Donating Saves Lives
Living kidney donation can allow someone with kidney failure to receive a transplant without waiting for a kidney from a deceased donor.
A healthy person has two kidneys but can live with one functioning kidney. During living kidney donation, one kidney is surgically removed from a carefully evaluated donor and transplanted into a person whose kidneys can no longer support the body adequately.
Living kidney donation can be life-changing, but it is also a serious medical decision. The potential donor must receive complete information, undergo extensive testing, understand the possible risks, and make the decision freely without pressure.
Marshall Kidney Foundation supports education and awareness about living kidney donation. However, the foundation does not medically evaluate donors, determine compatibility, arrange transplants, or collect private donor medical information.
Anyone interested in becoming a living kidney donor should contact a transplant center’s living donor program directly.
What Is a Living Kidney Donor?
A living kidney donor is a person who chooses to give one of their kidneys to someone in need of a kidney transplant.
A donor may be:
- A parent
- An adult child
- A brother or sister
- Another relative
- A spouse or partner
- A friend
- A coworker
- A member of a religious or community organization
- Someone who learned about a person’s need through social media
- A person who does not personally know the recipient
A donor does not always have to be related to the recipient.
The transplant center evaluates whether donation can be performed safely and whether the kidney is medically compatible with the intended recipient.
Can a Person Live With One Kidney?
Yes. A person can live with one functioning kidney.
Many carefully selected living kidney donors return to active lives after recovering from surgery. The remaining kidney performs the work needed to support the donor’s body.
However, living with one kidney is not the same as having two kidneys.
After donation, the donor has less kidney reserve. This means the donor should continue protecting the remaining kidney and receive regular medical follow-up.
Long-term health monitoring may include:
- Blood-pressure checks
- Blood tests for kidney function
- Urine testing for albumin or protein
- Diabetes screening
- Weight management
- Review of medications
- General preventive healthcare
Living donation should never be presented as completely risk-free. It is major surgery that permanently changes the donor’s body.
Why Living Kidney Donation Is Important
Many people with kidney failure spend years waiting for a transplant from a deceased donor.
Living kidney donation may allow a recipient to:
- Receive a transplant sooner
- Avoid or shorten time on dialysis
- Schedule surgery in advance
- Receive a kidney from a healthy, carefully evaluated donor
- Complete the transplant before becoming severely ill
- Spend less time waiting for a deceased-donor kidney
A living-donor kidney may begin functioning quickly, but no transplant result can be guaranteed.
A kidney transplant is a treatment for kidney failure. It is not a cure.
The recipient must continue taking anti-rejection medications and attending transplant appointments for as long as the kidney functions.
Who Can Be Considered for Living Kidney Donation?
Each transplant center has its own evaluation procedures, but potential donors are generally expected to be adults who are physically and emotionally capable of making an informed decision.
The transplant team may consider:
- Overall physical health
- Kidney function
- Blood pressure
- Diabetes or future diabetes risk
- Heart and lung health
- Weight and body composition
- Cancer history
- Infection history
- Blood-clotting risks
- Family history of kidney disease
- Mental and emotional health
- Ability to understand the risks
- Ability to participate in follow-up care
- Whether the decision is voluntary
- Whether there is pressure, coercion, or an offer of payment
A person may feel healthy but still be found medically unsuitable for donation.
When a transplant center declines a donor, it does not mean the person has done anything wrong. It means the team believes donation could create too much risk or that additional evaluation is needed.
You Do Not Have to Know Your Blood Type Before Calling
A person does not need to know whether they are a perfect match before contacting the transplant center.
The living donor team can explain:
- Blood-type compatibility
- Tissue compatibility
- Antibody testing
- Crossmatch testing
- Paired kidney donation
- Other possible donation options
A willing donor should not rule themselves out based only on assumptions about age, blood type, weight, family relationship, or medical history.
The transplant center should make the medical determination.
How the Living Donor Process Begins
A potential donor usually begins by contacting the intended recipient’s transplant center.
