Living kidney donors in outline: assessment, recovery and sharing

Many people who have had, or are waiting for, a kidney transplant meet the idea of a living donor at some point, and families often have questions about what it involves. This page is a short outline of what public bodies say about living kidney donation: what it is, who can be considered, how donors are assessed, what recovery looks like and how the UK sharing scheme works. It is information only. It is not written to encourage or discourage anyone, and the decision belongs to the individual in discussion with the living donor team. Practice differs between transplant centres, and the team looking after you has the final word.

What living kidney donation is

According to NHS Blood and Transplant, most living kidney donors are close relatives, partners or good friends of the person having the transplant. It also describes two less common routes: directed altruistic donation, where someone the recipient does not know comes forward to donate to them specifically, and non-directed altruistic donation, where a person offers a kidney to anyone on the national transplant waiting list.

The NHS page notes that the team looking after a patient cannot contact potential living donors on their behalf, so any approach to family or friends has to come from the patient.

In one sentence, the comparison with kidneys from people who have died is as follows. The US National Institute of Diabetes and Digestive and Kidney Diseases says a donated kidney can come from someone who has recently died or from a living person, that people waiting for a deceased donor kidney may wait many years, and that a kidney from a living donor does not have to be transported and may be in better condition.

Who can be considered, in general terms

The NHS Organ Donation website says anyone over the age of 18 (over 16 in Scotland) can be considered, and that there is no upper age limit because everyone is assessed individually. It gives general guidance on specific conditions. A person with high blood pressure may still be able to donate after extra tests that check the kidneys have not been affected. Someone at risk of diabetes or who already has it may not be able to donate. Being overweight means more tests and may mean not donating unless weight is lost beforehand. Some types of cancer may prevent donation, and heavy alcohol or recreational drug use may stop it going ahead, although each case is assessed individually.

These are not eligibility rules, and the page itself stresses that health conditions are discussed with a living donor coordinator. It also says a potential donor is entitled to a second opinion from another transplant centre and can ask to be referred for one.

Assessment

Before anyone donates, the sources describe a series of checks. NHS Blood and Transplant says a potential donor has a series of tests that look at the health of the heart and lungs and check that kidney function is excellent, and that the team looking after the potential donor will not allow donation if there is a serious risk to their health. NHS Organ Donation describes a thorough assessment to make sure that the short and long term risks for the donor are as low as possible. The NIDDK page likewise says living donors need to be tested to make sure they are healthy enough to donate.

Assessment is therefore partly about the donor's own long-term health, not only about whether the kidney is a good match for the recipient. The recipient's tests are separate, and the way recipient follow-up works is covered in clinic follow-up and what the tests mean.

The operation and recovery, in outline

NHS Blood and Transplant says removing the kidney is usually done through keyhole surgery, takes around two to three hours, and that most living donors stay in hospital for two to four days, adding that there are risks to donating a kidney which are explained to the potential donor. The NIDDK page says donor and recipient surgery are usually done at the same time in side-by-side rooms, and that a newer technique using a smaller cut may allow some donors to leave hospital in two to three days.

The NHS Organ Donation recovery page adds that donors are usually seen for a surgical review within four to eight weeks, are offered lifelong follow-up, and are usually back to normal activity within four to six weeks. It advises avoiding vigorous exercise and heavy lifting for eight to 12 weeks and being guided by stamina and symptoms. It also notes that after donation the estimated glomerular filtration rate (eGFR, an estimate of how well the kidneys filter waste) will be lower than before, which it describes as a normal result of one kidney doing the work of two. It says that donating can be an emotional process and that some units have psychological support, with others reached through a GP or local mental health services.

Paired and pooled donation in the UK

Sometimes a willing donor is not a match for the person they hope to help because of blood or tissue type. NHS Blood and Transplant describes a sharing scheme that offers a chance to swap or exchange donor kidneys with another donor and recipient pair in the same situation, which it calls paired or pooled donation. The UK Living Kidney Sharing Scheme page explains how it works.

Routes described by NHS Blood and Transplant and NHS Organ Donation

Route	In outline
Donation to someone the donor knows	A relative, partner or friend is tested and, if suitable and a match, donates directly.
Paired or pooled donation	Where a donor is not a match, the pair joins the UK Living Kidney Sharing Scheme, which joins one or more donor and recipient pairs to improve everyone's chances of a match.
Donation to someone the donor does not know	Called non-directed altruistic donation. The scheme page says it is very likely that such a donor donates into the sharing scheme to start a chain of transplants.

The scheme page says NHS Blood and Transplant runs a matching run four times a year using a computer program, after which the transplant centres carry out their own blood testing to confirm each transplant can go ahead. The aim is for all identified transplants to go ahead within 10 weeks of the run, although timings vary and can change if a donor or recipient becomes ill. It says donors can remain anonymous, that taking part through the scheme could help up to three people, and that everyone involved is expected to respect each other's privacy and anonymity, particularly on social media.

What it means for recipients and families

A recipient of a living donor kidney still takes immunosuppressant medicines, which are described in immunosuppressant medicines and living with them. The NIDDK page notes that a living donation can be scheduled in advance, and that rejection is less common when the kidney comes from a living donor than from a deceased donor. What the first months look like is covered in the first months after a kidney transplant. Anyone considering donation, or being asked, should speak to the transplant centre's living donor team, which is where each source points.

The short version

Living kidney donation is one of several routes to a transplant, with each donor assessed individually and offered follow-up after the operation. Where a donor and recipient do not match, the UK Living Kidney Sharing Scheme can link pairs together. For anything specific to your own situation, the living donor team at the transplant centre is the right place to ask.