Eligibility Criteria

Overview

Not everyone can be a living donor, and that is by design. The evaluation is built to protect you, not just the recipient. The team confirms you are healthy enough for surgery and likely to stay healthy long after. Your age, your health, your habits, and the specific organ you would donate all factor in.

If you do not meet the criteria, it is not rejection. It means donation would carry too much risk to your own health. Some barriers can be addressed with time, like quitting nicotine or controlling blood pressure. Others are permanent, and that is okay. The team will walk you through what they find and what your options are.

Can you donate?

Who can be a Living donor?

Most healthy adults can donate. If you're 18–65 with no serious medical conditions, you likely qualify. But each person is unique, and the evaluation determines your individual candidacy.

Living donors come from all backgrounds and relationships to recipients:

• Family members (spouse, parent, sibling, adult child)
• Friends and colleagues
• People who've never met the recipient (altruistic donors)
• Donors in paired exchange programs

Interestingly, age alone doesn't disqualify you. Donors in their 70s and 80s have successfully donated. A healthy older donor may be a better candidate than a younger person with serious health conditions.

Medical requirements

Your transplant center will run a comprehensive evaluation to ensure you're healthy enough for surgery and can live safely with reduced organ function. This identifies any condition that might make donation unsafe or compromise your long-term health.

Age and health

You must be at least 18. Donors over 65 face more scrutiny because age increases surgical risk, but older donors aren't automatically excluded—they need more testing to confirm health and surgical tolerance.

Your baseline health is critical. You need normal blood pressure (controlled with medication is fine), normal kidney and liver function, and a healthy heart that can tolerate surgery. Active cancer within the past 5 years or serious infections like HIV or hepatitis generally disqualify you. Well-controlled diabetes may be acceptable depending on organ damage, but this requires careful evaluation.

Your weight matters significantly. Being overweight or obese increases surgical risk. Most centers use BMI as a screening tool, though cutoffs vary.

Organ-specific criteria

Different organs have different requirements because donation means something different depending on which organ you're giving.

Kidney donors need to meet specific criteria related to kidney function and overall renal health:

• Two kidneys present. Confirmed on imaging with normal anatomy
• Normal kidney function. GFR ≥80 mL/min/1.73m² ensures adequate renal reserve
• Stable blood pressure. Even if controlled with medication
• No protein in urine. Proteinuria indicates kidney stress
• Family history clear. No hereditary kidney disease

Kidney donors are the most common type of living donor because you can live well with one kidney. But the remaining kidney must be healthy enough to last your lifetime.

Liver donors face different criteria because the liver regenerates. Your remaining liver must be large enough and healthy enough to grow back:

• Normal liver function tests. No signs of liver disease or damage
• No cirrhosis or fibrosis. Scar tissue would impair regeneration
• Normal liver anatomy. Confirmed on imaging
• Minimal or no fatty liver disease. Fatty infiltration slows regeneration
• Adequate remaining volume. At least 25–30% of your liver stays with you

Lung donors have the most restrictive criteria because lung function is critical for post-operative survival. Your lungs must be healthy and strong:

• Normal lung function. Confirmed with pulmonary function testing
• No smoking history. Active smoking disqualifies you; past smoking requires evaluation
• Normal chest imaging. No signs of disease or damage
• Good functional capacity. Ability to tolerate surgery and recovery challenges

Behavioral and lifestyle factors

Medical tests don't tell the whole story. Transplant centers want to understand your lifestyle and decision-making patterns because these strongly predict how well you'll recover and whether you'll follow through with necessary follow-up care. Someone who struggles with compliance—whether it's smoking cessation, taking medications, or keeping appointments—faces higher complication risks.

You'll be asked about personal health habits and circumstances:

• Smoking. Current smoking may disqualify you; quitting can open doors
• Alcohol use. Heavy drinking raises surgical risk; moderate use is acceptable
• Drug use. Active substance abuse is grounds for disqualification
• Mental health. Stable mental health is important; active suicidal ideation disqualifies
• Adherence. Will you follow medical instructions and attend follow-up appointments?
• Decision-making. Are you choosing freely, without coercion or pressure?

These questions matter because they predict success. A donor who smokes, drinks heavily, or isn't reliable with medical care is at higher risk for complications and less likely to show up for lifelong follow-up appointments.

Conditions that may rule you out

Some medical conditions make donation unsafe because they increase your surgical risk or affect your ability to live safely with one organ. Cardiovascular and metabolic conditions are among the most common disqualifiers.

Cardiovascular and organ function issues are frequently screening criteria:

• Uncontrolled high blood pressure. Significant hypertension increases surgical and anesthesia risk
• Heart disease. Including history of MI, coronary artery disease, or heart failure
• Chronic kidney disease. GFR <60 is generally disqualifying for kidney donors
• Lung disease. COPD, pulmonary hypertension, or significant smoking history

Metabolic and systemic conditions also matter because they affect how you'll heal and function long-term:

• Diabetes with end-organ damage. Including kidney disease, neuropathy, or retinopathy
• Liver disease. Cirrhosis, chronic hepatitis, or fatty liver disease
• Autoimmune diseases. Some centers are cautious; lupus and scleroderma require extra scrutiny

Infectious diseases and cancer require careful evaluation due to transmission risk or recurrence risk:

• HIV, hepatitis B or C, active TB. Or other serious infections that could be transmitted
• Active cancer. Or cancer within 5 years (some exceptions exist)

Finally, behavioral and safety factors matter significantly:

• Bleeding or clotting disorders. These increase intra-operative and post-operative risk
• Uncontrolled mental illness. Or active suicidal ideation
• Morbid obesity. BMI >40 or center-specific limits
• Pregnancy. You'll wait until after delivery and recovery

This isn't an exhaustive list. Every condition is evaluated individually and may be acceptable with extra testing.

What if I am not eligible?

Being ineligible can feel like a disappointment or rejection. It's neither. If you don't meet criteria, it's because the transplant center determined that donation carries unacceptable risk to your health. That's the center protecting you, not shutting you out.

If you're not eligible:

• Ask why. Get a clear explanation of what disqualified you.
• Ask if anything can be fixed. Sometimes blood pressure control, weight loss, or smoking cessation opens the door.
• Get a second opinion. Different centers have slightly different criteria. Speak to another transplant center if you want.
• Consider non-directed donation if you're set on helping. Some people with conditions that preclude their own donation become altruistic donors to help someone else (the organ goes to whoever is next on the list, not to a specific person).
• Stay involved in other ways. You can advocate, volunteer, or support the recipient in non-medical ways.