In the past, living donors had to have a compatible blood type with the recipient. In living donation, the following blood types are compatible:

  • Donors with blood type A... can donate to recipients with blood types A and AB
  • Donors with blood type B... can donate to recipients with blood types B and AB
  • Donors with blood type AB... can donate to recipients with blood type AB only
  • Donors with blood type O... can donate to recipients with blood types A, B, AB and O (O is the universal donor: donors with O blood are compatible with any other blood type)


  • Recipients with blood type O... can receive a kidney from blood type O only
  • Recipients with blood type A... can receive a kidney from blood types A and O
  • Recipients with blood type B... can receive a kidney from blood types B and O
  • Recipients with blood type AB... can receive a kidney from blood types A, B, AB and O (AB is the universal recipient: recipients with AB blood are compatible with any other blood type)

However, there are some programs are available to help donor/recipient pairs with blood types that are otherwise incompatible: paired exchange and plasmapheresis.

Exchange Programs

Paired Exchange

Sometimes a loved one may want to donate a kidney but their blood type is incompatible. Some transplant centers will help incompatible pairs of recipient/donors through a process called paired exchange, which involves two living donors and two recipients.

If the recipient from one pair is compatible with the donor from the other pair, and vice versa– the transplant center may arrange for a "swap"–for two simultaneous transplants to take place. This allows two transplant candidates to receive organs and two donors to give organs though the original recipient/donor pairs were unable to do so with each other.

paired exchange

Figure 1: In paired exchange, an incompatible donor/ recipient pair (such as a mother and son that don't have compatible blood types) are matched with another incompatible donor/recipient pair for a "swap". Each donor gives a kidney to the other person's intended recipient.

Both donors and candidates are carefully evaluated and tested medically and psychologically to assure that the benefits outweigh the risks. It is important for both surgeries to be scheduled for the same time in case either donor changes their mind at the time of surgery. Surgeries can take place at the same or different hospitals. It can be advantageous if the surgeries take place at the same hospital though this may mean extra costs of travel and housing for one couple.

Never Ending Altruistic Donor (NEAD) chain

A NEAD™ chain (Never Ending Altruistic Donor chain) begins with one non-directed (altruistic) potential donor. In this program, the non-directed donor gives to a person waiting for a transplant, and that recipient's willing – but incompatible – donor gives to another person waiting, and so on.

Each living donor in this system gives to a stranger, and the chain of donors is kept going as long as possible.

paired exchange

Figure 2:

In A NEAD™ chain, a non-directed potential donor is matched up with a recipient who has a willing, but incompatible donor. Then that recipient's incompatible donor then gives to another incompatible pair, and so on.

For More Information

If you are interested in one of these exchange programs:

Talk with your transplant hospital. If you're already working with a transplant hospital: Talk to them about your options. Ask them if any of these programs are an option for your situation, and if so, does that hospital offer them?

  1. If not: contact transplant hospitals (in the recipient's area) to ask. To find a transplant center in your area click here. Select "transplant center by organ," then select "kidney," and then select your state.
  2. Contact a transplant hospital that has an exchange program. It's always a good idea to check with your transplant hospital, or hospitals nearby.
  3. Contact other organizations which might help. Following are links to other organizations which help to facilitate exchanges.(Note: these organizations and their websites are not under the control of the NKF, and NKF assumes no responsibility for their content or services. These links are provided for information purposes only, and should not be considered an endorsement or recommendation by the National Kidney Foundation.)

OPTN/UNOS Kidney Paired Donation Program The vision of the OPTN/UNOS Kidney Paired Donation Program is that every kidney transplant candidate with an incompatible but willing and approved living donor receives a living donor kidney transplant. The mission is to develop a successful Kidney Paired Donation (KPD) program with universal access to all UNOS/OPTN members that prioritizes the medical and psychosocial safety of living donors and candidates.

Alliance for Paired Donation The mission of the Alliance for Paired Donation™ is to save lives by significantly reducing the wait time for a kidney transplant through kidney paired donation.

National Kidney Registry The mission of the National Kidney Registry is to save and improve the lives of people facing kidney failure by increasing the quality, speed, and number of living donor transplants in the world.


New protocols consisting of medications, spleen removal, and a form of blood filtering called plasmapheresis are allowing transplant candidates to receive kidneys from live donors with blood types that have traditionally been deemed incompatible.

Until now, a transplant patient could only receive an organ from someone with a compatible blood type. An organ from an incompatible blood type would be perceived as foreign and vulnerable to attack by the recipient's natural antibodies.

Now, through a process of immune conditioning, a recipient is able to receive a kidney from a donor of a different blood type. This new procedure is currently being provided at a limited number of transplant centers.

The new protocol involves testing the proposed recipient to assess the risk of rejection from harmful antibodies. Next the recipient undergoes plasmapheresis, a process involving the removal of the plasma portion of the blood that contains harmful antibodies and the administration of a medication to prevent their production. The patient is then ready to undergo transplant surgery where, in addition to receiving a donor organ, the patient's spleen is removed using minimally invasive surgical techniques. In some cases, spleen removal can be avoided through the use of a new drug that creates similar effects.

Post transplant, the patient undergoes additional plasmapheresis treatments before being discharged from the hospital. He or she will then take the same immunosuppression medications as patients receiving a compatible kidney.

For more information about plasmapheresis, talk to your transplant hospital and ask if this is an option for you.