Kidney Donation: 5 Key Things to Know Before You Donate

Thinking about donating a kidney is a generous decision that can save a life.

In the U.S., approximately 90,000 people are waiting for a kidney transplant, and living donors help shorten the wait and improve outcomes. This guide explains five key things to know—how kidney donation saves lives, who’s eligible, what the process looks like, risks and recovery, and costs and protections—so you can make an informed choice.

1) How kidney donation can save a life

Living kidney donation offers recipients better outcomes than staying on dialysis and often better than receiving a kidney from a deceased donor. One year after a living-donor kidney transplant, patient and graft survival typically exceed 95%, and living-donor kidneys often function longer on average than deceased-donor kidneys. You can explore center-level outcomes on the Scientific Registry of Transplant Recipients (SRTR).

Donation isn’t only one-to-one. If you aren’t compatible with your intended recipient, kidney paired donation can match you with another pair so both recipients get compatible kidneys. Non-directed donors (those who donate to anyone in need) can also start a “donation chain,” multiplying the number of lives saved.

Many donors choose to give to a loved one, but you can also donate to a stranger through a transplant center’s program. While donating organs for money is illegal in the U.S. under the National Organ Transplant Act, reimbursement of certain expenses and donor protections are available (see the support section below and OPTN FAQs).

2) Eligibility: Can you donate a kidney?

Each transplant center sets its own criteria, but common eligibility basics include:

Age: Most centers consider healthy adults 18+; donors in their 50s–60s (and sometimes older) may be eligible if otherwise low risk.
Overall health: You need two functioning kidneys and no significant kidney disease. Centers assess kidney function (eGFR), urine tests, and imaging.
Blood pressure: Well-controlled blood pressure may be acceptable; uncontrolled hypertension is usually a reason to defer.
Diabetes: Type 1 or type 2 diabetes typically excludes donation in the U.S., though criteria evolve—discuss specifics with your center.
Body weight: Many centers prefer BMI below 30–35; recommendations vary.
Other conditions: Significant heart disease, active cancer, or uncontrolled mental health or substance use issues can be disqualifying until addressed.
Infections and compatibility: Blood type and crossmatch testing ensure your kidney is a safe match. If incompatible, paired exchange is an option.

Special cases exist. Under the federal HOPE Act, some centers can transplant kidneys from HIV-positive donors to HIV-positive recipients in controlled research settings. Always talk with your center about your unique situation.

3) The kidney donation process: step by step

1. Initial outreach and screening

Start by contacting a transplant center directly or visiting UNOS: Living Donation to learn more and connect with a program. You’ll complete a health questionnaire and provide basics like height, weight, medications, and medical history.

2. Compatibility testing

Blood tests check your ABO blood type and whether your immune system will react against the recipient (crossmatch). If you want to donate to someone specific but are incompatible, the team may discuss paired donation.

3. Comprehensive evaluation

You’ll have labs, urine tests, imaging (often CT angiography), EKG, and a physical exam. A psychosocial assessment ensures you understand the risks and are donating voluntarily. You’ll also meet an Independent Living Donor Advocate whose sole role is to protect your interests.

4. Informed consent and decision-making

The team will explain surgical risks, long-term considerations, alternatives for the recipient, and your right to stop at any time—privately and without pressure. If you or the team decide donation isn’t right for you, they’ll support you and protect your confidentiality.

5. Surgery and hospital stay

Most living donations use minimally invasive (laparoscopic) nephrectomy. Hospital stays are often 1–3 days, with return to light activity within 2–4 weeks and full recovery by 6–8 weeks, depending on your job and health.

6. Follow-up

Centers will track your health after donation—commonly at 6 months, 1 year, and 2 years. Long-term, plan annual primary care checkups with blood pressure, kidney function, and urine protein testing.

4) Risks, recovery, and long-term health

Surgical risks: As with any surgery, there’s risk of bleeding, infection, blood clots, or injury to surrounding structures. Serious complications are uncommon at experienced centers; the estimated risk of death from donation surgery is roughly 0.03% (about 3 in 10,000). Discuss your personal risk with your surgeon.

Life with one kidney: Most donors live normal, active lives. The remaining kidney typically enlarges to take on more work. You’ll be advised to maintain a healthy lifestyle, keep blood pressure under control, and avoid certain high-dose NSAIDs.

Long-term kidney health: Research shows a small increase in the lifetime risk of kidney failure for donors compared with carefully selected non-donors, but the absolute risk remains low for most healthy people. Your team will evaluate your individual baseline risk before approving donation. See summaries from the National Kidney Foundation and American Society of Transplantation.

Pregnancy considerations: People who become pregnant after donation have slightly higher rates of gestational hypertension and preeclampsia compared with similar non-donors. Most still have healthy pregnancies; plan preconception counseling and close prenatal monitoring.

Recovery tips:

Arrange 2–6 weeks away from strenuous work; desk jobs may resume sooner with your doctor’s clearance.
Walk daily to reduce clot risk; avoid heavy lifting until cleared.
Stay hydrated, follow your pain plan, and attend all follow-ups.

5) Costs, protections, and support

What’s covered: In the U.S., the recipient’s insurance typically covers your medical evaluation, surgery, and immediate follow-up. You should not receive medical bills for the donation care itself; ask your center how they handle billing to keep costs separate from your own insurance.

Out-of-pocket expenses: Travel, lodging, meals, childcare, and lost wages aren’t always covered. The National Living Donor Assistance Center (NLDAC) may reimburse eligible donors for travel and related costs. Some programs and nonprofits also offer wage support—ask your center about available resources.

Employment and leave: Many donors use paid time off, short-term disability, or unpaid leave. The U.S. Family and Medical Leave Act (FMLA) provides eligible workers up to 12 weeks of unpaid, job-protected leave. Some states offer additional paid family leave or tax credits for donors.

Extra protections: If you donate through a center that partners with programs like Donor Shield, you may receive added safeguards (travel/lost wage coverage, life/disability insurance, and complication coverage). Availability varies by center.

Legal note: Selling organs is illegal in the U.S., but reimbursement of reasonable expenses is permitted (see OPTN guidance). Always coordinate expenses through your transplant team.

Practical next steps

Learn the basics: Explore UNOS’s living donation overview and the NIDDK guide.
Choose a center: Compare transplant center outcomes on the SRTR center search and contact a living donor coordinator.
Discuss with your doctor: Review your medical history, medications, and any conditions that could affect donor eligibility.
Plan logistics: Talk with your employer about time off, and ask your center about NLDAC, housing options, and support programs.