Renal Transplant Program

Living Kidney Donation

Living Kidney Donation

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The journey begins

Living kidney donation follows a structured, phased approach designed to protect your health and support informed decision‑making at every step. 

Each phase in the living kidney donation process builds on the one before it, starting with education and initial testing and moving through surgery, recovery and long‑term follow‑up care. The sections below outline what happens in each phase and how the living kidney donor team supports you throughout your donation journey.

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You are in control

You may pause or stop the process at any time. 

A doctor in a white coat holds a tablet and talks with a smiling patient sitting on an exam table in a bright medical office.

Phase 1: Getting started

Phase 1 is the starting point of the living kidney donation process. It includes education, consent and initial medical testing to determine whether it is safe for you to move forward. 

You begin by completing a self-directed learning module that explains living kidney donation, the evaluation process and possible risks. This helps you understand what donation involves and what to expect.

After reviewing the information, you will be asked to sign consent forms confirming that you understand the process and agree to proceed with testing.

You will be asked to complete a Medical, Social and Travel Questionnaire (MST). This provides the team with important information about your health, lifestyle and travel history.

You will also have a nursing assessment, which includes:

  • Testing your blood pressure.
  • Measuring your height and weight.
  • Reviewing your medications and allergies.

You will complete two sets of blood and urine tests. These tests will be used to assess your overall health and kidney function.

Some donors may also need cancer screening. This is required for:

  • Donors over 50 years of age.
  • Donors with a family history of certain cancers.

Tissue typing and crossmatch testing are done at The Ottawa Hospital Tissue Typing Lab. This is a blood test that checks whether the recipient has antibodies that react against your blood.

During this testing:

  • Blood samples are collected from both you and your recipient.
  • Your blood is mixed with the recipient’s blood (crossmatch test).

Your nurse will book this appointment for you. Results can take up to two weeks.

Crossmatch testing is different from blood type (ABO) testing. Because antibody levels can change over time, crossmatch testing will be repeated closer to the surgery date.

Healthcare professional with a stethoscope reviewing information on a tablet while seated beside a patient in a clinical setting.

What if you are not a match?

If testing shows that you are not a compatible match with your intended recipient, living donation may still be possible through the Kidney Paired Donation (KPD) Program.

Through KPD Program:

  • You and your recipient are entered into the program together.
  • You may be matched with another donor-recipient pair.
  • Nondirected anonymous donors may also participate.

You must still complete all phases of the donor evaluation to participate in KPD.

Learn More about KPD

What happens next

At the end of Phase 1, the living kidney donor team will contact you to let you know:

  • If you can proceed to Phase 2.
  • If more testing is needed before moving forward.
  • If donation is not recommended at this time based on your results.

The decision is always guided by your safety and long-term health. 

During your work-up, our team will consider:

  • The current health of the potential living kidney donor.
  • Risk factors to the living kidney donor should they proceed with donation.
  • The long-term health of the living kidney donor after donation. 

Phase 2: Taking a closer look

Phase 2 includes more detailed medical testing and in-depth appointments with members of the living kidney donor team. These steps help confirm that donation is safe for you now and in the long term.

One-day evaluation program

The Ottawa Hospital offers one-day evaluations for Phase 2. This allows most tests and donor team appointments to be completed in a single day at the General Campus, typically between 7:30 a.m. and 4 p.m. The program runs once a month and can accommodate up to three potential donors. Your nursing coordinator will talk with you about whether this option is suitable for you.  

Phase 2 testing provides detailed information about your kidneys, heart and overall health.  

You may complete the following tests:

Abdominal CT scan

  • Shows the anatomy of your kidneys and blood vessels.
  • Helps the surgeon determine which kidney is safest to remove.
  • Takes about 30 minutes to complete.

Kidney function tests (renal scan)

  • Shows how well each kidney is working.
  • Requires an IV to be placed in your arm.
  • Uses a small amount of radioactive tracer to track blood flow through your kidneys.
  • Exposes you to a level of radiation similar to that of an Xray.

Chest X-ray

  • Produces an image of your lungs.
  • Uses a small amount of radiation.

Electrocardiogram (ECG)

  • Records the electrical activity of your heart.
  • Involves placing small stickers on your chest.

