Who is eligible to be a living kidney donor?
Donors often have misconceptions that only family members can donate. However, there are many different types of donors, and many are not blood relatives of the person who needs a kidney.
Most people over the age of 21 (and in some cases, over the age of 18) can become kidney donors if they are in good general health and have normal kidney function and anatomy.
According to the Consensus Statement on the Live Organ Donor...
"The person who gives consent to be a live organ donor should be competent, willing to donate, free from coercion, medically and psychosocially suitable, fully informed of the risks and benefits as a donor, and fully informed of the risks, benefits, and alternative treatment available to the recipient."
JAMA 2000;284:2919-2926
Donors must be free of major diseases such as diabetes, high blood pressure (some mild forms of high blood pressure are no longer considered an exclusion to donating), or severe heart disease.
Donors should not have recent cancer, history of certain forms of cancer, liver disease or a history of multiple kidney stones.
Testing of the potential donor will ensure that there is adequate kidney function so that the donor can survive on one kidney alone. The donor needs to be living in a stable environment with social supports and must have medical insurance before donation. The potential donor must be able to demonstrate understanding of the donation process, the risks involved in the surgery, and the need for follow-up visits after donation.
Potential donors do not need to be a relative of the person needing a kidney, although relatives often offer a better genetic match for the recipient.
Thanks to advances in surgical techniques that enable minimally invasive surgery for donors as well as improvements in anti-rejection medications, we can now allow both related and unrelated people to donate.
Generally, unrelated donors have some emotional relationship with the recipient, such as a spouse, friend, neighbor, or co-worker. However, altruistic donors (people who wish to donate a kidney but do not have a specific recipient in mind) now represent an increasing proportion of living donors.
In addition, blood type and crossmatch compatibility used to be required for living donor transplantation. However, due to the availability of Kidney Paired Donation programs, donor and recipient pairs that are blood type or crossmatch incompatible can "swap" with other pairs. These programs are also offered to compatible pairs seeking a better age or genetic matched kidney.
Learn more about Kidney Paired Donation.
What are the different types of living donor relationships?
Living Related — Living related kidney donors are blood relatives of the person needing the transplant. Examples of living related donors include a parent, an adult child, a sibling, or an aunt, uncle, or cousin.
Living Unrelated — Living unrelated kidney donors are people the transplant candidate has a relationship with, outside of blood relatives. This can be a spouse or partner, in-law, friend, neighbor, co-worker, or other acquaintance.
Altruistic — An altruistic donor is a person that wishes to donate a kidney but who has no intended recipients; they simply want to donate to someone who can benefit from a transplant. Other terms used to describe altruistic donors include "non-directed" or "Good Samaritan" donors. Altruistic donors are a huge part of the success of Kidney Paired Donation transplants because they add a donor but not a recipient into a registry, thereby increasing the donor pool.
How can we allow living kidney donation?
When initially considering living kidney donation, one may consider the question of how or why the medical profession would allow someone to undergo surgery to donate a kidney to give to someone else in need of a transplant.
Many studies have been performed to assess the risks of kidney donation on the people who made the choice to become a donor.
The majority of studies have found that:
• The risk to a donor's physical health is minimal in both the short-term (surrounding the surgery) and long-term (in terms of kidney function, high blood pressure, and the donors lifespan).
• Kidney donors tend to have higher quality of life scores after donation, as compared to the general population.
• Donors have similar or improved psychosocial health after donation.
• The overwhelming majority of donors would choose to donate again.
The Basic Principles of Living Kidney Donation
1. The prospective living organ donor should be:
• Capable of making the decision to donate
• Willing to donate
• Free of coercion, manipulation, or undue solicitation by any party regarding the decision to donate
• Medically suitable to donate
• Psychosocially suitable to donate, based on an evaluation that includes a series of specific components
• Fully informed of the risks and benefits to the donor, as demonstrated by the donor's expression of understanding of these risks and benefits
• Fully informed of the risks, benefit and alternative treatment available to the recipient, within the constraints of the transplant center's obligation to maintain the confidentiality of recipient medical information
• Willing to sign a statement attesting that the donor is not providing the organ for monetary gain
2. The prospective live organ donor should not be called upon to donate in clinically hopeless situations
3. The benefits to both the donor and recipient should outweigh the risks associated with the donation and transplantation of the living donor organ
4. Medical and psychosocial follow-up of the living donor after donation should be undertaken by the living donor program
from Guidelines for the Psychosocial Evaluation of Living Unrelated Kidney Donors in the United States (Dew MA et al, Am J Transplant 2007; 7(5):1047)
I want to donate my kidney to a child. Is that possible?
