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Living donor transplant in the UK - how it actually works.

Kidney, part of a liver, and in rare cases a lung lobe. Every living donation in the UK needs Human Tissue Authority approval, takes place in an NHS-designated centre, and cannot lawfully be paid for.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

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–£5,000. The transplant itself: NHS only.

Assessment step Indicative range
Consultant transplant physician consultation £250–£500
Organ function bloods + virology £300–£600
Blood group and HLA tissue typing £400–£900
CT or MR angiography (donor mapping) £600–£1,400
Cardiac and respiratory assessment £700–£1,400
Transplant itself (NHS-designated centre) NHS-funded

Under the Human Tissue Act 2004 it is a criminal offence to give or receive any payment or reward for an organ in the UK. Every living donation must be approved by the Human Tissue Authority after an Independent Assessor has interviewed donor and recipient separately. Donors are lawfully reimbursed for genuine travel costs, accommodation and loss of earnings.

The problem

Living donation is regulated tightly - and for good reason.

A healthy person undergoing major surgery for someone else raises questions no other operation does. The UK framework is built around one principle: the donor must be protected, informed, and entirely free of pressure or payment.

  • Not sure which route applies?

    Directed donation, paired exchange, altruistic donation and incompatible transplantation each solve a different problem. The right one depends on compatibility.

  • Wondering what the donor is signing up for?

    Kidney donation and liver donation carry very different risks. We set both out plainly, with the actual numbers.

  • Worried about pressure within a family?

    The Independent Assessor interviews the donor alone, precisely to test this. A donor can withdraw at any point without explaining why.

When it helps

When living donation is the right route.

What can be donated by a living person in the UK, which situations it suits, and the presentation that needs emergency care instead.

  • Kidney donation

    By far the commonest living donation in the UK, with over a thousand performed each year. A living-donor kidney lasts around fifteen to twenty years.

  • Partial liver donation

    The left lateral segment for a child or a right lobe for an adult. Both livers regenerate, but donor risk is far higher than for kidney donation.

  • Paired and pooled exchange

    Incompatible donor-recipient pairs are matched with other pairs through the UK Living Kidney Sharing Scheme, so everyone receives a compatible organ.

  • Altruistic non-directed donation

    Donating to a stranger on the waiting list is lawful and supported here, and frequently triggers a chain of several transplants.

  • Antibody-incompatible transplantation

    Antibody removal by plasma exchange or immunoadsorption allows transplantation across a blood group or HLA barrier at specialist centres.

  • Pre-emptive transplantation

    Transplanting before dialysis begins gives the best graft and patient survival. It is the strongest reason to start assessment early.

  • Living lobar lung donation

    Two donors each give a lower lobe. Effectively obsolete in the UK, and mentioned mainly because people ask about it.

  • Red flag: acute deterioration

    Breathlessness at rest, confusion, vomiting blood or a very high potassium mean emergency assessment. Living donation is a planned pathway, not an emergency one.

Donation routes

The routes available in the UK.

What each route involves - and which obstacle it is designed to overcome.

  • Directed living donation

    A named donor gives to a named recipient - usually a relative, partner or friend. The commonest route, and the simplest, provided they are compatible.

  • Paired and pooled exchange

    Incompatible pairs are matched with other pairs so each recipient gets a compatible kidney. The UK scheme runs matching several times a year.

  • Altruistic non-directed donation

    Donation to an unknown recipient from the national list. It frequently starts a domino chain, so one act can enable several transplants.

  • Antibody-incompatible transplantation

    Plasma exchange or immunoadsorption with rituximab removes the offending antibodies, allowing transplantation across an incompatibility.

  • Living donor kidney transplant

    Laparoscopic donor nephrectomy with implantation into the recipient’s iliac fossa. Two to four nights for the donor, five to ten for the recipient.

  • Living donor liver transplant

    A left lateral segment, left lobe or right lobe depending on recipient size, with both livers regenerating over six to twelve weeks.

  • Deceased donor transplantation

    The alternative route, allocated nationally by NHS Blood and Transplant. For most UK adults needing a liver, this is the realistic pathway.

  • Assessment and second opinion only

    An honest review of which route is realistic, what the donor would be taking on, and whether the timing is right. Sometimes that is the whole answer.

Safety and recovery

What it asks of the donor, honestly.

Donating an organ is the only common operation where a healthy person accepts surgical risk for someone else. The UK framework exists to make sure that decision is informed, unpaid and freely made - and the numbers deserve stating plainly.

  • Kidney donor mortality: around 1 in 3,000

    Comparable to other elective laparoscopic surgery. Long-term kidney failure risk rises slightly, from roughly 0.3 to 0.9 per cent over a lifetime.

  • Liver donor mortality: 1 in 200 to 1 in 1,000

    Substantially higher, and dependent on which part is donated. Right lobe donation for an adult carries the greatest risk; left lateral segment donation for a child the least.

