Alternatives to the Transplant Waiting List

Patients generally cannot control when a suitable deceased-donor kidney will become available. That is deliberate and it is fair. It is also why patients look for alternatives to the transplant waiting list — not to jump it, but to find a route that does not depend on it.

What waiting actually looks like

More than 90,000 people in the United States are waiting for a kidney. The average wait is three to five years at most centers, and longer in some parts of the country. Blood type affects it: some blood types wait considerably longer than others.

Alternative one: a living donor

This is the main alternative and the most consequential. A living donor does not depend on the deceased-donor waiting list, the surgery can be scheduled, and the outcome is better: a living-donor kidney lasts about 15 to 20 years on average against 8 to 12 for a deceased-donor kidney.

A living donor can be a relative, a friend, a colleague — or someone who finds you through a registry such as MatchingDonors, where more than 15,000 potential donors are registered.

Alternative two: paired exchange

If you have a willing donor who is not a match for you, paired exchange solves it. Your donor gives to a compatible stranger, and you receive a kidney from that stranger's incompatible donor. Chains can link many pairs at once. Thousands of donors registered with MatchingDonors have indicated they are willing to take part in paired exchanges and chains.

Alternative three: multiple listing

You may list at more than one transplant center. OPTN sets out how multiple listing and waiting-time transfer work. It can shorten waiting if you can realistically travel to another center on short notice — but each center evaluates you separately, and travel and insurance make it impractical for many.

Where MatchingDonors fits

MatchingDonors does not replace your transplant center and does not perform medical care. It is a nonprofit that helps patients and potential living donors find each other; your center evaluates every donor and makes every clinical decision. Practically, it widens the pool of people who might come forward beyond those you already know.

What you can actually control

Although you cannot control when a deceased-donor kidney becomes available, there are important steps you can take while you wait.

• Staying transplant-eligible. Attending appointments, managing blood pressure and weight, and staying well enough for surgery keeps you on the list.
• Telling people. Living donors overwhelmingly come from people who knew a patient needed one. Letting others know you need a kidney can expand the number of people who may consider living donation.
• Your profile, if you register with a service such as MatchingDonors — a specific, human profile with a photograph reaches people that a medical summary never will.
• Being reachable. Centers may call with little notice; make sure they have current numbers.
• Asking about paired exchange if you have a willing but incompatible donor.

For how to build a profile that people respond to, see how to find a living kidney donor.