As part of Phase 2, you will meet with several members of the living kidney donor team. These appointments will allow the team to better understand your health, circumstances and readiness to donate.  They will also give you time to ask questions and raise concerns.

All potential donors meet with a social worker. This conversation will explore your emotional wellbeing, social supports and any financial or practical considerations related to donation.  

The social worker will help the team assess whether donation is the right choice for you and may recommend a referral to the psychiatrist if additional support or assessment is needed.

A psychiatrist assessment is not required for all donor candidates, but it is mandatory for all anonymous donors. This appointment will focus on your mental and emotional health and will ensure that your decision to donate is informed, voluntary and well supported.

You will also meet with a surgeon (urologist). During this appointment, the surgeon will review your CT scan and renal scan to confirm that kidney removal can be done safely. They explain the surgical approach, discuss possible risks and benefits, and review which kidney would be removed and why.

Your final appointment in Phase 2 is with a nephrologist (kidney doctor). The nephrologist will review all test results from Phases 1 and 2, along with assessments from other team members. They will discuss with you the potential benefits and risks of donation and determine whether you can safely proceed to the next phase. 

Before a surgery date is confirmed, the surgeon will review potential risks of living kidney donation with you. These include bleeding, infection, blood clots, reactions to anesthesia, damage to nearby organs, pain, and testicular swelling or tenderness. The risk of death is rare, estimated at 3 in 10,000 donors.  

During Phase 2 testing, you may learn that further steps are needed before moving forward. This may include managing high blood pressure, addressing a risk for diabetes, reducing weight, or completing additional tests such as cardiac assessments. Testing may also uncover a health issue that you were not previously aware of. In some cases, donation may be delayed or not recommended at this time due to medical, emotional or mental health concerns.

There are also practical and personal factors to think about when considering living kidney donation. These may include out-of-pocket costs such as parking fees or income lost due to time away from work for appointments and recovery. Personal commitments, such as work responsibilities, travel plans or important social events, may also affect timing. Legal and financial planning, including life insurance, wills and power of attorney, may be important to review before donation. 

What Phase 2 helps determine

Together, Phases 1 and 2 allow the team to determine whether you are healthy enough to donate now, whether your kidney is suitable for the recipient, and whether you are likely to remain healthy over your lifetime after donation. If you are unable to proceed or need further testing, the living kidney donor team will support you and help guide next steps. 

Phase 3: Final assessments

Phase 3 takes place once you have been approved to proceed with living kidney donation. This phase focuses on preparing you safely for surgery and confirming that both you and the recipient are still ready to move forward. 

Your surgery date will be carefully planned to ensure the best outcome for everyone involved. The date will be determined based on several factors, including your availability, the recipient’s readiness for transplant and operating room availability at The Ottawa Hospital.

The team will also consider whether your donation is:

  • A direct donation to your intended recipient, or
  • Part of the Kidney Paired Donation (KPD) Program. 

In the weeks leading up to surgery, you will complete a series of appointments and tests to confirm that your health remains stable and that donation is still safe.

Approximately two to three weeks before your surgery date, you will receive an agenda outlining all of your preoperative appointments. 

Less than 30 days before surgery

You will have appointments with:

  • The surgeon, to review final surgical details.
  • The anesthesia team, to discuss how you will be safely put to sleep during surgery.

You will also complete:

  • A health questionnaire with a nurse.
  • Bloodwork to reassess your health.

About two weeks before surgery

You will complete:

  • A repeat crossmatch test to confirm that you are still a compatible match with the recipient.

About 10 days before surgery

You will complete:

  • A follow‑up health questionnaire with a nurse.

Within 48 hours before surgery

You will complete: 

  • Additional bloodwork, if required.
  • A COVID‑19 swab, depending on current hospital policy.

Phase 4: Donation day

Phase 4 is the day of your living kidney donation surgery. Your care team will guide you through each step and closely monitor your health throughout your hospital stay.

Your surgery will take place at General Campus of The Ottawa Hospital. You will arrive at the hospital on the morning of your surgery and will be admitted the same day.