The donor may complete:
- An online questionnaire
- A confidential telephone screening
- A medical-history form
- An initial discussion with a donor coordinator
The donor should contact the transplant center personally.
The recipient should not complete medical forms on behalf of the potential donor or pressure someone to begin the process.
The donor’s information is private. The transplant center may not share the donor’s medical details with the recipient without permission.
The Donor Evaluation Process
Living donor evaluation is intentionally thorough because the transplant team must protect the donor’s health.
Testing may include:
- Medical-history review
- Family-history review
- Physical examination
- Blood-pressure measurements
- Blood-type testing
- Tissue-compatibility testing
- Antibody and crossmatch testing
- Blood tests
- Urine testing
- Kidney-function testing
- Imaging of the kidneys
- Imaging of the kidney blood vessels
- Heart testing
- Lung testing
- Cancer screening
- Infection testing
- Psychological or social work evaluation
- Financial and employment review
- Surgical consultation
The evaluation may require several appointments.
Some testing may be completed near the donor’s home, while other testing may have to be completed at the transplant center.
Blood-Type and Compatibility Testing
Blood-type testing helps determine whether the donor and recipient may be compatible.
The transplant team may also perform tissue typing and a crossmatch.
A crossmatch helps determine whether the recipient has antibodies that may attack the donor kidney.
A donor who is not directly compatible may still be able to help through kidney paired donation.
Being incompatible does not always mean the donation process must end.
Kidney-Function Testing
The transplant center must determine whether both kidneys are healthy enough for donation.
Testing may include:
- Creatinine
- Estimated glomerular filtration rate
- Cystatin C in some cases
- Urine albumin or protein
- Twenty-four-hour urine collection
- Urine testing for blood
- Imaging of both kidneys
- Review of kidney size and structure
The center may also examine the donor’s future risk of developing:
- High blood pressure
- Diabetes
- Chronic kidney disease
- Protein in the urine
- Other conditions that could affect the remaining kidney
Kidney Imaging
Potential donors usually undergo detailed imaging of the kidneys and surrounding blood vessels.
Imaging may help the surgical team examine:
- Kidney size
- Kidney structure
- Arteries
- Veins
- Urinary drainage
- Cysts
- Stones
- Masses
- Structural differences
The surgical team may determine which kidney is most appropriate to remove while leaving the donor with the kidney considered best for their long-term health.
Heart and General Health Testing
Because donation involves major surgery and anesthesia, the transplant center must evaluate whether the donor can safely undergo the operation.
Testing may include:
- Electrocardiogram
- Chest imaging
- Stress testing in selected cases
- Blood-pressure evaluation
- Diabetes screening
- Cholesterol testing
- Cancer screening
- Infection testing
- Age-appropriate preventive examinations
Additional testing may be required based on the donor’s age, health history, family history, or initial results.
Emotional and Social Evaluation
Living donation involves more than medical testing.
A social worker, psychologist, or other transplant professional may discuss:
- Why the person wants to donate
- Whether anyone is pressuring the person
- Emotional readiness
- Family support
- Recovery arrangements
- Employment concerns
- Financial concerns
- Expectations about the recipient’s outcome
- The possibility that the transplant may not succeed
- The donor’s ability to cope with unexpected results
The purpose is not to judge the donor. It is to make sure the decision is informed, voluntary, and emotionally safe.
The Independent Living Donor Advocate
A potential donor should have access to an independent living donor advocate.
The advocate’s responsibility is to protect the donor’s interests.
The advocate may help the donor understand:
- Medical risks
- Surgical risks
- Emotional considerations
- Financial concerns
- Insurance issues
- The right to privacy
- The right to stop the process
- The right to make a voluntary decision
The donor advocate is not present to convince the person to donate.
The donor’s wellbeing must remain the priority.
The Donor Can Change Their Mind
A potential donor may stop the evaluation or withdraw from donation at any time.
The donor does not have to continue because:
- Testing has already begun
- Family members are expecting the donation
- The recipient is already preparing for surgery
- Money has been spent on travel
- The donor initially said yes
- The recipient is seriously ill
- The donor feels embarrassed about changing their mind
Consent must remain voluntary throughout the process.
