Donating a kidney: UK process

[Rasool]

TL;DR: for a kidney donation to a stranger, the health requirement for the donor is relatively high. The timescale for the whole process is on the order of months

Rigor: I didn’t take detailed notes during the process, so am reconstructing this based on call/​email logs and memories of conversations. I’m >80% sure I’ve hit all the major points, though the process may have changed recently. Happy to make edits if anyone has more up to date info.

Edit: A more thorough and up to date post on this topic can be found here

Introduction

In the UK, the process of donating your kidney to a stranger is known as a ‘non-directed altruistic donation’. There is some information online, certainly more than when I applied in 2020 but I thought I’d share my personal experience.

Non-directed altruistic donations are used in ‘chains’, where your donation would facilitate 3+ transplants.

You cannot legally sell your kidney in the UK, only donate.

Process

The process is roughly as follows:

1. You send an email registering your interest. You can see which hospitals offer kidney donations and then apply to the one most convenient to you. In London there were 4 options (I chose the Royal Free Hospital in Hampstead)

2. You receive a ~30 minute screening call from a nurse. This is basically to ensure that you understand what you’ve registered for and aren’t acting rashly or being coerced.

3. A 1-2 hour in-person/​video call with a psychologist. Among other things they want to check your motivations for donating, for example that you aren’t doing it in response to a recent trauma. There were also some questions about how you would feel if you were unable to donate, the fact that you don’t get to pick who gets your kidney, and about the fact that there is little recognition or kudos after the surgery is complete.

4. Blood and urine tests, blood pressure tests, and chat with a nurse about the surgery/​recovery etc. Probably a total of 1-2 hours in the hospital.

5. Meeting with a renal doctor to discuss test results and the surgery/​recovery etc. Around 1 hour in the hospital.

6. Full day of tests to check your kidney function. It involves ingesting something with a radioactive trace in the morning, then making you do a bunch of stuff, and seeing how it gets processed.

7. Your application gets submitted to some kind of review board which meets quarterly. At this stage apparently they consider your application closely to make sure that you aren’t being coerced or paid.

8. You wait for a match...

My journey

I personally did not make it past step 5. I was a reasonably fit and healthy 30 year old, but with a family history of cardiovascular disease and diabetes which meant I was too high-risk for a non-directed altruistic donation, but would have still been allowed to donate to a friend or family member.

Why they didn’t screen for this earlier on in the process I don’t know.

Practicalities

• Communication was pretty disorganised, a lot of stuff was arranged over the phone only, with no follow up email/​text, and no way of contacting anyone to confirm/​rearrange/​cancel.

• Things took a long time to progress from one step to the next. I initially applied in August 2020, but did not speak to the psychologist until April 2021, with my final meeting with the renal doctor in July 2021.

• I was told that the NHS would reimburse travel expenses but I didn’t enquire into this.

• Most availability for these steps are at the same time each week (eg. the slots for you to go to the hospital for tests are only Thursday afternoons). As you can imagine these are during work hours Monday-Friday.

P.S. My motivation

Lots has been written about kidney donation through the lens of effective altruism (there’s even a forum tag on the topic!), including a recent post which is what spurred me to write this post.

While I did like Alexander Berger’s point of view, what resonated with me more was Dylan Matthew’s argument, that while it may be more efficient for an individual to donate to charity (the time spent recovering from kidney surgery I could have instead worked and donated the money for more QALYs saved), donating a kidney could serve as a symbol and a talking point to influence those around me to create a kind of multiplier effect.

[Heye Groß]

If anyone from Germany is wondering, just found out that it’s not possible to donate a kidney “altruistically” in Germany. You have to be a direct relative or a spouse.

[Rasool]

I just came across an interesting (and not too long) article on this point. Quoting the juicy parts:

In 1996, Dr. Jochem Hoyer, a well-known German surgeon and head of a transplantation unit at a university hospital was told by a colleague, “It is easy for you as a transplant surgeon to praise living donors as long as it is NOT you who has to donate, but someone else.”³ Hoyer then voluntarily donated a kidney to an unknown recipient on the Munich waiting list⁴ with the idea that this would make a “very strong statement.”⁵

His action led to proposals in Germany for nondirected donation. However, the German Transplantation Act of 1997 prohibited nondirected transplants from living donors.⁶ Opponents of nondirected transplants feared that this would produce a market in which donors would expect financial compensation. Some surgeons did think that if organs from living donors were to go to someone to whom the donor felt connected, donations might increase.⁷

One change that might be attributed to Dr. Hoyer’s donation was a substantial increase in the percent of living kidney donations in Germany, jumping from 4% to 20% of all renal transplants.⁸ The 1997 Transplantation Act was legally challenged, but the German Constitutional Court upheld it.⁹ In 2012, regulations permitted only first- and second-degree relatives, spouses, and registered life partners to receive a kidney from a living donor. No nondirected donations were allowed.¹⁰ This was reaffirmed in 2018: “Altruistic or anonymous [kidney] donation is legally not allowed.”¹¹

Dr. Hoyer stated that it is “…incomprehensible that legislation…disapproves of a consistently lived Christian charity by refusal of an altruistic nondirected donation.”¹² Dr. Hoyer was fired from the institution in which he had worked for thirty years.