Living Kidney Donation at Mayo Clinic: What are my Options?

Dec 11, 2023 | Kristin Eggebraaten | @keggebraaten

Today over 100,000 men, women and children are waiting for an organ transplant and over 80,000 of those are waiting for a kidney. Increasing the number of possible living donors and coming up with innovative ways to get more people transplanted are two of the best ways to reduce this waiting list. One unique innovation doctors have used to transplant more kidney candidates is paired donation kidney transplant.

Kidney transplants can be performed from a deceased or living donor. Living donors are often a family or friend, but they can also be anonymous, non-directed donors, meaning the recipient and donor do not know each other. Often, when someone wishes to donate anonymously, that donation can spark a chain of kidney transplants, a process known as paired donor kidney transplant. Generally, non-directed donors are genuinely altruistic, very giving and unselfish people. They also must be age 21 or older.

In kidney paired donation, the non-directed kidney donation goes to someone who had a donor lined up, but the donor was not a compatible match. That donor then “pays forward” their donation to someone else who is waiting. Living donation gives transplant patients a chance for better quality of life and a longer life. Living donor surgery can be planned, and if possible, the patient can be transplanted before dialysis is needed. Kidney paired donation is only available for living donor transplants.

Mayo Clinic performed its first paired kidney donation in 2007 with a two-way paired donation. A son desperately wanted to donate to his father, but their blood types weren’t a match. However, the son had the option to swap his kidney with someone else who had a donor that didn’t match. Mayo Clinic was able to find another donor/recipient pair that was incompatible due to antibody resistance. The pairs matched and the transplants were performed in November 2007.

With over 15 years of experience facilitating paired donor kidney transplants, Mayo Clinic has now completed hundreds of transplants using this model and is now the top transplant center in paired donation in the U.S.

Mayo Clinic has also established a relationship with the National Kidney Registry (NKR). Working with the NKR has allowed Mayo Clinic to expand the donor pool for recipients because NKR matches living donors and recipients through a national registry with transplant hospitals throughout the United States. With a large pool of donors and recipients, more exact matches can be made, which allows for optimal long-term outcomes.

There are a variety of options to donate a kidney at Mayo Clinic. Each option would be discussed with the donor at the time of evaluation and the care team would assist you in understanding and selecting which option best fits yours and the recipient's situation. Here are some brief descriptions of each possible situation.

Direct Donation: A donor chooses to donate directly to a known recipient. If the donor does not match the recipient, the donor will be ruled out.

Paired donation: The donor and recipient are not compatible (not a match) or it is recommended to “swap” for a better matched donor for the recipient. An example would be when the donor is much older than the recipient or a better antigen/genetic marker match is preferred.

Remote Donation: Remote donation allows the donor the opportunity to be evaluated and have surgery with a transplant center much closer to home. This typically lessens the financial and caregiver burden.

Voucher Donation: This allows a donor to donate at a separate time from the recipient receiving their transplant, in essence, advanced donation.

One advantage of voucher donation is you are able donate according to your schedule while providing a voucher for your friend or family member who needs a transplant. This makes your recipient the “voucher holder.” This voucher holder is then activated for matching when ready for transplant.
In addition to the recipient who needs a transplant, you can also name five family members as back-up voucher holders should the original recipient receive a deceased donor transplant or is no longer a candidate for transplant.
However, only one person can “redeem” the voucher with NKR. The voucher cannot be traded or given to another person after the donor donates.
NKR does not guarantee a match will be found for the donor or the recipient.
Mayo Clinic does not track voucher holders. Mayo Clinic would not be responsible for finding a donor for the voucher holder.
The Voucher holder can “redeem” their voucher at any transplant center participating with NKR.

Becoming a donor is a choice you need to make for yourself. You should not feel pressured to be tested or to donate. Not everyone can be a donor and not everyone should be a donor. A person needs to be medically healthy and psychosocially stable and financially in a good position to take time off work. By qualifying to be a living donor, whether for someone you know and love or just because you know there is a need, you could save the lives of many people by starting a chain of kidney transplants through the paired donor process we described. If you would like more information about kidney donation, visit our living donor toolkit.

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