The transplant center can protect the donor’s privacy when the donor decides not to proceed.
A person should never feel required to provide private medical details to justify withdrawing.
Donation Must Be Free From Pressure
No one should be pressured, threatened, manipulated, or made to feel guilty about donating a kidney.
Pressure may come from:
- Family members
- The intended recipient
- Friends
- Employers
- Religious groups
- Community members
- Fundraising organizations
- Social media followers
- Anyone offering money or another benefit
Living kidney donation must be a voluntary decision based on complete information.
Marshall Kidney Foundation will never pressure someone to become a donor or attempt to influence a transplant center’s medical decision.
Buying or Selling a Kidney Is Illegal
It is illegal in the United States to buy or sell a human organ.
A donor cannot legally receive payment in exchange for a kidney.
However, legal reimbursement may be available for certain reasonable donation-related expenses, such as:
- Travel
- Lodging
- Meals
- Lost wages
- Childcare
- Elder care
Receiving approved expense reimbursement is not the same as selling an organ.
Potential donors should discuss all financial assistance with the transplant center and approved donor-assistance programs.
What If the Donor and Recipient Are Not a Match?
A person may be healthy enough to donate but not compatible with the intended recipient.
This can happen because of:
- Blood-type incompatibility
- Recipient antibodies
- A positive crossmatch
- Other medical compatibility concerns
Kidney paired donation may provide another option.
In a paired exchange:
- One donor gives a kidney to another compatible recipient.
- Another donor gives a compatible kidney to the first donor’s intended recipient.
Some exchanges involve two donor-recipient pairs. Others involve several donors and recipients in a longer chain.
Paired donation allows willing donors to help their intended recipients even when they cannot donate directly to them.
Nondirected Living Donation
A nondirected donor gives a kidney without naming one particular recipient.
This is sometimes called altruistic or anonymous donation.
A nondirected donation may:
- Help someone on the transplant waiting list
- Begin a kidney-donation chain
- Make several transplants possible through paired exchange
Nondirected donors undergo the same careful medical and emotional evaluation as other living donors.
The transplant center determines how the kidney is allocated in accordance with applicable policies.
What Happens During Donor Surgery?
Living donor kidney removal is called a donor nephrectomy.
The surgery is performed under general anesthesia.
Many donor surgeries are completed using minimally invasive techniques, although the surgical approach depends on the donor’s anatomy, health, and transplant center.
During surgery, the team:
- Removes one kidney
- Preserves the kidney’s blood vessels and urinary connection
- Prepares the kidney for transplantation
- Monitors the donor closely
- Transplants the kidney into the recipient in a separate operation
The donor and recipient have separate surgical and medical teams.
Hospital Recovery
The length of the hospital stay varies.
During recovery, the donor may experience:
- Surgical pain
- Abdominal soreness
- Fatigue
- Nausea
- Reduced appetite
- Constipation
- Difficulty moving comfortably
- Temporary limitations on activity
The healthcare team may encourage:
- Walking
- Deep breathing
- Pain control
- Hydration as instructed
- Gradual return to eating
- Prevention of blood clots
- Monitoring of kidney function
The donor should receive written discharge instructions before leaving the hospital.
Recovery at Home
Recovery differs from person to person.
Some donors return to desk work sooner than those whose jobs require:
- Heavy lifting
- Repeated bending
- Climbing
- Driving for long periods
- Physical labor
- Patient handling
- Construction work
- Warehouse work
The transplant team should explain:
- When driving may resume
- How much weight may be lifted
- When exercise may resume
- When work may resume
- How to care for the incision
- Which symptoms require a call
- When follow-up appointments are scheduled
Donors should not rush recovery because they feel responsible for returning to work or caring for others.
Possible Short-Term Risks
Living kidney donation is major surgery.
Possible short-term risks may include:
- Pain
- Bleeding
- Infection
- Blood clots
- Reaction to anesthesia
- Pneumonia
- Urinary problems
- Injury to nearby structures
- Hernia
- Wound complications
- Need for additional treatment
- Need for another procedure
- Rare life-threatening complications
The transplant surgeon must explain the donor’s individual risks before surgery.
