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Overview
Not every center has the same living donor experience. Some have large, established programs. Others are smaller. The center you choose becomes the team that protects you through surgery and follows you for years.
Centers that do more living donations tend to have better outcomes. The other questions are practical. Insurance, distance from home, and whether the center follows donors for life all matter. Strong programs also have a donor advocate, a person whose only job is to protect you. A good center welcomes the questions you bring.
Starting your search
Finding a Living donor program
Researching programs
Start by identifying transplant centers near you or willing to accept you. Several resources can help you find programs:
- OPTN's transplant center database (optn.transplantation.org) lists all U.S. centers by organ type and location
- Your state's OPTN region can provide local resources and regional network information
- National Living Donor Assistance Center (NLDAC) at nldac.org helps find centers and financial assistance
- Disease-specific foundations like the National Kidney Foundation and American Liver Foundation have donor resources
- Internet search for "living kidney/liver donor program" plus your location or state
Once you've identified potential centers, contact their donor program coordinator. Ask whether they accept donors with your background and what their next steps are for evaluation.
What to look for in a center
Program experience and volume
Quality living donor programs share certain characteristics. Assess their experience with your specific organ type—kidney, liver, or other. Volume matters significantly—centers performing 50+ living donations per year have better outcomes than those doing only 5–10.
Key metrics to ask about:
- How many living [your organ] donations annually?
- What are your complication rates?
- What are your graft survival rates at 1, 5, and 10 years?
This single volume metric predicts their outcomes, complication rates, and experience level. Higher volume programs develop expertise and systems that directly benefit donors.
Long-term donor follow-up and support
A good program follows donors long-term, not just 6 months. Ask about their long-term follow-up policy and whether they track donor outcomes at 1 year, 5 years, and 10 years. Better programs maintain ongoing relationships and actively monitor for long-term complications. This matters especially for kidney donors, whose long-term health depends on careful monitoring of the remaining kidney.
Also ask about psychosocial support and whether the program offers peer support groups or can refer you to therapists trained in transplant psychology. Strong programs recognize that donation is emotionally complex.
Advocacy and transparency
Strong advocacy and transparency separate excellent programs from mediocre ones. Independent donor advocacy should be a dedicated role with ability to meet privately with the advocate. The advocate should independently recommend against surgery if they have concerns about your welfare.
Transparent programs share their data:
- Graft survival rates at 1, 5, and 10 years
- Donor complication rates by type and severity
- Donor readmission rates and reasons
- Long-term donor follow-up data
If a center won't provide outcome data, that's concerning and may indicate poor results. Ask for a dedicated living donor coordinator who answers questions, schedules appointments, and guides you through evaluation. This person should be your consistent point of contact.
Does it have to be the same center?
For directed donors, evaluation should typically happen at the recipient's transplant center. The center needs to manage both of you, ensure compatibility, and coordinate surgery timing.
In rare cases, you might seek evaluation elsewhere:
- The recipient's center has an extremely long waitlist
- You have concerns about the center's donor protections or practices
- You need geographical distance from the recipient or their family
- The center lacks expertise in your organ type
For non-directed donors, you can choose any center with a strong non-directed donor program. Consider centers with high non-directed volume because these programs develop specific expertise in matching incompatible pairs and navigating the chains-of-giving process.
Questions to ask a potential center
When you contact a center or visit in person, ask about their outcomes and experience. Key questions include their annual volume for your organ type, complication rates, and graft survival at 1, 5, and 10 years. Understand their policy for long-term donor follow-up and whether you can meet privately with the independent donor advocate.
Additional important questions:
- What is your average evaluation timeline?
- What happens if I develop a medical condition during evaluation?
- What support do you provide donors during recovery?
- Do you have a peer support group for donors?
Listen carefully to how the center responds to these questions. Do they seem confident and transparent, or evasive? Do they emphasize your autonomy and right to decline, or make you feel obligated to donate? A good center respects your right to change your mind at any point.
Insurance and location
Insurance coverage
Insurance coverage is essential to verify before committing to a center. Most transplant centers accept Medicare, Medicaid, and major private insurance, but verify that your specific insurance (or the recipient's insurance, for directed donors) is accepted. Confirm that evaluation, surgery, and follow-up care are covered. Some centers have financial assistance programs if coverage is incomplete.
Geographic considerations
Location affects your evaluation and recovery experience. A center close to home is convenient, while a distant center requires travel and lodging during evaluation and surgery. Some people intentionally choose distant centers for psychological distance from the recipient.
If evaluating a distant center, ask:
- Can evaluation components be done locally (imaging, labs with your doctor)?
- Are initial consultations available virtually?
- Does the center provide travel or lodging assistance?
- What happens if you need follow-up care post-surgery?
These questions help determine whether a distant center is practical and manageable for your situation.
Additional Detailed Information
Additional Information
Center volume and outcomes
Volume-outcome relationship. Studies consistently show that transplant centers performing higher volumes of living donation have better perioperative outcomes, fewer complications, and longer graft survival. This is particularly true for liver donors, where center-specific outcomes vary widely.
OPTN outcome reporting. All U.S. transplant centers are required to report outcomes to OPTN. These data are publicly available on OPTN's website and can be searched by center.
Living donor program growth. Centers with dedicated living donor programs (vs. those treating living donation as an adjunct to deceased donor transplant) typically have better donor outcomes and higher satisfaction.
Geographic variation and access
Program distribution. Living donor programs are concentrated in urban areas and medical centers. Rural and underserved regions have fewer programs, contributing to health equity disparities in living donation access.
Travel burden. Donors traveling >100 miles for evaluation and surgery report lower satisfaction and higher dropout rates during evaluation.
Advocacy and oversight
OPTN living donor protections. OPTN requires all centers to have an independent donor advocate and specific protocols for assessment of coercion and informed consent.
Accreditation. Centers accredited by the American Commission on Accreditation of Transplant Programs (ACOTP) must meet specific standards for living donor protections and outcomes.
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.