  • Donor complications are not rare

    Wound infection, hernia, bleeding, pain and, for liver donors, bile leak. Kidney donors experience complications in around 5 to 10 per cent, liver donors 20 to 40 per cent.

  • Lifelong monitoring for kidney donors

    Annual blood pressure, urine protein and kidney function checks, permanently. This is part of what donation commits you to.

  • Psychological assessment is mandatory

    Independent assessment tests for pressure to donate and prepares the donor for a poor recipient outcome, which affects donors profoundly when it happens.

  • Payment is unlawful; expenses are not

    Reimbursement of travel, accommodation and lost earnings is lawful and routine. Any payment or reward for the organ itself is a criminal offence.

  • The donor can withdraw at any time

    At any point, without giving a reason. Centres provide a confidential route to withdraw that protects the donor from family fallout.

  • Recipient immunosuppression is lifelong

    Tacrolimus-based therapy for the life of the graft, with raised risks of infection, kidney impairment, diabetes, hypertension and skin cancer.

  • Red flags after surgery

    For either party: fever, wound discharge, severe or spreading pain, breathlessness, or - for recipients - reduced urine output or jaundice. Contact the transplant centre the same day.

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 written after assessment keeps to the same shape.

A UK consultant transplant physician reviewing donor and recipient assessment results

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.

  1. 01 Header

    Indication and organ function

    The underlying disease, the recipient’s current organ function and trajectory, and why living donation is being considered now.

  2. 02 Technique

    Compatibility and imaging

    Blood group, HLA type, crossmatch and antibody levels, along with the donor imaging that shows whether the anatomy allows safe donation.

  3. 03 Findings

    Donor suitability

    Organ function, cardiovascular and metabolic health, and the independent psychological assessment. Any factor that would count against donation is set out here.

  4. 04 Impression

    Route, HTA approval and timing

    Read this first: which donation route is proposed, when the Independent Assessor interview happens, and the realistic timeline to transplant.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

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 transplant.

Quick answers on which organs can be donated, HTA approval, whether donors can be paid, and what donation asks of a healthy person.

  • Which organs can a living person donate in the UK?

    A kidney, most commonly - over a thousand living kidney donations take place each year. Part of a liver is the other established route, mainly for children. A lobe of lung is theoretically possible but effectively obsolete here. Living donation of a heart or a whole liver is, for obvious reasons, not possible.

  • Do I need Human Tissue Authority approval?

    Yes, in every case, without exception. An Independent Assessor accredited by the HTA interviews donor and recipient separately, confirms that consent is free, informed and unpaid, and reports to the Authority. No living donation may proceed in the UK until that approval is granted. It typically adds several weeks to the pathway.

  • Can a donor be paid?

    No. Payment or reward for an organ is a criminal offence under the Human Tissue Act 2004, carrying a prison sentence. What is lawful and routine is reimbursement of genuine expenses - travel, accommodation, and loss of earnings during assessment and recovery. That reimbursement is administered through the transplant centre.

  • Does the donor have to be a relative?

    No. Genetic relation is not required. Spouses, partners, friends and even people who have never met the recipient all donate in the UK. Altruistic non-directed donation to a stranger on the waiting list is lawful, supported, and frequently triggers a chain of paired transplants.

  • What if the donor and recipient are not compatible?

    Two options. The UK Living Kidney Sharing Scheme matches your pair with other incompatible pairs so each recipient receives a compatible kidney. Alternatively, antibody-incompatible transplantation removes the offending antibodies with plasma exchange or immunoadsorption before the transplant, at specialist centres.

  • How risky is it for the donor?

    It depends entirely on the organ. Kidney donation carries a mortality of around 1 in 3,000 and a complication rate of 5 to 10 per cent. Liver donation is considerably more serious - mortality of roughly 1 in 200 to 1 in 500 for a right lobe, with complications in 20 to 40 per cent. Both figures are stated explicitly during consent.

  • How long does the whole process take?

    Typically four to six months from the start of assessment to transplant. Donor imaging, cardiac assessment and HTA approval are the usual bottlenecks. Private assessment can remove several months from the front of that pathway, which matters most where the recipient is deteriorating.

  • Can the donor change their mind?

    At any point, for any reason, without explanation. The Independent Assessor interview exists partly to confirm the donor knows this. Transplant centres routinely offer a confidential route to withdraw, framed so the donor is not exposed to family pressure or blame.

  • Is a living-donor organ better than a deceased-donor one?

    For kidneys, clearly yes - living-donor kidneys last around fifteen to twenty years against ten to fifteen, start working immediately more often, and can be transplanted before dialysis. For livers, recipient outcomes are broadly comparable, but living donation carries meaningful donor risk and a higher rate of biliary complications.

  • When should I go to A&E rather than book a clinic?

    Before transplant: breathlessness at rest, confusion, vomiting blood, or a known very high potassium. After surgery, for donor or recipient: fever, severe or spreading pain, breathlessness, reduced urine output or jaundice. All are same-day emergencies.

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