No website can replace the transplant center’s informed-consent process.
Possible Long-Term Considerations
Most carefully selected donors do well, but donation may be associated with long-term considerations.
These may include:
- Reduced kidney reserve
- High blood pressure
- Protein or albumin in the urine
- Possible future kidney disease
- Pregnancy-related considerations
- Emotional stress
- Financial strain
- Insurance concerns
- The need for lifelong health monitoring
Some future risks cannot be predicted with complete certainty at the time of donation.
Potential donors should discuss their personal risk based on age, family history, blood pressure, weight, kidney function, race, ethnicity, pregnancy plans, diabetes risk, and other factors.
Pregnancy After Kidney Donation
Many people have successful pregnancies after donating a kidney.
However, pregnancy after donation may involve an increased risk of certain blood-pressure-related complications.
A potential donor who may become pregnant in the future should discuss:
- Pregnancy plans
- Recommended waiting time after donation
- Blood-pressure monitoring
- Kidney-function monitoring
- Pregnancy-related risks
- High-risk obstetric care when appropriate
The transplant center and obstetric healthcare team should provide individualized guidance.
Emotional Outcomes After Donation
Many donors report satisfaction from helping another person.
However, donors may also experience:
- Anxiety
- Sadness
- Depression
- Stress
- Family tension
- Financial worry
- Disappointment
- Difficulty adjusting after surgery
Emotional distress may be greater if:
- The recipient experiences complications
- The transplanted kidney does not function
- The recipient does not follow medical instructions
- The donor’s relationship with the recipient changes
- Recovery is more difficult than expected
Donors should be encouraged to seek emotional support when needed.
Donation Does Not Guarantee the Recipient’s Outcome
A living donor kidney may provide the recipient with an excellent opportunity, but the transplant may still experience:
- Surgical complications
- Delayed kidney function
- Infection
- Blood clots
- Rejection
- Medication side effects
- Recurrence of the original kidney disease
- Loss of the transplanted kidney
- Other serious complications
The donor should understand that they are giving an opportunity—not guaranteeing a particular outcome.
The donor is not responsible if the transplant fails.
Who Pays for the Donor’s Medical Evaluation and Surgery?
The transplant recipient’s insurance generally covers the donor’s transplant-related medical expenses.
These commonly include:
- Donor evaluation
- Compatibility testing
- Transplant-related blood tests
- Kidney imaging
- Surgical evaluation
- Donation surgery
- Hospital care related to the donation
- Certain required follow-up services
The donor should not assume that every service will automatically be covered.
Before testing begins, the donor should speak with the transplant center’s:
- Financial coordinator
- Living donor coordinator
- Social worker
- Independent donor advocate
The transplant center should explain what the recipient’s insurance covers and whether any services require prior authorization.
Some Routine Health Tests May Not Be Covered
The recipient’s insurance may not cover routine preventive services that are not considered part of the donation itself.
Examples may include:
- Routine dental examinations
- Mammograms
- Colonoscopies
- Prostate examinations
- Pap tests
- General medical visits
- Treatment of an unrelated condition discovered during evaluation
These services may be billed to the potential donor’s own health insurance.
Potential donors should verify coverage before completing outside testing.
What Expenses Are Often Not Covered by the Recipient’s Insurance?
The recipient’s insurance may not pay for nonmedical expenses such as:
- Travel
- Airfare
- Gas
- Hotels
- Meals
- Parking
- Lost wages
- Childcare
- Elder care
- Pet care
- Household help
- Recovery supplies
- Transportation for a caregiver
These costs can become a major concern for donors and their families.
The potential donor should discuss financial planning early—not after expenses have already accumulated.
Financial Assistance May Be Available
Eligible living donors may receive help through the federally supported Living Organ Donation Reimbursement Program, administered through the National Living Donor Assistance Center.