Yes, it is possible for an adult to donate a kidney to a child in need of a transplant. Children usually need to be about 2 years old before it is feasible to put an adult-sized kidney into their body. Depending on the size of the child, the transplant surgeon may place the kidney in a different position compared to a standard kidney transplant.
Can I donate if I am a smoker?
The answer to this question varies from center to center. Some transplant centers will not allow active smokers to donate, while others will. In either case, becoming a kidney donor can be an important impetus to assist you in quitting, and some transplant centers will assist you in this endeavor.
The concern is related to an increased risk of pulmonary, cardiovascular, and wound healing complications that is seen in the general population of smokers undergoing anesthesia.
Although kidney donors represent healthy people undergoing surgery, and therefore the risk of complications is likely not as high, it is still important to take smoking status into consideration.
There is little data specific to the population of people undergoing donor nephrectomy. One study found an increased risk of wound complications in donors who smoke, while another study found no difference in complications surrounding the surgery.
At Weill Cornell Medicine and NewYork-Presbyterian, we strongly advise potential donors to stop smoking at least four weeks prior to their scheduled surgery.
Who makes a good living kidney donor?
A good living donor is motivated to donate, free of coercion, healthy, and has normal kidney function. The person must be both medically and psychosocially fit, and must understand the risks of donation. Visit the Risks and Benefits of Living Kidney Donation section for more detailed information.
How do I go about becoming a donor?
The answer to this question depends on your individual situation.
If you have someone specific that you want to donate to, you should contact the transplant center where your intended recipient is being evaluated and/or is on the waiting list for a kidney transplant. The transplant center will then refer you to the donor team responsible for evaluating potential donors, and they will explain what your next steps are.
If you are interested in being an altruistic donor, that is, you want to donate a kidney but do not have a specific recipient in mind, you can contact one of several organizations that registers people who are interested in serving as an altruistic donor, such as the National Kidney Registry or the OPTN Kidney Paired Donation Pilot Program. You can also contact a local transplant center near your home and ask to speak with someone on the donor team.
Are there any age restrictions on living donation?
You must be a minimum of 21 years old to be a living donor at Weill Cornell Medicine and NewYork-Presbyterian. We have had living donors in their late 70's successfully donate kidneys. Each person is evaluated on a case by case basis.
What testing will I have to undergo to see if I can be a donor?
The evaluation process involves both a psychosocial and medical component.
The psychosocial evaluation is performed by a psychiatrist, psychologist, or social worker, and addresses issues such as motivation guiding decision to donate, ability to understand the risks of donation, availability of support during the recovery period after donation, financial impact of donation, impact of donation on insurability, and other important issues.
The medical aspect of the evaluation process ensures that the potential donor is healthy enough to donate and not at high risk for developing diseases that could impact the function of their remaining kidney. Components of the medical evaluation include general medical history, social history, physical exam, kidney-focused exam, general laboratory tests, kidney-focused laboratory tests, immunological testing (blood type and crossmatch compatibility), metabolic-focused testing (to look for issues such as diabetes or high cholesterol), anatomic assessment of the kidneys and their blood flow, screening for transmissible diseases (such as HIV and hepatitis), and cancer screening.
Do I have to be a relative of the person needing a transplant in order to donate?
Kidney donors do not need to be a blood relative of the person in order to donate.
Although blood relatives can often provide a better genetic match than an unrelated donor, the availability of newer, more potent anti-rejection medications makes genetic matching much less important than it was in the early years of transplantation.
An increasing number of unrelated people are serving as living kidney donors, and could be spouses, partners, in-laws, friends, co-workers, neighbors, community members, and other acquaintances. Even total strangers are serving as kidney donors through programs that enable Good Samaritans (also called altruistic or non-directed donors) to donate because they have a desire to donate but do not have a specific person they want to give their kidney to.
What if I am told I am not a match (not compatible) with the person I want to donate to?
There are several options that are available if a potential donor is not compatible with their intended recipient.
If available, the person needing a kidney could bring other donors forward to be tested to see if a match can be found.
