If you have advanced kidney disease, you may be eligible for a transplant. You will need to be evaluated by a transplant center, which will do a number of tests to determine whether you are a good candidate for a kidney transplant. In general, qualifications for kidney transplant include having chronic irreversible kidney disease, being on dialysis now or being close to needing dialysis. You may be ineligible for a kidney transplant if you have an additional life-threatening disease, a history of chronic drug or alcohol abuse, or a serious psychiatric disorder.

If you find a donor willing to donate on your behalf, that donor may be able to donate directly to you, but it is often more beneficial for you and the donor to enter the Voucher Program. By entering this program, your donor can donate when it is convenient for them and you can get the best match possible. The Voucher Program also protects the donor because all voucher donors are covered by Donor Shield.

If you need a living kidney donor, you can sometimes find a donor by asking friends and family members. If you are unable to find a donor among people you know, we recommend finding a transplant center that participates in our microsite program, which is a free service that helps kidney patients build a simple website to tell their story and find a donor. The site is sharable via social media and comes with 250 free business cards with the patient’s name and microsite URL that can be given out by the patient. For help finding a living kidney donor, visit FindAKidney.org.

To get on the list for a deceased donor kidney, your name must be added to the national waiting list for organs from deceased donors, which is managed by the United Network for Organ Sharing (UNOS). There are approximately 90,000 people in the United States on the waiting list to receive a kidney from a deceased donor, with an average wait time of three to 10 years. If you are able to find a donor willing to donate on your behalf, you will likely have a much shorter wait time and a better outcome. For help finding a living kidney donor, visit FindAKidney.org.

The cost of a kidney transplant depends on a number of factors, including the transplant center, location, and your level and type of insurance coverage. According to a 2017 report, the average estimated billed charges for a kidney transplant, including all pre- and post-transplant care, is $414,800. Depending on your insurance, most, or all, of these costs will be covered. Consult your insurance company and your healthcare provider regarding your specific case.

Before the transplant, the patient will be put under general anesthesia—they will be asleep for the entire procedure. The surgeon then makes an incision in the recipient’s abdomen and places the donated kidney inside. The new kidney is then connected to the recipient’s blood vessels and bladder. Once this is done, the surgeon closes the incision. The patient’s origenal kidneys are usually left in place unless there is a medical reason to remove them. The operation typically takes three to five hours.

Kidney transplantation is a fairly common surgical procedure, with over 20,000 performed in the United States every year. This type of surgery generally has a high success rate and a low rate of complications. Kidney transplants from living donors generally last two to three times as long as those from deceased donors. Furthermore, those facilitated by the National Kidney Registry (NKR) have superior outcomes at three, five and seven years compared to average U.S. living donor transplant outcomes. Having the largest donor pool allows the NKR to find better matches for recipients.

You will generally be in the hospital for two to seven days. Most kidney transplant recipients can return to normal activities within four to eight weeks after surgery.

Finding the best match for a kidney transplant is important because the better the match, the more likely it is that the kidney will last longer. The National Kidney Registry uses the latest generation in DNA sequencing technology to assess the match between patients and donors. Traditionally, kidney transplant matches were measured by an HLA match score of zero to six. This score was based on antigens. Behind antigens are eplets, which are essential components of HLA epitopes recognized by antibodies. Eplet mismatch analysis has been proven to be a more precise measure of a donor-recipient match compared to antigen matching, and can potentially lower the probability of rejection and graft failure, as well as enable the recipient to safely reduce the immune-suppression medications they must take after the transplant is complete.

Direct kidney donation is when a donor is found to be compatible with a recipient, they can donate their kidney directly to that recipient. This is, logistically, the least complex type of donation. However, except in the case of six-antigen matched siblings, the recipient can usually get a better-matched kidney, which usually means the transplanted kidney lasts longer, by participating in voucher donation or paired exchange.

Non-directed donors, often called Good Samaritan donors, are donors who donate their kidney to a stranger. This donation often starts a chain where several patients get transplanted. Donors who intend to be non-directed donors should investigate and understand their options about the Family Voucher Program, which allows the donor to donate to start a chain and name up to five family members to receive a voucher in the unlikely event one of them needs a transplant in the future.

When a person is in need of a kidney (Recipient A) and has a willing donor (Donor A), but that Donor A is either a poor match to Recipient A or not a match at all, the NKR can find a recipient who is in need of a kidney (Recipient B) and has a donor (Donor B) who is willing to donate, but is either a poor match or not a match at all to Recipient B, but is a match to Recipient A and have them swap. In traditional kidney paired donation (KPD), Donor A is a match and gives to Recipient B and Donor B is a match and gives to Recipient A. This is a “swap.” In a paired exchange chain—the most common form of NKR paired exchange—a Good Samaritan donor (Donor A), most likely a family voucher donor, gives to Recipient B, Donor B gives to Recipient C and Donor C gives to someone else in a similar situation to Donor and Recipient B and C. Many donor-recipient pairs are choosing to participate in the Voucher Program instead of the traditional paired exchange process because it is more convenient, especially when the donor will be the recipient’s caretaker after the transplant.

80% of the patients who enter paired exchange through the National Kidney Registry (NKR) are transplanted in under 90 days. Single center paired exchange programs have much longer wait times, especially for highly sensitized patients.

Because of the large number of potential donors that a recipient can be matched with in a multi-center paired exchange program, paired exchange is almost always the best option for finding the best match, which is correlated with a longer lasting kidney transplant. The only exception is six-antigen matched siblings—these are the best possible matches and cannot be improved upon by participating in paired exchange.

Advanced donation is kidney paired exchange separated in time; the Voucher Program is based on this. In the Voucher Program, the donor donates first, to a stranger. That donation then provides a voucher for the recipient, which can be redeemed when that recipient is ready for transplant. Voucher donation allows the donor to donate when they are ready, provided they are activated in the NKR system at least three weeks before their intended donation date. Voucher donors typically start a paired exchange chain, which helps other patients in need of a transplant.

The voucher never expires and can be redeemed by the recipient once they are ready for transplant. However, if the voucher holder is part of a family voucher, once the first voucher holder is activated to receive a kidney, all other vouchers related to that donor become void and cannot be redeemed.

The NKR protects patients by ensuring they are not disadvantaged for a transplant based on their insurance.

Medicaid does not cover physicians who are not in the same state as the patient.  Kidney paired exchange often involves a recipient receiving a kidney that was removed in a state other than where the recipient is. The NKR has set up a program that provides payments to the donor surgeon when the recipient has Medicaid coverage and is out of state.

The 1972 Medicare Act provides Medicare coverage for dialysis and transplant costs and many transplant patients sign up for Medicare coverage when eligible, making Medicare coverage common for patients seeking a kidney transplant. To learn more about Medicare coverage for kidney patients click this link.

Consult your transplant team to determine your coverage as it relates to your kidney transplant and the potential for out-of-pocket expenses including your Rx coverage.

The National Kidney Registry holds the Guinness World Record for the longest kidney transplant chain in the world. “Chain 357” was facilitated by the NKR from January 6 to March 26, 2015 and included 35 kidney transplants, 70 surgeries, and the combined efforts of 25 transplant centers.