Depending on eligibility and program rules, assistance may be available for qualifying expenses related to evaluation, surgery, and follow-up, including:
- Travel
- Lodging
- Meals and incidentals
- Lost wages
- Childcare
- Elder care
Potential donors should ask the transplant center about the program before paying expenses whenever possible.
Eligibility is not automatic, and assistance should not be promised until the program has reviewed the application.
Employment and Time Away From Work
Donation may require time away from work for:
- Medical testing
- Travel
- Surgery
- Hospital recovery
- Home recovery
- Follow-up visits
Potential donors should speak with:
- Their employer
- Human resources
- Their leave administrator
- The transplant social worker
- The financial coordinator
- Their disability insurance provider
Questions may include:
- Do I have paid sick leave?
- Can I use vacation time?
- Do I qualify for family or medical leave?
- Do I have short-term disability coverage?
- Is my job protected while I recover?
- Will I need temporary work restrictions?
- When can I return to heavy lifting?
- What medical documentation will my employer require?
Not every donor qualifies for paid leave, disability benefits, or federal job protection.
The transplant center should help the donor prepare for possible time away from work.
Health, Life, and Disability Insurance Questions
Potential donors should discuss possible insurance concerns before donation.
Questions may include:
- Who covers donation-related follow-up?
- Who pays if a complication occurs later?
- Will my own health insurance be billed?
- Could a donation affect future life-insurance applications?
- Could a donation affect disability-insurance applications?
- What records should I keep?
- What protections apply in my state?
Federal guidance notes that the recipient’s insurance may not cover every long-term health problem a living donor develops after donation. Living donation may also affect a donor’s future insurance eligibility or costs.
The donor should receive answers from the transplant financial coordinator and independent donor advocate before surgery.
Follow-Up After Donation
Follow-up is an important part of donor safety.
The transplant program will generally request follow-up information after donation. Current federal guidance requires transplant centers to report donor follow-up information for at least two years.
Follow-up may include:
- Blood pressure
- Weight
- Creatinine
- Estimated kidney filtration
- Urine albumin or protein
- Diabetes screening
- Review of medications
- Emotional wellbeing
- General health status
After the transplant center’s required follow-up period, the donor should continue receiving regular care from a primary healthcare professional.
Donation should become part of the donor’s permanent medical history.
Protecting the Remaining Kidney
After donation, donors should take reasonable steps to protect the remaining kidney.
These may include:
- Attending routine medical appointments
- Controlling blood pressure
- Maintaining a healthy weight
- Managing blood glucose
- Avoiding smoking
- Staying physically active
- Following a balanced eating plan
- Avoiding dehydration
- Discussing NSAID pain medicines with a healthcare professional
- Reviewing supplements and herbal products
- Informing healthcare professionals about the kidney donation
- Completing blood and urine testing as recommended
Donors should not assume that every medication, supplement, or high-protein diet is safe simply because they feel healthy.
The Recipient Also Has Responsibilities
The transplant recipient should respect the donor’s independence throughout the process.
The recipient should:
- Avoid pressuring the donor
- Respect the donor’s privacy
- Understand that the donor may withdraw
- Allow the transplant center to speak privately with the donor
- Avoid asking the donor to hide medical information
- Avoid offering money or valuable items in exchange for the kidney
- Maintain insurance and financial clearance
- Complete required medical testing
- Follow the transplant center’s instructions
- Take anti-rejection medication after a transplant
- Attend all transplant follow-up appointments
A donated kidney is a profound gift, but the donor should not be made responsible for controlling the recipient’s future medical decisions.
Questions Potential Donors Should Ask
Consider asking the transplant center:
- Am I healthy enough to donate?
- What tests will I need?
- What risks apply specifically to me?
- How much kidney function will I have afterward?
- What happens if testing discovers another medical condition?
- Who will have access to my medical information?
- Can I withdraw confidentially?
- Who is my independent donor advocate?
- What type of surgery will I have?
- How long will I be in the hospital?
- How long will recovery take?
- When can I drive?
- When can I return to work?
- When can I lift heavy objects?
- What expenses will the recipient’s insurance cover?
