What is Kidney Prioritization for Living Kidney Donors?

When you donate a kidney through the National Kidney Registry (NKR), you receive kidney prioritization if you ever need a transplant in the future.

This system provides a safety net for living kidney donors, honoring their generous gift by ensuring they are given special consideration for a living donor transplant should they experience kidney failure later in life.

The NKR offers this protection to address concerns donors may have about their future kidney function. In other words, what if you donate a kidney now, but then you need a kidney transplant in the future?

Here’s how it works:

1. If you previously donated a kidney through the NKR and have been diagnosed with kidney failure, you contact the transplant center where you donated and let them know that you are in need of a transplant and that you qualify for living donor kidney prioritization under Donor Shield.
2. The transplant center will do a medical evaluation and contact the NKR to activate your case.
3. Once you are active in the NKR’s kidney-matching system, your priority status goes into effect immediately and the NKR will begin the search for a living kidney donor to facilitate your transplant.
4. You will also be prioritized on the deceased donor waitlist. Specifically, four years will be added to your wait time in the UNOS system, so the system treats you as if you have been waiting four years longer than you actually have. This improves your position on the list, although highly sensitized patients already on the waitlist still receive priority. While this added wait time increases the chances of being matched with a kidney from a deceased donor, a kidney from a living donor is still preferable.

It is important to note that if you become a living kidney donor, it is extremely unlikely that you will need a kidney transplant in the future. As of May 2025, the NKR has facilitated more than 10,500 transplants, and none of these donors have ever needed a kidney transplant.

In fact, living kidney donors may be less likely to be diagnosed with kidney disease than the general public. All potential living donors undergo an extensive medical evaluation before being approved as donors, and assessing kidney function is a large part of that evaluation. Only people with healthy, well-functioning kidneys are accepted as donors. If your kidneys are healthy enough to get you approved as a kidney donor, chances are they will continue to function normally for many years to come.

In a 2017 study, which tracked 133,494 living kidney donors from 1987 to 2015, just 331 (about 0.25%) were diagnosed with kidney failure later in life. A 2014 study found that just 0.03% of living kidney donors experienced kidney failure within 15 years after donation. Another 2014 study, which followed 1,901 kidney donors for an average of 15 years, found a rate of kidney failure of 302 cases per million (0.0302%).

Kidney prioritization is available through NKR’s Voucher Program, NKR swaps, NKR internal direct donations, remote direct donations, and Kidney for Life direct donations.