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Overview
Donor evaluation is a careful look at your whole picture, and it is built to protect you. The team needs to confirm three things. Are you healthy enough for the surgery? Will you stay healthy after donating? Are you making this choice freely? Blood work, imaging, heart and lung testing if needed, and a mental health evaluation all answer those questions.
The whole process usually takes four to eight weeks. You will meet with coordinators, surgeons, specialists, and a mental health professional. The pace can feel slow, but it is not a test you can fail by being human. At the end, the team gives you a clear answer about whether donation is safe for you.
What the evaluation covers
What is the donor evaluation?
The donor evaluation is a multi-part process designed to answer three core questions:
- Are you healthy enough to donate surgery safely?
- Will you maintain your health after donation?
- Are you making this choice freely, with full understanding of the risks?
The evaluation involves medical testing, psychological screening, meetings with the transplant team, and conversations with the independent donor advocate. By the end, the team will have a complete picture of your health, your psychological state, and your autonomy.
Medical testing
Medical testing is extensive. You'll have blood work, imaging, and specialized tests depending on your age and health. Some tests are standard for all donors; others are ordered if the center has concerns about your health.
Blood and urine tests
You'll give multiple blood draws and urine samples during evaluation. The lab runs extensive testing to assess kidney function, liver function, infection status, and blood type compatibility. Blood work typically happens at least twice—once during early evaluation and again closer to surgery to ensure no new issues have developed.
Core blood tests include:
- Complete blood count (CBC) to check red blood cells, white blood cells, and platelets
- Comprehensive metabolic panel to assess kidney and liver function, electrolytes, and glucose
- Kidney-specific testing including glomerular filtration rate (GFR), which is calculated from creatinine and age
- Coagulation studies (PT/INR and PTT) to check your clotting ability
- Infectious disease screening for HIV, hepatitis B and C, syphilis, and tuberculosis
For directed donation, your blood will also be tested against the recipient's blood to detect antibodies that could cause immediate rejection. A urinalysis checks for protein, blood, or signs of infection. Your blood type and tissue type (HLA) are determined to optimize matching with the recipient.
Imaging
Imaging lets the team see your organs and confirm they're healthy and suitable for donation.
- Ultrasound of the abdomen: First-line imaging for kidney donors; checks for cysts, stones, or abnormalities
- CT angiography: For most donors, to visualize kidney or liver blood vessels and confirm normal anatomy
- MRI: Used by some centers to get additional detail on kidney vasculature
- Chest X-ray: Screening for lung abnormalities, pneumonia, or other chest pathology
- Renal artery duplex (ultrasound): May be used instead of CT for kidney imaging
Imaging is essential for surgical planning. The surgeon needs to know exactly where your blood vessels are and which kidney or liver lobe is better suited for donation.
Heart and lung tests
If you're older than 50, have cardiac risk factors, or show symptoms of heart or lung disease, the team will order additional testing. An EKG detects arrhythmias or signs of ischemia. If the EKG shows concerns, a stress test or nuclear imaging studies your heart's response to physical stress. An echocardiogram provides detailed ultrasound images of your heart structure and function.
Pulmonary function tests assess lung capacity if there's respiratory concern. These tests confirm your heart and lungs can safely tolerate general anesthesia and the physical demands of surgery. They're not routine for all donors but are common for older donors and those with diabetes, high blood pressure, or a family history of heart disease.
Psychosocial evaluation
The psychosocial evaluation assesses your mental health, your decision-making capacity, and whether you're being pressured.
You'll meet with a mental health professional (psychiatrist, psychologist, or clinical social worker). This isn't about whether you're "crazy" or "too emotional"—it's about confirming you're making a voluntary, informed decision and that you understand the psychological and emotional dimensions of donation.
The evaluation covers:
- Mental health history: Depression, anxiety, bipolar disorder, psychosis, substance abuse
- Current mental health: Are you experiencing depression, anxiety, or other mental health concerns now?
- Motivation and understanding: Why do you want to donate? Do you understand the risks and permanent nature of donation?
- Decision-making capacity: Are you able to understand information and make decisions?
- Coercion assessment: Are you under pressure? Is this truly your choice?
- Coping skills: How do you handle stress? Do you have support?
- Baseline psychological functioning: How are you doing emotionally right now?
If the evaluation identifies concerns—uncontrolled depression, active substance abuse, signs of coercion—the team may recommend delaying donation until concerns are addressed, or may recommend against donation.
How long does evaluation take?
