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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

Voucher Program

Voucher Donation is a kidney paired exchange separated in time. There are two types of Voucher Donation cases:

  1. Standard Voucher, where the intended recipient is on dialysis or is in imminent need of a kidney transplant.
  2. Family Voucher, where the intended recipients are currently not in need of a kidney transplant and may never need a transplant. Both types of voucher cases allow donors to donate their kidney before their intended recipient receives a kidney.

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.

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

How We Help & Support Living Kidney Donors

We have donated

Two senior leaders in the NKR organization, including the CEO, 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 provides 'kidney prioritization' to all NKR swap 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 last approximately twice as long as deceased donor kidneys. 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 donation life insurance

Any donor who registers through the DCN and donates through NKR will be automatically provided with basic kidney donation life insurance which is purchased by NKR. The insurance includes a $500,000 principal sum covering a period of 365 days post donation. Notification of a claim must be provided within 90 days of a covered accident.

We provide donation disability insurance

Any donor who registers through the DCN and donates through NKR will be automatically provided with basic donation disability insurance coverage which is purchased by NKR. The temporary total disability insurance includes a maximum $1,500 weekly benefit for 365 days subject to the donors last 12 months of earnings, with a 30-day waiting period.

We provide lost wage reimbursement

Donors who donate through an NKR swap may be eligible for reimbursement of up to 4 weeks of lost wages, with reimbursement for weeks 3 and 4 requiring clearance from the transplant center. Reimbursement is limited to $1,500 per week. Lost wages are defined and limited to documented expected earnings that a donor lost due to time missed at work as a result of the kidney donation.

We provide travel & lodging reimbursement

Donors who donate through an NKR swap are eligible for up to $2,000 in reimbursements of their travel and lodging expenses, for them and a travelling companion, related to their kidney donation based on submitted receipts. Add-on or luxury expenses are excluded. Driving expenses are reimbursed at the IRS medical mileage rate. Lodging reimbursement covers hotels in the proximity of the transplant center.

We provide financial protection

In the unlikely event that a kidney donor experiences post-surgical complications (e.g. hernia, etc.) related to kidney donation, the medical costs should be paid for by the recipient's medical insurance. Sometimes insurance companies avoid paying these costs by limiting the time period that they will pay for donor complications, and sometimes they ask the donor for a co-payment for donor complications. While these instances are very rare, they do happen. Through the NKR's Donor Protection Program, we ensure that any donor who participates in an NKR swap is never asked to pay 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 either cover all uncovered donor complications for NKR donors that undergo donor surgery at the Member Center's Hospital, or the Member Center is charged a fee that is added to the NKR Donor Protection Fund that is used to pay for NKR donor complications. If you have an uncovered complication related to your kidney donation in an NKR swap, please speak to the transplant program that performed your surgery so that we can ensure that you are not asked to pay for any costs related to the complication.

We Provide Reimbursement for Travel, Lodging & Lost Wages for Donor Complications

Donors are eligible for travel, lodging and lost wage reimbursement for treatment of any donation related complications in the event they have one. Lost wage, travel and lodging reimbursement for donation complications meets the same criteria for the donation related reimbursement.

We provide legal support

Generally most employers and insurance companies are supportive of living kidney donation. Some employers (e.g. the Federal Government, the National Kidney Registry, etc.) offer paid leave to employees that donate a kidney. However, we have seen situations where employers are not so supportive. In one situation, the NKR was instrumental in winning a wrongful termination case when a donor involved in an NKR living swap was fired for taking time off work to donate. We also understand that some donors, after they donate, lose their health insurance or see health insurance premium increases due to donating a kidney. These cases are very rare, but are wrong. If you donate your kidney as a part of an NKR swap and are wrongfully terminated, 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 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 asked to fill out medical history forms multiple times during the intake process. The NKR has eliminated this problem by collecting screening and medical history data in an easy to use web based format. Once the candidate completes the screening and medical history, the data is electronically transferred to the transplant center.

Donor Care Network

The Donor Care Network (DCN) Centers of Excellence (COE) are a network of elite transplant centers that have agreed to the DCN commitments and are supporting programs that focus on the highest standards of living kidney donor support and service. The DCN COEs are represented in the map below.

Donor Shield

The Donor Shield Program Centers offer protections to donors whether they donate directly to their recipient or through an NKR exchange. All donors who donate at a Donor Shield Center, represented in the map below, will receive the following protections already offered to all NKR donors:

  1. Lost Wage Reimbursement for up to 4 weeks with a max $1,500 per week reimbursement
  2. Travel, Lodging, & Mileage Reimbursement up to $2,000 for donors and their support person/travel companion
  3. Life Insurance with a $500,000 principal sum
  4. Disability Insurance for $1,500 / week maximum for up to 52 weeks
  5. Legal Support
  6. Coverage for Uncovered Donor Complication Costs

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.
  • You will be provided with donor protections offered through NKR swaps.

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.
  • You will be provided with donor protections offered through NKR swaps.
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.

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. In a 2015 paper published in the American Journal of Transplantation; donor surgery has a .007% mortality rate (i.e., 7 in 100,000). 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 200 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

American Journal of Transplantation - 2015
Perioperative Complications After Living Kidney Donation: A National Study

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

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.

Remote Donation

Remote Kidney Donation allows someone who wants to donate a kidney to a friend or family member in a distant city without requiring the donor to travel to the transplant center in the distant city. Remote donation utilizes proven logistics systems pioneered in kidney swaps by the National Kidney Registry over the past decade to safely transport the kidney from the donor’s local hospital to the transplant center in the distant city. click here for more info.

Below is a map of the centers that participate in the remote donation network.

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.

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