Evaluation & Testing

The donor work-up checks kidney health, overall fitness, and readiness—medically and emotionally. You can pause or stop at any time; your reasons stay private with the transplant team.

How matching works (quick primer)

• Blood type (ABO): Some types match easily (O donates to anyone), others may need a swap program.
• HLA typing: A genetic “fingerprint” the immune system uses to recognize tissue.
• Crossmatch: Mixes donor cells/serum with the recipient’s to see if there’s a reaction.
  • Negative crossmatch → generally compatible.
  • Positive crossmatch → usually incompatible; a paired exchange or desensitization may be discussed.

Phases of evaluation

1) Pre-screen

• Health questionnaire & phone call with a coordinator/ILDA (Independent Living Donor Advocate).
• Local labs: blood type, basic kidney and urine tests. Sometimes a 24-hour urine collection.

2) Full work-up (often 1–2 clinic days)

• Kidney function: creatinine/eGFR; sometimes a measured GFR for precision.
• Urine testing: protein/albumin, microscopic exam; 24-hour collection if needed.
• Imaging: CT angiography of both kidneys (looks at arteries/veins, anatomy) to plan which kidney to remove.
• Heart & lungs: EKG; chest X-ray; stress test if age/risk factors suggest it.
• Infectious disease & metabolic labs: standard screening; glucose/A1c, lipids, etc.
• Consults: nephrologist, surgeon, social worker, dietitian, and psychologist/psychiatrist.
• Women of child-bearing potential: pregnancy test; up-to-date cancer screening per guidelines (Pap, mammogram, colonoscopy based on age).

3) Review & decision

• Approved: you’re medically cleared; surgery scheduling starts.
• Deferred: something needs attention (e.g., BP optimization, weight loss, repeat test).
• Declined: donation not recommended for your safety. Your reason remains confidential unless you choose to share it.

If you’re incompatible

• Paired exchange: you and your recipient swap with another pair.
• Non-directed donation + priority for your recipient: some programs allow a non-directed donation that benefits your intended recipient via a chain.

Timeline

Many centers finish evaluation in 1–3 months. Fast-tracks exist for urgent cases; complex findings can add time (extra imaging, repeat labs, consults).

Costs & logistics

• Medical bills: evaluation and surgery are usually covered by the recipient’s insurance through the transplant center.
• Travel & time off: coverage varies; ask about reimbursements, lodging, and employer forms.
• Insurance questions: life/disability policies may ask about donation history—clarify before surgery.

How to prepare

• Bring a medication list, allergies, and past surgeries.
• Follow fasting instructions for labs/imaging; drink water unless told otherwise.
• Avoid new supplements; limit NSAIDs unless your team says they’re okay.
• Wear comfortable clothes/shoes; expect lots of walking between departments.

What to expect on “evaluation day”

• Check-in, blood/urine labs, EKG, chest X-ray.
• CT scan block (contrast given for kidney imaging).
• Visits with nephrologist, surgeon, social worker, dietitian, ILDA.
• Plan on 6–8 hours; bring a snack and questions.

This page is informational and not medical advice. Policies and eligibility vary by center and your personal health history.