A living donor is a person who donates an organ or part of an organ to someone else while still alive. Most commonly, this means giving one kidney or a portion of the liver, though living donation can also involve segments of the lung, pancreas, or intestine. In the United States, you must be at least 18 years old to be a living donor, and some transplant centers require donors to be 21 or older.
Living donation exists because the waitlist for organs from deceased donors far exceeds supply, and organs from living donors tend to perform better and last longer than those from deceased donors.
What Living Donors Can Give
The kidney is by far the most common living donation. Humans have two kidneys but can live a full life with one, which makes the math straightforward. After a kidney is removed, the remaining kidney gradually compensates by increasing its filtering capacity.
The liver is the second most common. Because the liver regenerates, a surgeon can remove a lobe or segment and transplant it into the recipient. According to Johns Hopkins Medicine, the donor’s liver begins regenerating immediately after surgery and returns to its normal size within eight to 12 weeks. The transplanted portion grows in the recipient as well.
Less frequently, living donors give a lobe of a lung, a portion of the pancreas, or part of the intestine. These donations are rarer and carry different risk profiles, so they’re typically reserved for specific medical situations.
Types of Living Donation
Living donation falls into two broad categories based on who receives the organ. In a directed donation, the organ goes to a specific person the donor names, usually a family member, spouse, or close friend. In a non-directed donation, the donor gives to a stranger. Non-directed donors are sometimes called altruistic or Good Samaritan donors, though transplant policy uses “non-directed” as the neutral term.
A third pathway is the paired exchange, which solves a common problem: you want to donate a kidney to someone you know, but your blood type or tissue markers aren’t compatible. In a paired exchange, your incompatible pair is matched with another pair in the same situation. You donate to their recipient, and their donor gives to yours. These exchanges can involve just two pairs or stretch into long chains. At Mayo Clinic, a single altruistic donor can start a chain that helps several recipients in sequence.
How Outcomes Compare to Deceased Donation
Transplants from living donors consistently outperform those from deceased donors. Data from the U.S. Renal Data System show that one-year graft survival for living donor kidney transplants reached 97.8% for recipients transplanted in 2020. For deceased donor kidneys transplanted the same year, one-year survival was 92.3%.
The gap widens over time. Five-year graft survival hit 88.5% for living donor kidneys transplanted in 2016, compared to 77.1% for deceased donor kidneys transplanted that same year. The difference comes down to organ quality: a kidney from a healthy living donor spends almost no time without blood flow, while a deceased donor organ endures hours of transport and preservation.
The Evaluation Process
Transplant centers put potential living donors through extensive screening before approving them. You can expect a full physical exam, blood and imaging tests, and screenings for cancer and other conditions. The center also reviews your complete medical history.
A separate psychological evaluation is required by national policy and must be conducted by a psychiatrist, psychologist, or licensed clinical social worker. This evaluation covers several areas: your mental health history, any substance use, your understanding of the medical risks, and whether your decision to donate is genuinely voluntary. Evaluators specifically look for signs of coercion or financial inducement. They also assess whether you have a realistic recovery plan, including adequate social support, time off work, and financial stability to handle the donation period.
The psychological screening isn’t a formality. It exists because donating an organ is major surgery with no direct medical benefit to you, so transplant teams have an ethical obligation to confirm that donors understand what they’re agreeing to and aren’t being pressured.
Surgery and Recovery
Most kidney donations today are performed laparoscopically, meaning the surgeon works through several small incisions rather than one large opening. According to Mayo Clinic, laparoscopic donors typically spend just one to two days in the hospital and return to work within six to eight weeks. Open surgery, which involves a larger incision, requires a longer hospital stay and a slower recovery, but it’s less common now.
Liver donation is a bigger operation. Because a lobe of the liver must be removed, the incision is larger, the hospital stay is longer (often five to seven days), and full recovery can take two to three months. The liver’s ability to regenerate means the donor’s organ returns to functional size relatively quickly, but the surgical recovery itself is more demanding than a kidney donation.
Long-Term Health Risks for Donors
For most kidney donors, the long-term outlook is very good. The 15-year risk of kidney failure is less than 1% for the general donor population, according to a review in the Annual Review of Medicine. However, certain populations may face higher risk, particularly donors who are younger, Black, or who have a family history of kidney disease. There is also a small increased risk of high blood pressure developing later in life, and for women, a slightly elevated risk of hypertension-related complications during pregnancy.
These risks are real but statistically small, and transplant centers weigh them against each individual donor’s health profile during evaluation. A 25-year-old donor with a family history of kidney disease faces a different risk calculus than a 45-year-old with no risk factors.
Legal and Financial Protections
One of the biggest concerns potential donors have is whether donating will affect their insurance or job security. The Living Donor Protection Act, introduced in Congress, addresses both. It prohibits insurance carriers from denying, canceling, or imposing special conditions on life insurance, disability insurance, or long-term care insurance based solely on someone’s status as a living organ donor. It also classifies recovery from donation surgery as a serious health condition under federal medical leave law, meaning eligible employees are entitled to job-protected time off.
The financial reality of donation still involves out-of-pocket costs for some donors. The recipient’s insurance typically covers the donor’s surgery and immediate medical care, but lost wages, travel expenses, and childcare during recovery often fall on the donor. Several nonprofit programs exist to help offset these costs, and transplant centers are required to discuss the potential financial implications during the evaluation process.