The Big Ask, The Big Give

The evaluation process is meant to protect you. It ensures that you are healthy enough to donate a kidney. While there are inherent risks of living donation and with any surgery, the rigorous evaluation process provides a systematic way of determining any specific, known risks to you.

You will meet with multiple members of the living donor evaluation team. This team is specially assigned to you, the potential living donor. All members of your team will have no interaction with the potential recipient. This is done on purpose to ensure that there are no conflicts of interest and that the evaluation is done in your best interests and without bias. There will be many opportunities and ample time to ask questions and address any concerns you may have. A living donor advocate will be an important member of your healthcare team who you can feel free to discuss any concerns or hesitations you may have. All conversations between the living donor and the transplant team and the results of medical testing will be kept confidential.

If at any point in the evaluation process you decide that you do not want to donate your kidney, your living donor transplant team can help you decline in a way that preserves the family relationships.

How do I start the process to see if I can donate a kidney?

If you have two healthy kidneys, you may be able to donate one to save someone's life. Visit the How to Donate page to learn more.

What will happen after I'm connected with a transplant center?

After you are connected with a transplant center, they will begin a basic medical screening. They will ask you questions about your medical history to find out if you have any conditions that would prevent you from donating. You may be sent a health questionnaire to fill out. This initial screening is followed by a blood test to find out whether you are compatible with the recipient.

You will also be assigned an Independent Living Donor Advocate (ILDA), who will assist you during the donation process. This person’s sole job is to look after your best interest. They will answer your questions and help you get information. They will also make sure you understand the possible risks and benefits of donation, and any impact it may have on your emotional life, finances, family, future employment, and health. Everything that is discussed between you and the ILDA is kept private and confidential.

If you are interested in donating a kidney, you will start a full evaluation process.

What does a “full evaluation” involve?

You must complete a financial consultation, a psychological evaluation, and extensive medical tests. The results will be kept completely confidential. They will not be shared with the recipient.

Financial consultation

Staff at your transplant center will ask about your finances and insurance coverage.In general, if you are donating to a family member or friend, the recipient's insurance will pay your expenses for testing and surgery.However, you may be responsible for travel expenses, lost wages, and some follow-up care. If any health problems that require treatment are discovered during your medical tests, you or your health insurance will be responsible for them.

Psychological evaluation

The transplant team makes sure that each donor is in good mental health and understands the donation process. They will educate you about all aspects of living donation and make sure you are able to make an informed decision. One reason this is done is to make sure there is no pressure from friends or family, no promise of financial incentive, and that your expectations are realistic. This is also an opportunity for you to express yourself more fully than you might be able to with family or the recipient present.

Medical Tests

Medical history. You will be asked to give a complete and thorough history of any illnesses, surgeries, and treatments you’ve had in the past. You will also be asked about your family’s medical history. If any problems or abnormalities are found, they will be investigated further.
Physical exam. You will be given a physical examination to make sure you are healthy enough to donate a kidney.
Chest X-ray and electrocardiogram (EKG). These tests are done to check for heart or lung disease.
Radiological testing. These tests allow physicians to look at your kidney, including its blood vessel supply.
Urine testing. A 24-hour urine sample is collected to make sure you have good kidney function.If it is found that your kidney function is low, they will most likely advise against donation.
Gynecological examination. Female donors may need to have a gynecological exam and mammography.
Cancer screening. You may also be given some cancer screening tests, which may include a colonoscopy, prostate exam, and skin cancer screening.

Compatibility Tests

A blood sample will be taken to check for compatibility between you and the recipient. This includes: Blood typing. Your blood type will be checked to see if it is compatible with the recipient.

Tissue typing. This blood test checks the tissue match between your white blood cells and the recipient’s white blood cells.
Crossmatching. In this test, blood cells from the donor and recipient are mixed. If the recipient’s cells attack and destroy the donor cells, the crossmatch is positive. A “positive” crossmatch means that your organ will not match the recipient’s. A “negative” crossmatch means that your organ is compatible with the recipient’s.

Other Blood Tests

Additional blood tests are done to check for any viral activity or transmissible diseases (like HIV/AIDS, hepatitis, cancer, or others), glucose intolerance, electrolyte balance, and to assess your kidney function.

Learn more detailed information on the Testing Involved in the Living Donor Evaluation Process page.

What if my kidney is not compatible with my intended recipient?

You may consider a “paired exchange.” A paired exchange involves two pairs of living donors and their recipients. The two recipients “swap” donors so that each receives a kidney from a compatible donor. If this is an option for you, your transplant team will coordinate the entire process, including finding the matching pair.

How long does the evaluation process take?

The length of time it takes to complete the evaluation process is different for each person. It will depend on your availability for testing, the results of your tests, and the individual policies and procedures of the transplant center involved. If the recipient’s transplant center is far away, you may be able to complete some tests at a hospital or lab near your home.

What happens after the evaluation is complete?

Your test results will be sent to the transplant team, who will review them carefully. They will make a decision about your physical health and suitability as a donor. If you are a suitable candidate for living donation, and you decide to go ahead with it, an operation will be scheduled. The final decision to proceed will be a group decision among you, your recipient, and the transplant team.