Another option is to sign up to participate in a Kidney Paired Donation program, where you and your intended recipient would enter a registry of other incompatible pairs in hopes of being matched to someone with whom you are compatible, while your intended recipient receives a transplant from another donor within the registry.
What can I do if I am not able to donate but still want to help someone who needs a kidney transplant?
Many people are frustrated by their inability to donate; some are prior kidney donors who obviously cannot donate again, others want to donate but are ruled out because of their own medical problems, others want to donate but for financial or work-related issues just cannot afford to donate, and others are children too young to donate but who want to help a loved one or friend.
There is a huge role that this group of people can play in the lives of someone (or many people) who need a transplant: They can become an advocate for living kidney donation and educate others about living kidney donation.
We have developed a "Kidney Champion" program to assist people like you in educating others about living donation. Please visit the Living Donor Kidney Champions page to learn more.
What are the benefits of living donor kidney transplantation?
For many donors, the benefit of donating a kidney is often personal one. Each donor's motivations may vary greatly and each donor has a unique experience as they go through the journey of donating their kidney, from the initial decision to be evaluated as a potential donor to years after the donation occurs.
Key findings of various research studies that have attempted to quantify the benefits and/or quality of life after kidney donation include:
• Kidney donors tend to have higher quality of life scores after donation, as compared to the general population.
• This may be related to an increase in the donor's self-esteem and an increased sense of well-being
• Donors have similar or improved psychosocial health after donation.
The intense screening process that donors must undergo has also helped some potential donors discover serious health issues that require medical attention. At times, screening has led to early detection of kidney disease, high blood pressure, diabetes, and cardiac disease, which can benefit from early diagnosis and intervention.
How do I prepare for the surgery to remove my kidney?
Each transplant center will have instructions for the donor that may vary slightly. Timing of the preparation will also vary depending on the time of day that your surgery is scheduled for.
An example of donor preparation includes:
• The day before your scheduled surgery, you will need to take in only clear liquids beginning at noon.
• At 4p.m., you take 5 ounces of magnesium citrate (known as your bowel prep), which will cause you to have bowel movements that will help to clear out your intestines.
• From midnight on, you should not eat or drink anything.
Is the operation to remove my kidney dangerous?
The operation to remove your kidney does involve risk, since you are undergoing surgery requiring general anesthesia, similar to any other laparoscopic surgery (such as removal of your gallbladder).
These risks include pain, infection, blood clots, reaction to anesthesia, conversion to open nephrectomy, need for re-operation, need for re-admission to the hospital, hernia development, intestinal obstruction, and death.
Please visit the Risks and Benefits of Living Kidney Donation section to see a detailed description of the potential complications of this procedure.
How much pain will I experience after the surgery?
The amount and degree of pain that each donor will experience is highly individualized. People have very different pain thresholds, and this impacts how donors will feel after their surgery as well as how much pain medication they require after donating.
Donors usually receive intravenous pain medication for about a day after the surgery, and are then transitioned to oral pain medications. After discharge from the hospital, the donor may require pain medication anywhere from a few days to a few weeks after the surgery. Although it is rare, some donors do develop chronic pain issues after the surgery.
How long will I be in the hospital?
Using today's surgical techniques (conventional laparoscopic or single site surgery), most donors are in the hospital for approximately two days.
The morning after the surgery, the bladder catheter placed during the surgery is removed, you begin to walk around, and you are placed on a clear liquid diet. On the second morning, most patients receive solid food, and are discharged home later in the day.
What will my scars look like after donating my kidney?
The scar(s) you will have depends on the type of surgery that you have. Most patients will have at least one incision (which is the incision through which the kidney is removed) that is approximately 3 inches long.
This main incision may be concealed within the belly button or may be several inches below the belly button, depending on the type of surgery.
Additional small incisions (2 to 4) may be present on the abdomen; these are the incisions through which the laparoscopic instruments are placed.
Please visit the "Scarring/Cosmetic Risks" section of the Risks and Benefits of Living Kidney Donation page to view pictures of typical scars from the different procedures used to remove the kidney.
How long will I need to be out of work?
The answer to this question depends on the type of work that you do. People who work in an office setting usually return to work in 2 to 3 weeks, while people with more physically demanding jobs may need to recover 4 to 6 weeks before returning to work.
What is the recovery period after donation?
The recovery process is another area that will vary greatly from donor to donor. In general however, most donors undergoing laparoscopic procedures to remove their kidney feel back to "normal" or back to "100%" of their usual activities by about one month after the surgery.
