Donating a kidney is a structured process that typically takes three to six months from your first inquiry to surgery day. Whether you want to donate to a specific person or to a stranger on the transplant waitlist, every donor goes through the same sequence: an initial screening, a thorough medical and psychological evaluation, and finally the surgery itself. About 59,452 people were on the kidney transplant waitlist in 2024, and living donors can dramatically shorten a recipient’s wait.
Who Can Donate
Most transplant centers require donors to be at least 18 years old and in good overall health. Beyond that baseline, the medical team looks at specific thresholds. A BMI above 35 may disqualify you, though some centers evaluate higher-BMI donors on a case-by-case basis. Uncontrolled high blood pressure, especially with signs of organ damage, is a firm exclusion. Kidney function below a certain level (roughly 80 mL per minute on a filtration test) can also take you out of the running.
Having a single, well-managed condition doesn’t automatically rule you out. People over 50 with mild high blood pressure and low risk of kidney disease may still be considered. The screening exists to protect you: the transplant team won’t move forward unless they’re confident you can live a full, healthy life with one kidney.
Types of Living Donation
The simplest path is a directed donation, where you give your kidney to someone you know. But if your blood type or tissue markers don’t match your intended recipient, you’re not out of options.
Kidney paired donation, run through a national program managed by the Organ Procurement and Transplantation Network, swaps donors between incompatible pairs. You donate to a stranger whose donor, in turn, gives to your recipient. A computerized system matches pairs across transplant centers nationwide, and these exchanges can involve two pairs or many more. When a non-directed donor (someone donating without a specific recipient) starts a chain, up to 20 pairs can benefit in a single sequence, with the final kidney going to someone on the deceased-donor waitlist.
You can also donate as a non-directed (altruistic) donor. In that case, the transplant center matches your kidney to a compatible recipient you’ve never met.
The Evaluation Process
Once you contact a transplant center, you’ll fill out a health history questionnaire. If nothing in your history is disqualifying, you’ll be invited for a full evaluation that can take several days. This includes a complete physical exam, blood tests, imaging (X-rays, CT scans, or MRIs), cancer screening, and any additional tests your health history warrants.
Psychological and Social Assessment
Every donor also goes through a psychosocial evaluation. This isn’t a pass/fail mental health test. It’s designed to make sure you’re donating freely, that you understand the risks, and that you have support during recovery. Evaluators assess your motivation, looking specifically for signs of coercion or external pressure. They ask about your expectations for recovery, your relationship with the recipient, and whether you have realistic ideas about what life after donation looks like.
The team will also want to know whether you have a caregiver lined up, whether your primary support system (spouse, partner, family) is on board with the decision, and whether your life is stable enough to handle several weeks of recovery. A history of substance use disorder or untreated mental health conditions doesn’t necessarily disqualify you, but evaluators will want to see that those issues are well managed.
What Happens During Surgery
Nearly all donor kidneys are now removed laparoscopically, through a few small incisions rather than one large one. Compared to open surgery, this approach means less pain medication, a shorter hospital stay, and faster recovery. Some centers use robotic-assisted or hand-assisted variations, but outcomes across these techniques are similar in terms of blood loss, complications, and time in the hospital.
The operation itself generally lasts two to three hours. You’ll be under general anesthesia the entire time. Laparoscopic technique has improved steadily over the years, and the procedure has gotten faster as surgical teams have gained experience.
Recovery Timeline
Most donors spend one to two nights in the hospital after surgery. If you live far from the transplant center, the team will ask you to stay in the area for about a week in case you need to return.
The first two weeks are the most restrictive. You likely won’t be able to drive during that period, so you’ll need a care partner for daily tasks and transportation. For six weeks after surgery, you shouldn’t lift anything heavier than a jug of milk. If you have a desk job, you may be able to return to work before the six-week mark. If your job is physical, ask your employer about temporary light-duty assignments.
Most living donors make a full recovery within four to six weeks and return to normal activities on that timeline.
Long-Term Health After Donation
Living with one kidney is safe for the vast majority of donors. Your remaining kidney compensates by growing slightly and filtering more efficiently. The risk of eventually developing kidney failure after donation exists, but it’s less than 1%. That risk is somewhat higher for Black men, though still small in absolute terms.
After donation, you’ll need regular checkups that include kidney function tests and blood pressure monitoring. These follow-up appointments are part of ensuring your one kidney stays healthy for life.
Who Pays for Donation
The recipient’s health insurance covers all medical costs tied to your donation. That includes your evaluation (lab work, imaging), the surgery itself, your hospital stay, and follow-up appointments. This is true whether you know your recipient or are donating altruistically.
What insurance doesn’t cover are the non-medical costs: travel, meals, lodging, lost wages, and childcare. Several programs exist specifically to fill that gap. The National Living Donor Assistance Center (NLDAC) reimburses travel and meal expenses for you and your caregiver during evaluation, hospitalization, and recovery, and also covers lost wages and dependent care. The National Kidney Registry’s Donor Shield program and the Alliance for Paired Kidney Donation’s Donor Protect Benefits offer similar coverage if you donate through their partner centers.
Legal Protections for Donors
Federal legislation has been introduced to strengthen protections for living donors. The Living Donor Protection Act, reintroduced in 2025, would explicitly classify recovery from organ donation surgery as a serious health condition, entitling eligible employees to job-protected leave under the Family and Medical Leave Act. The bill also addresses a longstanding concern about life insurance and disability insurance discrimination against donors, directing the Department of Health and Human Services to update educational materials on how donation affects insurance access.
Some states already have their own donor protection laws. Before you begin the process, it’s worth checking what protections apply in your state, particularly around employment and insurance.
Why Living Donation Matters
The kidney transplant waitlist in the United States stood at roughly 59,500 people in 2024. Wait times vary dramatically by blood type. Three years after being listed, 77% of patients with blood type AB had received a transplant, compared to just 46% of patients with blood type O. Five years out, more than half of type O patients were still waiting. Living donation bypasses much of that wait, and kidneys from living donors tend to function longer than those from deceased donors.