3 Paths to Giving

A Non-Directed Donor (NDD), also known as an altruistic donor, is a living person who donates a kidney or part of their liver without a specific recipient in mind. Instead of donating to a friend or family member, their organ goes to the most suitable recipient on a transplant list, often initiating a donation chain (in the case of kidney donation) that helps multiple people receive transplants.

Many NDDs choose to donate because they want to make a difference in someone's life, even if they don’t know the person. Some are motivated by a personal connection to transplant, while others simply see it as an opportunity to help.

To donate a kidney, a donor candidate must be in good physical and mental health. Individual transplant centers set age limit guidelines. Candidates must also have normal kidney function. There are some medical conditions that could prevent someone from being a living donor. These include, but are not limited to, uncontrolled high blood pressure, cancer, acute infections, or a high BMI. 

To be eligible to donate a portion of your liver, you must typically be between 18 and 60 years old and in good physical and mental health with no serious chronic conditions such as diabetes, uncontrolled high blood pressure, or active infections. A BMI of 32–35 or lower is usually required, as excess weight can affect liver health and surgical outcomes. Additionally, you must have normal liver function with no signs of liver disease or excessive fat.

Living donor protections are policies and programs designed to ensure that kidney and liver donors do not face financial, medical, or employment-related hardships as a result of their donation. These protections vary by transplant center.  While all transplant centers provide non-directed donors with basic protections through the National Living Donor Assistance Center (NLDAC), some go further by partnering with the Alliance for Paired Kidney Donation (APKD) and/or the National Kidney Registry (NKR). Centers with these partnerships are often more donor-focused and offer additional support.  Donor protections can include the following:

Financial Protections:

• Coverage for Medical Expenses: The recipient's insurance covers the donor’s medical evaluation, surgery, and immediate post-op care.
• Lost Wage Reimbursement: Programs like NLDAC, The Alliance for Paired Kidney Donation and the National Kidney Registry may provide compensation for lost wages during recovery.
• Travel and Lodging Assistance: Many programs reimburse travel and lodging expenses for donors and a companion.
• Tax Deductions & Credits: Some states and countries offer tax deductions or credits to offset donation-related costs.  The American Kidney Fund (AKF) Living Donor Protection Report Card provides a state-by-state overview of existing and proposed legislation related to living organ donors.

Legal and Employment Protections:

• Job Protection: The Family and Medical Leave Act (FMLA) in the U.S. allows eligible donors to take up to 12 weeks of unpaid, job-protected leave.
• Anti-Discrimination Laws: Some states have laws preventing employment or insurance discrimination against living donors.
• Insurance Safeguards: Certain policies prevent donors from being denied health, life, or disability insurance due to their donor status.

Long-Term Health Monitoring:

• Donor Follow-Up Care: Transplant centers typically provide long-term health monitoring, though the extent of coverage varies.
• Priority on Transplant Lists: In the U.S., living kidney donors who later need a kidney transplant receive priority on the deceased donor transplant list.  In some cases living kidney donors who later need a kidney transplant would be eligible to receive a living donor transplant.

An NKDO Volunteer Mentor is a trained volunteer with the National Kidney Donation Organization (NKDO) who provides guidance and support to potential living kidney and liver donors. These mentors are experienced living donors themselves and help educate prospective donors about the donation process, answer questions, and offer emotional support.

Donating a kidney to a stranger can come with concerns about what happens if a friend or loved one needs a kidney in the future, and you no longer have an extra one to give. 

For donors who don’t have a specific recipient in mind, if you elect to donate through an exchange program like the National Kidney Registry or the Alliance for Paired Kidney Donation, you will be given a voucher which can be redeemed by a friend or family member of yours if they ever need to be prioritized to receive a kidney in the future. 

Each program has differing rules regarding how the voucher can be redeemed and who will qualify. You can learn all about both options by clicking the links above. 

Kidney donors:  Donors with desk jobs that don’t require heavy lifting can typically return to work within 2-4 weeks of surgery. Donors with a laptop working from home may feel ready to resume work within a week of surgery. Donors with more active jobs may need 6-8 weeks to fully recover.

Liver donors:  On average, liver donors typically need about 6 to 8 weeks off to recover from surgery, but some may need longer, especially if their job involves physical labor.  Full recovery can take up to 3 to 6 months, during which donors should avoid strenuous activities.

Kidney donors:  Kidney donors do not need to follow a special diet. Nutrient-rich foods will help you keep their weight in check and lower the risk of high blood pressure and diabetes. Those steps will help maintain kidney health. Some doctors recommend that donors avoid eating too much whey-based protein, especially from protein powder, supplements, or red meat. Excess protein, especially from animal-derived sources, may make the kidney work harder.

Liver donors:  After liver donation, donors are advised to follow a healthy, balanced diet rich in protein, fruits, vegetables, and healthy fats to support healing. For several months, a low-fat diet is recommended, especially if the gallbladder is removed (which is very common), as it can affect fat digestion. Small, frequent meals may help with digestion, and alcohol should be avoided. Over time, most donors can return to a normal diet, but some may still need to limit high-fat foods. It’s important for donors to follow their surgeon’s advice and consult a dietitian if needed.

Kidney donors:  Yes, as a general rule, anything you can do with 2 kidneys, you can do with one kidney, including drinking alcohol.  The only major restriction you will have as a kidney donor is that you should refrain from taking NSAIDS (Advil and Ibuprofen) after you donate a kidney.

Liver donors: Liver donors can drink alcohol in moderation after they have fully recovered from surgery. However, doctors typically recommend avoiding alcohol for at least three to six months post-donation to allow the liver to regenerate and heal properly.

The risk of a living kidney donor later needing a kidney transplant is very low, but it does happen. Studies show that about 0.5% to 1% of living kidney donors will eventually develop kidney disease severe enough to require a transplant. This means that out of every 1,000 donors, about 5 to 10 may need a transplant in their lifetime.

Because of this small risk, the U.S. gives prioritization on the deceased donor waiting list to living kidney donors who later need a transplant themselves. This helps ensure they receive a kidney more quickly if they ever require one.  In many cases, a living kidney donor who later needs a transplant would receive priority for a living donor transplant.

No, in general, living donors tend to live slightly longer than the average population. This is because organ donors are typically among the healthiest individuals, as they must meet strict medical criteria before donating.

Yes, women who plan to have children should discuss this with their donor care team and OBGYN. Most transplant centers recommend waiting at least a year after donation before becoming pregnant.

The recipient’s insurance covers the donor’s testing, evaluation, and surgery, ensuring that organ donation remains a cost-neutral process. Donor protections help make this possible by covering expenses such as lost wages, childcare, travel, lodging, and more. Your NKDO volunteer mentor will go over these details with you, and you will also be assigned a social worker from your transplant center to help ensure that your donation is cost neutral.