Nephrology · UK
Private assessment for living donor kidney transplant, alongside the NHS pathway.
A kidney from a living donor lasts longer than one from a deceased donor and can be transplanted before dialysis ever starts.
Indicative pricing
What private assessment costs - and what it cannot buy.
The transplant operation is not on this list, because in the UK it cannot be bought at any price.
In short
A full private pre-referral work-up: £2,000–£4,500. The transplant itself: NHS only.
| Assessment step | Indicative range | Typical duration | Results |
|---|---|---|---|
| Consultant nephrologist consultation | £250–£450 | 45 min | Same visit |
| Renal function + immunology bloods | £300–£600 | 20 min | 3–7 days |
| Blood group and HLA tissue typing | £400–£900 | 15 min | 1–2 weeks |
| CT renal angiogram (donor) | £600–£1,100 | 30 min | 48 hours |
| Isotope GFR + split function scan | £600–£1,000 | 3 hours | 3–5 days |
| Transplant itself (NHS-designated centre) | NHS-funded | 2–4 hours | 5–10 nights |
Under the Human Tissue Act 2004 it is a criminal offence to give or receive payment for an organ in the UK, and every living donation requires Human Tissue Authority approval following an Independent Assessor interview. Donors are reimbursed for genuine expenses and loss of earnings, which is lawful; payment for the organ is not. Transplantation takes place in NHS-designated centres.
The problem
The kidney you get from a living donor is a better kidney.
A living donor kidney typically lasts fifteen to twenty years against ten to fifteen from a deceased donor, starts working immediately far more often, and can be timed to happen before dialysis ever begins. The obstacle is almost always the pace of assessment.
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Racing to avoid dialysis?
Pre-emptive transplantation gives the best graft and patient survival. Once eGFR falls below 20, the clock on assessment matters enormously.
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Have a willing donor who is not a match?
The UK Living Kidney Sharing Scheme runs paired and pooled exchanges, and antibody-incompatible transplantation is possible at specialist centres.
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Worried about the risk to your donor?
Donor mortality is around 1 in 3,000 and long-term kidney failure risk stays very low. The assessment exists to protect the donor first.
When it helps
When living donation is the right route.
The situations where a living donor changes everything, the ones where it will not, and the sign that means urgent assessment.
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Approaching end-stage kidney disease
An eGFR falling below about 20 with a clear trajectory. This is the moment to start assessment, so transplantation can happen before dialysis.
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Already on dialysis
Living donation still gives far better outcomes than remaining on dialysis or waiting for a deceased-donor kidney, at any point on the list.
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A willing and compatible relative or friend
Genetic relation is not required. Spouses, partners, friends and altruistic strangers all donate in the UK, subject to HTA approval.
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Blood group or HLA incompatible donor
The UK Living Kidney Sharing Scheme matches incompatible pairs with others, or antibody removal allows incompatible transplantation directly.
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Failing previous transplant
A second or third transplant is entirely feasible, though higher antibody levels make matching harder and assessment more involved.
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Polycystic kidney disease
ADPKD is a common indication. Occasionally native nephrectomy is needed first to make room, which changes the sequencing.
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Altruistic (non-directed) donation
Donating a kidney to a stranger is lawful and supported in the UK, and often triggers a chain of paired transplants through the sharing scheme.
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Red flag: uraemic symptoms or fluid overload
Breathlessness at rest, severe nausea and vomiting, confusion or a very high potassium mean urgent renal assessment or A&E, not a routine appointment.
Donation routes
More than one route to a living donor kidney.
The pathways available in the UK - and which situation each one solves.
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Directed living donation
A relative, partner or friend donates directly to a named recipient. The commonest route, requiring HTA approval and an Independent Assessor interview for both parties.
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Paired and pooled exchange
Two or more incompatible pairs are matched through the UK Living Kidney Sharing Scheme so each recipient receives a compatible kidney. Matching runs quarterly.
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Altruistic non-directed donation
Donation to a stranger on the waiting list. It often initiates a domino chain, allowing several transplants from one altruistic act.
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Antibody-incompatible transplantation
Where no exchange match exists, antibody removal by plasma exchange or immunoadsorption plus rituximab allows an incompatible transplant at a specialist centre.
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Pre-emptive transplantation
Transplantation before dialysis has ever started. It gives the best graft and patient survival, and avoiding dialysis entirely is a substantial quality-of-life gain.
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Laparoscopic donor nephrectomy
The standard donor operation - keyhole or hand-assisted, two to three hours, with a small extraction incision, two to four nights in hospital and rapid recovery.
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Deceased-donor transplantation
The alternative if no living donor is available. Allocation is national through NHS Blood and Transplant, with a median adult wait of two to three years.
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Assessment and second opinion only
An honest review of whether transplantation is the right route now, whether dialysis should come first, and what to optimise in the meantime.
Safety and recovery
What it asks of the donor, honestly.
Living kidney donation is one of the most carefully regulated procedures in UK medicine, and the assessment exists primarily to protect the donor. The risks are small but they are real and they deserve stating plainly.
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Donor mortality is around 1 in 3,000
The risk of death from donor nephrectomy is roughly 0.03 per cent - comparable to other elective laparoscopic surgery, but not zero, and it is discussed explicitly during consent.
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Donor kidney function afterwards
The remaining kidney compensates, and donors typically settle at around 70 per cent of their previous eGFR. Long-term kidney failure risk stays low but is slightly above the general population.