The timeline varies. Some centers can complete evaluation in 2-3 weeks; others take 6-8 weeks. Factors affecting timeline include:
- Center volume and schedule
- Whether any test results require follow-up
- Whether you need additional specialists
- Insurance approval processes
- Your own schedule (if you're traveling to a distant center)
As a general rule, expect 4-6 weeks from initial screening to final clearance for surgery.
During evaluation, you'll have:
- Initial evaluation visit (1-2 hours)
- Blood work appointments (may be multiple visits)
- Imaging appointments (ultrasound, CT, or MRI)
- Meetings with different specialists (surgeon, nephrologist, cardiologist if needed)
- Psychosocial evaluation
- Final clearance visit with the donor physician
What could disqualify you?
The evaluation is comprehensive because some conditions make donation unsafe. Certain medical conditions may disqualify you: kidney disease with GFR <60, uncontrolled high blood pressure, or poorly controlled diabetes. Heart disease, significant lung disease, liver disease, or active cancer typically result in disqualification.
Common medical reasons for disqualification include kidney disease (GFR <60), uncontrolled high blood pressure, and diabetes with kidney complications. Cardiac disease, respiratory disease, liver disease, and active cancer are disqualifying. The team prioritizes protecting your health for the long term.
Other medical barriers:
- Bleeding disorders or anticoagulation that can't be stopped safely
- Active infection including HIV, hepatitis B or C, or tuberculosis
- Severe obesity (BMI >40 at some centers) due to anticipated surgical risk
Psychological disqualification may occur if the team determines you're being pressured to donate, don't fully understand the risks, have active substance abuse, or lack capacity to make informed decisions. The team wants to protect your autonomy and ensure this choice is genuinely yours.
If disqualified, ask specifically why and what could potentially change the decision. Some barriers (blood pressure control, weight loss, smoking cessation) can be addressed through lifestyle changes, allowing you to reapply later. Other barriers are permanent, and that's okay—the center is protecting your health and safety.
Additional Detailed Information
Additional Information
GFR measurement and clearance criteria
GFR estimation methods. Glomerular filtration rate is estimated using serum creatinine, age, and gender via the CKD-EPI equation. Some centers also measure cystatin C or perform 24-hour creatinine clearance for more accurate assessment, particularly in elderly or obese donors.
Minimum GFR thresholds. Current OPTN guidelines suggest minimum GFR of 80 mL/min/1.73m² for kidney donors. Some centers accept GFR 70–80 in young, healthy donors with other reassuring factors. GFR <60 is a contraindication.
Proteinuria assessment. Donors with proteinuria >150 mg/day are typically excluded. Microproteinuria (30–150 mg/day) is reassessed and may or may not disqualify depending on other factors.
Crossmatching and tissue typing
HLA typing. Human leukocyte antigen (HLA) tissue typing is performed for all donors. Donors are typed for HLA-A, B, and DR loci. Better HLA matching correlates with longer graft survival.
ABO crossmatch. For ABO-compatible pairs, direct crossmatch uses recipient serum against donor T and B lymphocytes. Positive crossmatch typically contraindicates donation unless desensitization protocols are planned.
Calculated panel reactive antibody (cPRA). For recipients with prior sensitization (prior transplant, pregnancy, transfusion), cPRA is calculated to assess likelihood of finding a compatible donor. High cPRA increases virtual crossmatch importance.
Psychological screening standards
OPTN requirements. OPTN policy mandates psychosocial evaluation by a mental health professional for all living donors, with specific assessment of voluntariness, decision-making capacity, and coping resources.
Validated instruments. Some centers use validated instruments (e.g., Beck Depression Inventory, State-Trait Anxiety Inventory) to standardize assessment. Others use clinical interview alone.
Coercion detection. Structured assessment for coercion includes evaluation of family dynamics, specific pressures, and donor perception of choice freedom.
Written By:
Transplants.org Staff
Last Reviewed: February 26, 2026
Informed By:
Transplants.org, with participation from 23 leading U.S. transplant centers, led the largest comparative analysis of patient educational materials in transplant history. We recognize the participating centers who helped inform and inspire our direction with initial patient-centered educational content:
- Mayo Clinic (Co-Author)
- Vanderbilt University Medical Center (Co-Author)
- Johns Hopkins Hospital (Co-Author)
- UCLA Medical Center (Co-Author)
- UCSF Medical Center (Co-Author)
Transplants.org is an independent nonprofit organization and participation is not an endorsement by these organizations.
