How does kidney donation work?
When it comes to registering to be a kidney donor, you can either be a living or deceased donor. Doctors explore both living and deceased donors when helping patients with kidney failure, but living donation is often preferred. This is because kidneys from living donors tend to last longer, work better, and allow the transplant to be planned at a convenient time. If a living donor isn’t available or compatible, the patient is placed on the deceased donor waiting list, where they may wait months or even years for a suitable match.
Both types of donation save lives, but living donors can make an immediate and life-changing difference.

Initial steps of living kidney donation
Eligibility Assessment: The donor undergoes a detailed medical evaluation to ensure they are healthy enough to donate. This includes, medical history review, physical exams and blood and tissue tests to check compatibility with the recipient.
Counselling: Donors are counselled to understand the risks, benefits, and process.

Registering for deceased donation
Organ Donor Registry: Individuals can register their intent to donate organs after death. Some countries use national organ donor databases.
Informing Family: Donors should inform their families about their decision to avoid delays if donation is considered after death.
The matching process - living and deceased donors
The matching process ensures the donated kidney is as compatible as possible with the recipient. This helps reduce the risk of rejection by the recipient’s immune system. The key factors of matching may include:
Blood type is the first factor in determining if a donor and recipient are compatible.
Blood type matching works as follows:
- Type O: Can donate to anyone (universal donor).
- Type A: Can donate to A and AB recipients.
- Type B: Can donate to B and AB recipients.
- Type AB: Can donate only to AB recipients (but can receive from anyone).
The Human Leukocyte Antigen (HLA) system plays a critical role in the immune system’s ability to recognise the kidney as “self” or “foreign.”
There are six key markers in the HLA system. A closer match reduces the likelihood of organ rejection.
A test is performed to see if the recipient’s antibodies will attack the donor’s kidney. This is done by mixing the donor’s blood cells with the recipient’s blood.
A negative crossmatch (no reaction) indicates compatibility, while a positive crossmatch means the recipient’s body might reject the kidney.
A kidney from a donor of a similar age and size as the recipient is often preferred to ensure proper function.
What is paired/pooled kidney donation?
What is paired/pooled donation? An altruistic (family or friend) person offers to donate a kidney (as a donor) to a patient who is family or a friend but that person is incompatible with their loved one, i.e. blood type, tissue type does not match (because of the blood group or tissue type) (HLA type) is in compatible. However, it may be possible for the potential donor to be matched with another recipient and donor pair in the same situation and for the donor kidneys to be ‘exchanged’ or ‘swapped’.
Why does ethnicity matter when it comes to kidney donation?
According to the NHS, in the UK, Black patients wait about six months longer for a kidney transplant than White patients (649 days vs. 463 days on average). This is due to a shortage of organ donors from Black communities, as matching is more likely within the same ethnic group. Efforts are ongoing to increase donor registrations among Black populations to reduce these disparities.
Certain HLA markers are more common in specific ethnic groups. A donor and recipient of the same ethnicity are more likely to have a closer HLA match, reducing the risk of rejection.
For example, patients of Black, South Asian, or other minority heritage are more likely to find a match from a donor within their own community.
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Minority ethnic groups are underrepresented on organ donor registries, creating longer wait times for patients from these communities. This is especially critical for Black, South Asian, and mixed-race patients, who may face additional challenges finding a compatible match.

Surgery preparation for kidney donation and transplantation

Long-Term Outcomes After Kidney Donation and Transplantation
For donors, giving a kidney is an extraordinary act of compassion. Your remaining kidney will adapt to do the work of both, and research shows donors live just as long and healthy as those who haven’t donated. Your decision to donate could give someone 15-20 years of life with their loved ones—a chance to thrive, celebrate milestones, and live fully again.
For recipients, receiving a kidney from a living donor offers the best outcomes. It’s not just a second chance at life but an opportunity to regain independence and hope. Whether you’re donating or receiving, this journey creates a profound connection and leaves a lasting impact, saving lives and changing futures.

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