Living-Donor Kidney Exchange 101 | UPMC HealthBeat

In the United States, there are more than 100,000 people on the kidney transplant waiting list. Every moment on the waiting list is critical, and the average wait for a deceased-donor kidney transplant is more than five years. But there is another option – a living donor transplant.  By identifying a living donor, patients can receive a transplant sooner.

But finding a living donor can be a long journey. Only one in four people evaluated to become a living donor are eligible candidates.

If you find a person who is healthy enough to become a living donor but the two of you are not a match, what do you do?

Speak with your doctor about a living-donor kidney exchange.

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What Is a Living-Donor Kidney Exchange?

A living-donor kidney exchange starts with a patient with end-stage kidney disease who has identified a potential living donor, but they are not a suitable match.

If that incompatible living donor agrees to take part in an exchange, they will “swap” recipients with another living donor. This allows both patients receive a kidney transplant from a compatible living donor. This simple, two-way exchange is called a “paired exchange.”

What Is a Donor Chain?

Through a more complex process called a “donor chain,” even more people can receive a life-saving transplant. Let’s say there are five patients with kidney disease who each need a transplant. They have all found a healthy living donor, but not all of the donors are suitable matches for the person they would like to donate to.

Most often, a chain starts with a person who signs up to become a living donor but doesn’t have a specific individual in mind to receive their donation (a non-directed donor). This generous person donates their kidney to the first patient on the chain with kidney disease. A living donor identified by the first patient will then donate their kidney to the second patient, and so on, until all five patients with kidney disease have received their transplant.

Because this chain starts with a non-directed donor, there is one potential living donor remaining at the end, who is called a bridge donor.

When a suitable match is found for that bridge donor, they can help start a new donor chain so that many more lives can be saved.

Why Take Part in Living-Donor Kidney Exchange?

Although recovery times and outcomes may vary, patients who receive a living-donor kidney transplant often undergo surgery sooner with improved outcomes and a quicker recovery.

By taking part in an exchange, you also gain two other benefits:

  • Eliminating incompatibility as a barrier – Living donors of any blood type can help save the life of a friend or loved one by taking part in a swap or chain.
  • Offering a more highly compatible match – Even compatible pairs are encouraged to take part in an exchange. This increases the pool for patients who are waiting for a swap and allows you to receive a transplant from a person who is the best medical match.

How Do I Participate in a Living-Donor Kidney Exchange at UPMC?

UPMC has a robust internal donor exchange program that works to match living donors with patients on the waiting list. This process allows our patients to gain access to transplants when they may otherwise have waited for years.

If you are a patient with end-stage kidney disease who would like to take part in an exchange, the first step is to be evaluated at our transplant center and speak with your doctor about a kidney exchange.

To get this process started, visit

About Transplant Services

For more than four decades, UPMC Transplant Services has been a leader in organ transplantation. Our clinicians have performed more than 20,000 organ transplant procedures, making UPMC one of the foremost organ transplant centers in the world. We are home to some of the world’s foremost transplant experts and take on some of the most challenging cases. Through research, we have developed new therapies that provide our patients better outcomes — so organ recipients can enjoy better health with fewer restrictions. Above all, we are committed to providing compassionate, complete care that can change – and save – our patients’ lives. Visit our website to find a provider near you.