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Donors need lifelong monitoring
Annual blood pressure, urine protein and kidney function checks for life. This is a permanent commitment, not a one-year follow-up.
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Pregnancy after donation
Pregnancy remains safe after donation, but the risk of gestational hypertension and pre-eclampsia is modestly increased and warrants obstetric awareness.
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Recipient rejection risk
Acute rejection affects roughly 10 to 15 per cent of living-donor recipients in the first year. Most episodes are detected on bloods and reversed with treatment.
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Recipient infection and immunosuppression
Lifelong immunosuppression brings raised risks of CMV and BK virus, other infections, diabetes, hypertension and skin cancer. Surveillance is lifelong.
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Surgical complications for the recipient
Ureteric leak or stricture, lymphocele, wound problems and, rarely, renal vessel thrombosis. Most are managed radiologically or endoscopically.
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Recurrent disease in the graft
Some diseases - FSGS, IgA nephropathy, membranous nephropathy - can recur in the transplanted kidney. Risk is discussed before listing, not afterwards.
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Red flags after transplant
Fever, reduced urine output, pain over the graft, rapid weight gain or a rising creatinine - contact the transplant centre the same day, at any hour.
Reading your assessment letter
Your assessment letter in four parts. Read the last one first.
Whether you are the recipient or the potential donor, the letter your nephrologist writes after assessment keeps to the same shape.
A quiet reminder
Transplant immunology language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the letter before your next appointment, just ask.
- 01 Header
Indication and kidney function
The cause of kidney disease, current eGFR and its trajectory, dialysis status, and whether pre-emptive transplantation is still achievable.
- 02 Technique
Immunology and imaging
Blood group, HLA type, crossmatch result and antibody levels; for donors, split renal function and the CT angiogram showing renal vessel anatomy.
- 03 Findings
Compatibility and suitability
Whether donor and recipient are compatible, whether the sharing scheme or antibody removal is needed, and any factor affecting suitability on either side.
- 04 Impression
Plan, HTA approval and timing
Read this first: what happens next, when the Independent Assessor interview occurs, and the realistic timeline to transplant.
Recognised by major UK insurers
Solid organ transplantation is not covered by UK private medical insurance and is not sold privately - it is delivered exclusively through NHS-designated transplant centres. What insurers do routinely fund is the work that surrounds it: specialist consultations, imaging, cardiac and respiratory assessment and second opinions.
Frequently asked
Everything we get asked about living donor kidney transplant.
Quick answers on who can donate, how long a living-donor kidney lasts, HTA approval, and what donation asks of the donor.
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Can I pay someone to donate a kidney in the UK?
No, and it is a criminal offence. The Human Tissue Act 2004 prohibits any payment or reward for an organ, and every living donation must be approved by the Human Tissue Authority after an Independent Assessor interviews donor and recipient separately to confirm consent is free, informed and unpaid. Donors are lawfully reimbursed for genuine expenses and lost earnings, which is a different thing entirely.
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Who can be a living kidney donor?
Any healthy adult with two normally functioning kidneys, normal blood pressure, no diabetes and an acceptable cardiovascular risk. There is no requirement to be genetically related - spouses, partners, friends and altruistic strangers all donate in the UK. Donors are usually between 18 and 70, though fitness matters more than age.
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How long does a living donor kidney last?
Typically fifteen to twenty years, against ten to fifteen for a deceased-donor kidney. Around 95 per cent of living-donor grafts are working at one year and roughly 85 to 90 per cent at five. Younger recipients and pre-emptive transplantation both push those figures higher.
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What if my donor is not a blood group match?
Two routes exist. The UK Living Kidney Sharing Scheme matches your incompatible pair with other pairs so everyone receives a compatible kidney, with matching runs several times a year. Alternatively, antibody-incompatible transplantation removes the offending antibodies with plasma exchange or immunoadsorption before transplant, at specialist centres.
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How long does the whole process take?
Typically four to six months from the start of assessment to transplant, though it can be faster where the donor is straightforward and both parties are seen promptly. The commonest sources of delay are donor imaging, cardiac assessment and the HTA approval interview - which is precisely where private assessment can remove months.
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What is recovery like for the donor?
Donor nephrectomy is keyhole surgery taking two to three hours, with two to four nights in hospital. Most donors return to desk work in two to four weeks and to physical work or full exercise in six to eight. Contact sports are generally discouraged afterwards to protect the remaining kidney.
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Will donating shorten my life or damage my health?
The evidence is reassuring. Donors settle at around 70 per cent of their previous kidney function, and long-term survival is comparable to the healthy general population. The absolute lifetime risk of kidney failure rises slightly, from roughly 0.3 to 0.9 per cent, which is why lifelong annual monitoring is part of the deal.
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Is a pre-emptive transplant really better?
Yes, and by a clear margin. Transplanting before dialysis begins gives better graft survival, better patient survival and avoids the cardiovascular strain and vascular access complications that dialysis brings. It is the single strongest argument for starting assessment when eGFR is falling towards 20 rather than waiting.
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Can I have a second or third kidney transplant?
Yes. Repeat transplantation is routine, though each previous graft raises antibody levels and makes finding a compatible donor harder. Highly sensitised patients are prioritised within the national allocation scheme and may benefit from antibody-incompatible protocols.
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When should I go to A&E rather than book a clinic?
Breathlessness at rest, severe vomiting, confusion, chest pain or a known very high potassium all need emergency assessment. After a transplant, fever, a sudden drop in urine output or pain over the graft means contacting the transplant centre the same day.
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