Requirements to be a living donor

There is no absolute age limit. Living kidney donors have successfully donated from age 18 to 80+. Eligibility is determined case by case based on your overall health, kidney function, and results of the complete medical evaluation.

Legal minimum: 18 years old in all states. Some centers accept emancipated minors with court authorization.

Maximum BMI varies by center, but generally accepted up to 35-40. A high BMI is not an automatic disqualifier, but it can increase surgical and post-operative complication risk. Many centers work with you to reach a healthier weight before surgery.

If your BMI is 35-40, ask the center about their specific requirements. Some accept with additional evaluation.

You must have two healthy kidneys and normal kidney function. Conditions that typically exclude or require special evaluation include:

• Type 1 diabetes (well-controlled type 2 may be acceptable)
• Uncontrolled hypertension or hypertension requiring multiple medications
• Kidney disease, proteinuria, or history of recurrent kidney stones
• Active cancer or recent cancer treatment (5 years disease-free usually required)
• Significant heart disease, recent heart attack or stroke
• Active hepatitis B/C or HIV (varies by center and state)
• Active psychiatric disorder or active substance use
• Current pregnancy (must wait at least 6 months post-partum)

Well-controlled conditions (mild hypertension on one medication, type 2 diabetes with HbA1c < 7%, etc.) are evaluated individually. Many centers have specialized programs for donors with stable chronic conditions.

Federal FMLA (Family and Medical Leave Act) gives you up to 12 weeks of unpaid medical leave with job protection. Your employer cannot fire you for donating an organ.

Applies to private employers with 50+ employees and to all public employers. Some states have additional protections.

Under federal law ACA section 2719A, health insurers cannot deny you coverage, raise your premium, or exclude you for being a living donor. Life insurers may do so in some states, but Donor Shield component 12 provides free legal support if an insurer discriminates against you.

Donor Shield reimburses up to $30,000 in related expenses: lost wages, travel, lodging, meals, dependent care, and pet care.

The evaluation process

The medical evaluation is free and takes several months. It includes:

• Complete blood work (type, compatibility, kidney and liver function)
• Urine analysis (proteinuria, infection)
• Imaging (CT angiography to map your kidneys and vessels)
• Cardiac evaluation (ECG, echo if >50 years)
• Psychological and social evaluation
• Consultation with nephrologist and transplant surgeon
• Informed consent in multiple stages

All donor medical costs are covered by the recipient's insurance or the public health system. Donor Shield reimburses up to $30,000 in non-medical related expenses: lost wages, travel, lodging, meals, dependent care, and pet care.

There is no economic compensation for the donation itself (it is illegal in the US), but the derived expenses are reimbursed.