button. Thank you for viewing my web site.

All patients start with a starter site. They can then choose to set up a custom site with pictures and details about their story of why they need a kidney, how they found out they needed a kidney transplant, what life without functioning kidneys is like, their donor search efforts thus far, what they plan on doing after their transplant, etc. Both types of sites are sharable through social media and come with 250 business cards with the microsite user's name and their site's url to hand out in their day to day lives. This program is meant to make the discussion surrounding asking someone to donate their kidney easier and more approachable. The program is entirely free to patients.

The CHIP program also helps patients without donors who are either children or are disadvantaged because they are sensitized. Member centers that evaluate Good Samaritan donors and have the ability to end chains at their centers can sometimes get patients transplanted who do not have a living donor. Below is the CHIP program description.

  • NKR member centers that have net chains started > 0 may enroll up to 50 candidates in the CHIP program
  • Net chains started is the total number of chains that a center starts less the total number of chains a center ends
  • CHIP candidates must be children (18 or younger) or sensitized adults
  • The most likely blood types to find a CHIP match are "AB" and "A" blood types
  • The CHIP program is used as a last resort. The probability of a match dramatically improves when a paired donor(s) are available

Next Steps

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

Help for Medicaid/Medi-Cal Patients

Medicaid and Medi-Cal patients are typically disadvantaged in paired exchange because these insurance programs will generally not pay for out of state physician's fees which will block matches with out of state donors. The best opportunity for Medicaid/Medi-Cal patients is to convert their insurance to Medicare. NKR Member Centers should be able to assist patients with the conversion to Medicare.


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