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Types of living donation

Although not all transplant centers perform all types, living donation has expanded to include many variations since the practice began in 1954. These include:

Note: Many transplant centers perform these types of procedures, but may not have information dedicated to that topic on their Web page. Contact transplant centers in your area to find out if that they have similar programs.


Unrelated living donors are healthy individuals emotionally close to, but not related by blood to transplant candidates. They can be:

  • spouses
  • in-law relatives
  • close friends
  • co-workers, neighbors or other acquaintances


Non-directed donors are living donors who are not related to or known by the recipient, but make their donation purely out of selfless motives. This type of donation is also referred to as anonymous, altruistic, altruistic stranger, and stranger-to-stranger living donation. Individuals who are interested in becoming non-directed donors should contact transplant centers in their area to discuss the possibility of becoming a donor.

Paired donation

Kidney paired donation (KPD) is a transplant option for candidates who have a living donor who is medically able, but cannot donate a kidney to their intended candidate because they are incompatible (i.e. poorly matched). Paired exchange donation consists of two or more kidney donor/recipient pairs whose blood types are not compatible. The two recipients trade donors so that each recipient can receive a kidney with a compatible blood type. Once all donors and recipients have been tested, the kidney transplant surgeries can be scheduled to occur.

How does KPD work?

Transplant center staff enter eligible donor and recipient medical information into United Network for Organ Sharing’s (UNOS) computerized system. UNOS works with transplant centers throughout the United States to search for cases where the donor in each pair is compatible with the recipient in another pair (or multiple pairs). By exchanging donors, a compatible match for both recipients can be found. To learn more, choose an option below:

Who can participate?

For recipients: If you are eligible for a kidney transplant and are receiving care at a transplant center in the United States, you can participate in kidney paired donation. You must have a living donor who is willing and medically able to donate his or her kidney, but cannot donate to you because you are incompatible.

For donors: you must also be willing to take part in an exchange. Like any living donation program, all potential donors are required to complete an extensive medical and psychological evaluation to decide if they may donate. Learn more about being a living donor

Non-directed donors: People who wish to donate a kidney to a person they do not know are referred to as “non-directed donors”. A non-directed donor may help to match incompatible pairs that could not otherwise be matched. This way, the non-directed donor can allow multiple patients to receive a kidney transplant as a result of their one gift.

What are the benefits of kidney paired donation?

  • The recipient may receive the benefits of a compatible living donor kidney transplant Kidneys that come from a living donor last longer, on average, than kidneys that come from a deceased donor.
  • The recipient may also require less immunosuppressant drug therapy after a transplant from a living donor.
  • Transplant recipients may wait less time for a transplant.
  • Transplant recipients may spend less time on dialysis.
  • Transplant recipients may receive a transplant before they begin dialysis.
  • It can be a rewarding experience for the donor as more recipients are transplanted and their families are helped by their donation.

What happens if a match is found?

When a match is found, the transplant center will contact both the recipients and the potential donors. Your transplant team will conduct medical testing to check compatibility of the recipient to their matched donor. If the tests show that the matched donors and candidates are compatible, the next step is for both recipient/donor pairs to agree to the exchange. Even if tests identify a possible recipient/donor match, there is no guarantee that the transplant will occur.

Where does the transplant take place?

View a list of transplant hospitals that participate in the OPTN KPD program.

For recipients: You will generally have surgery at the transplant center where you currently receive care. However, you may choose to travel to another transplant center if the potential matched donor is unable or unwilling to travel.

For donors: In most cases, your surgery will occur at the center where you were first evaluated. Transplant professionals can send your kidney to the center where the recipient will be having surgery. In some instances, you may be asked to consider traveling to the transplant center of the recipient you matched with to donate your kidney. Before you are ever matched, your transplant coordinator will indicate in UNOS’ computerized matching system whether or not you are willing to travel certain distances and if you are willing to accept a shipped kidney with your informed consent. Your transplant center will discuss the potential risks involved with shipping a kidney with you. Having the donor and recipient at the same hospital may lower the risk involved in moving the kidney.

Blood type incompatible

Blood type incompatible donation occurs when a transplant candidate receives a kidney from a living donor with an incompatible blood type. To decrease the risk of rejection of the donated organ, candidates receive specialized medical treatment before and after the transplant.

Positive crossmatch

Positive crossmatch donation involves a living donor and a transplant candidate who are incompatible because antibodies(a protein substance) in the candidate will immediately react against the donor’s cells, causing loss of the transplant. Specialized medical treatment is provided to the candidate to prevent rejection. Cross matching is a very sensitive, multi-phase test performed on a living donor and a transplant candidate. The positive crossmatch testing process is similar to the process used for ABO-incompatible living donor kidney transplants, where patients can receive kidneys from living donors with blood types incompatible with their own. Surgeons will usually only perform positive crossmatch live donor kidney transplants if no other live donors (with a negative crossmatch) exist.

Reference and Publication Information
United Network for Organ Sharing (UNOS) is committed to providing accurate and reliable information for transplant patients. The content on this page was originally created on February 25, 2005 by UNOS and last modified on August 8, 2016.
This Web site is intended solely for the purpose of electronically providing the public with general health-related information and convenient access to the data resources. UNOS is not affiliated with any one product nor does UNOS assume responsibility for any error, omissions or other discrepancies.

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