- What expenses might I have to pay?
- Can I apply for donor financial assistance?
- Who pays for complications?
- Who pays for follow-up care?
- Could a donation affect future insurance?
- What happens if I am not compatible?
- Is paired kidney donation available?
- What happens if the transplant does not succeed?
Write down the answers and request copies of important documents.
Questions Recipients Should Ask
Recipients may ask:
- How can someone contact the living donor program?
- Can potential donors contact the center confidentially?
- What information may the center share with me?
- Does the program offer paired kidney donation?
- What donor expenses does my insurance cover?
- What financial-assistance programs are available?
- What happens if the donor changes their mind?
- What testing must I complete before living-donor surgery?
- What medications will I need after transplant?
- How will my original kidney disease affect the new kidney?
- What happens if the transplant is delayed or canceled?
How to Begin
Someone interested in becoming a living kidney donor should contact the intended recipient’s transplant center and ask for the:
Living Kidney Donor Program
A person who wants to donate but does not have a particular recipient may contact a transplant center and ask about:
Nondirected Living Kidney Donation
The transplant center will explain:
- How to complete the confidential screening
- What medical information is needed
- How compatibility is tested
- What costs are covered
- Whether financial assistance may be available
- What risks should be considered
- What happens if the donor is not a match
- How the donor’s privacy is protected
Marshall Kidney Foundation’s Role
Marshall Kidney Foundation may provide:
- General living-donation education
- Links to transplant resources
- Questions to ask transplant professionals
- Awareness about paired kidney donation
- Information about donor financial assistance
- Encouragement to seek qualified transplant guidance
Marshall Kidney Foundation does not:
- Determine donor eligibility
- Test blood or tissue compatibility
- Recommend one person as a donor
- Arrange donor-recipient matches
- Collect donor medical records
- Provide donor medical clearance
- Guarantee insurance coverage
- Pay donors for organs
- Influence transplant-center decisions
An authorized transplant center must handle all donor screening and transplant decisions.
A Living Donation Is a Gift—Not an Obligation
Choosing to be evaluated as a living kidney donor can be an extraordinary act of compassion.
But donation must always remain:
- Voluntary
- Informed
- Private
- Medically appropriate
- Free from pressure
- Free from payment for the organ
- Focused on donor safety
A potential donor deserves time to ask questions, discuss concerns, understand the risks, and make the decision that is right for them.
Saying yes to testing does not require someone to complete the donation.
Saying no does not make someone selfish or uncaring.
The gift of life must begin with respect for the donor’s life and well-being.
Medical Disclaimer
This information is provided for general educational and informational purposes only. It is not medical, surgical, legal, financial, employment, or insurance advice.
Living kidney donation is major surgery and involves short-term and long-term risks. Donor eligibility, compatibility, surgical approach, recovery, follow-up, insurance coverage, and financial assistance must be evaluated individually by an authorized transplant center and other qualified professionals.
Do not stop medications, blood thinners, pain medicines, supplements, or other treatments in preparation for donor testing or surgery unless the transplant team and prescribing healthcare professional provide specific instructions.
The recipient’s insurance generally covers transplant-related donor evaluation, testing, and surgery, but coverage may vary. Nonmedical expenses, routine healthcare, long-term complications, follow-up care, travel, lodging, lost wages, and dependent care may not be fully covered. Obtain written information from the transplant center and insurer before incurring expenses.
Financial-assistance programs have eligibility requirements and do not guarantee reimbursement.
Buying or selling a human organ is illegal. Approved reimbursement of reasonable donation-related expenses is not the same as payment for an organ.
Call 911 or seek emergency medical care for severe breathing difficulty, chest pain, fainting, uncontrolled bleeding, severe abdominal or back pain, severe weakness, blue or gray lips, or any rapidly worsening or life-threatening condition.
Marshall Kidney Foundation does not provide donor screening, medical clearance, transplant matching, surgical advice, insurance guarantees, financial guarantees, legal advice, or emergency services.
Learn more with a trusted medical source: NIDDK-Living Kidney Donation