The surgical team most commonly uses a laparoscopic technique, which is less invasive than traditional open surgery. During the procedure:

  • The surgeon will make three small incisions to insert surgical instruments.
  • The surgeon will make one lower abdominal incision, usually three to four inches long, to remove the kidney.

This technique is associated with smaller incisions, less pain after surgery and a shorter recovery time compared to open surgery.

The procedure usually takes about three to four hours to complete. 

Phase 5: Recovery and follow-up care

Phase 5 focuses on your recovery after surgery, both in hospital and at home, as well as the long-term follow-up care that supports your health after donation. Recovery happens gradually, and each person’s experience is different.

After surgery, you will spend about one hour in the recovery area, where your care team will closely monitor you as you wake up. You will then be transferred to the surgical care unit.

Your doctor will discuss pain management options with you. It is common to experience nausea, bloating or constipation after surgery, and medications will be available to help relieve these symptoms. 

On the day of surgery, you will have several tubes and supports in place to help with your recovery, including:

  • A urinary catheter to help you urinate.
  • Oxygen prongs in your nose, if needed.
  • An IV in your hand or lower arm.
  • Compression stockings on your legs to support blood flow.
  • A bandage (dressing) over your incision.

Your care team will check on you regularly and helps keep you comfortable. 

The day after surgery, you will begin moving again. You will sit up in a chair and start walking in the hallway, with support as needed. Movement helps reduce complications and supports healing.

Over the next few days, the care team will remove the urinary catheter, oxygen tubing, IV and compression stockings as your recovery progresses.

Most donors will go home two to four days after surgery. When you are discharged, you may still have some discomfort at the incision site. You can take pain medication as directed by your doctor.

Some donors continue to experience nausea or bloating at home. These symptoms usually improve within the first few weeks after surgery.

During the first few weeks at home, pain is usually minimal. Many donors manage discomfort with over-the-counter pain medication. Use acetaminophen (Tylenol) based products only, unless your care team advises otherwise.

You will begin returning to regular daily activities, including walking, bathing and eating a normal diet. During this time, avoid lifting anything heavier than 10 pounds.

By six weeks after surgery, most donors will have returned to many of their usual physical activities. Avoid lifting over 10 pounds until you reach the six-week mark.

Fatigue is common and often one of the last symptoms to improve. Energy levels return gradually.

The timing of your return to work will depend on the type of work you do and how physically demanding it is. Most donors take at least three to four weeks off work. The program can provide letters for your employer if needed. 

Emotional recovery

Emotional recovery is an important part of healing. Some donors will experience feelings of sadness or low mood after donation. This may include grieving the loss of a kidney, stress from the evaluation and surgery, or changes in daily routine and social life. For some donors, the focus shifting to the recipient can also feel challenging.

If you would like support during this time, contact your nurse. Support from a social worker is available. 

Follow-up care after kidney donation

Follow-up care helps ensure your long-term health after donation.

You will have an appointment with the surgeon four to six weeks after surgery and complete bloodwork before this visit.

You will also see a kidney doctor (nephrologist) at six months and one year after surgery, with bloodwork completed before each visit.

After the first year, you will continue yearly follow-up with bloodwork. At that point, your care may be transferred to your family doctor, depending on your situation. 

Life after kidney donation

Long-term health after donation includes healthy daily habits. You will be encouraged to:

  • Drink 1.5 to two litres of water each day.
  • Maintain a healthy diet.
  • Exercise regularly.
  • Avoid contact sports.

You should limit the use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as Aleve, Advil, Motrin, ibuprofen, Celebrex and Arthrotec. If another health care provider prescribes an NSAID, contact the Living Kidney Donor Program.

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Pregnancy after living kidney donation

Female donors are advised to wait six months after donation before becoming pregnant.

Maintaining a primary care provider

The living kidney donor team strongly encourages you to maintain a relationship with a primary care provider, such as a family doctor, nurse practitioner or physician assistant, both before and after donation.

Your primary care provider supports your general health needs, including prescription renewals, vaccinations, cancer screening, treatment of illnesses and referrals to other specialists.

While the Living Kidney Donor Program provides annual post-donation follow-up related to kidney health, it cannot provide ongoing primary care. Staying connected with a primary care provider and attending your yearly donor follow-up appointments helps support your long-term health.