Will donating my kidney affect my lifestyle?
Kidney donation should not impact your lifestyle. Since kidney donors are healthy and generally have good health habits, it is recommended to continue to maintain a healthy lifestyle by eating a healthy diet, exercising, not smoking, etc.
Please visit the "Maintaining Health After Donation" section of the Life After Donation page for more information.
When do I have to come back for follow-up visits after donation?
After you are discharged from the hospital, you will usually come back to see your surgeon about 2 weeks after the surgery. You should also return to the transplant center for follow-up visits at 6, 12, and 24 months after donating.
Can I become pregnant if I have been a kidney donor?
Yes, female donors can become pregnant after donating a kidney. It is generally recommended that female kidney donors wait at least 6 to 12 months after donation to become pregnant. In addition, the kidney donation should be discussed with the physician managing the potential pregnancy.
Although the outcomes of pregnancy after kidney donation appears to be similar to that of the general population, some studies have shown that there may be an increased risk of preeclampsia/high blood pressure in women who previously donated a kidney. This is why it is important for female donors to discuss their kidney donation with their obstetrician/gynecologist.
What are the risks of living with one kidney?
The risks of living with one kidney appear to be small if donors remain healthy and do not develop diseases such as diabetes, high blood pressure, and/or obesity.
This is why we screen potential donors to try to ensure that they do not have these diseases at the time of donation and are also not at high risk of developing them in the future.
Please visit the "Long Term/Medical Risks" section of the Risks and Benefits page for more information.
What happens if I develop kidney failure in the future?
The current national policy is that former donors who require a transplant themselves at a future time are given 4 extra points on the waiting list, which will help them to move up on the list. This extra waiting time only applies to the wait for a kidney, not any other organ that a former kidney donor might need in the future.
Why do I need to have health insurance if my recipient's insurance pays for my surgery?
All donors are required to have health insurance in the event that medical issues/diagnoses arise during the course of their evaluation to be a donor.
In this instance, the recipient's insurance does not cover the donor's medical expenses, so the potential donor must have health insurance in place to ensure that they will be covered in such a circumstance.
Another reason why obtaining health insurance prior to donation is important: kidney donation may be considered a “pre-existing” condition by health insurers. While current law largely prohibits health insurers from denying you coverage or charging you more because of a pre-existing condition, some companies may still be able to refuse covering you for this reason.
Does the insurance coverage work the same way if I choose to be an altruistic donor or participate in donor exchange?
Yes, the insurance coverage provided by the recipient's insurance works the same way. Any logistics related to the insurance coverage (for example, if the donor is being worked up at a different transplant center than the recipient) are managed by the transplant centers.
Are there any expenses related to donation that aren't covered by my recipient's insurance?
Yes, there are "out-of-pocket" expenses that are not covered by insurance. These include expenses related to travel and hotel stays, childcare, elder care, follow-up costs (depends on where follow-up occurs (at transplant center or with your own doctor), and lost wages.
Your recipient is allowed by law to assist you with these types of expenses. In addition, there are assistance programs and tax deductions available related to these out-of-pocket costs that you might incur as a living donor.
Will I have trouble obtaining health insurance in the future?
In some cases, having been a kidney donor can impact the donor's ability to obtain both health insurance and life insurance. Therefore, it is highly recommended that people considering donation obtain these types of insurance prior to becoming a donor.
I want to donate to someone in the United States but live outside of the U.S. Is that possible?
It is possible to donate to someone who lives in the United States if you live outside of the U.S.
However, this ability varies greatly depending on where you live. In addition, this option is generally limited to donations to a blood relative.
It tends to be a slow process. First, you must go to your local doctor and have your blood type and other basic laboratory values checked, have a chest X-ray, have your medical history recorded, and a physical exam performed. The results of these tests are then sent to the transplant center in the United States, where they are reviewed.
If it looks like you are suitable to be a donor, the transplant center will generate a letter to assist you with your visa application. You are responsible for the rest of your visa application. If a visa is granted (usually for a 3 month time period), then the final testing and planning for the surgery can begin.
I have a different question.
Please contact us if you have other questions not addressed here.
We are happy to answer them for you and will be happy to post them on this website for the benefit of others who may have the same question.
We can be reached at livingdonorkidneycenter@med.cornell.edu.