How does the offering system work?

Learn how kidneys from deceased donors are offered to patients

Key points

  • It is important for a donated kidney to go to a patient who will benefit from it
  • Patients are prioritised based on many different factors
  • How long you have been waiting for a kidney is also taken into account
  • The organ offer will first go to your transplant team.
  • The organ offer will first go to your transplant team. If they feel it is suitable for you, they will get in touch

How are kidneys offered?

Every donated kidney is a precious gift, and it is important that the organ goes to a patient who will benefit from it.

Once a potential deceased donor is identified, blood tests are taken to check the donor’s tissue type, blood group, and to check the function of their organs. Other blood tests are taken to see whether the donor has any infections.

This information is the passed to NHS Blood and Transplant and a nationally-agreed computer programme checks the national transplant waiting list for suitable patients.

How are patients prioritised?

Patients are prioritised for a kidney from a deceased donor based on:

  • The compatibility of their blood group with the donor
  • The similarity of their tissue type with the donor
  • The similarity of their age with the donor
  • How long they have been on the transplant waiting list or on dialysis
  • How far apart their transplant hospital is from the donor’s hospital
  • How difficult it would be for them to get another organ offer

The way that deceased donor kidneys are offered is agreed by a national committee, with advice from NHS Blood and Transplant. The national committee agrees on how patients should be prioritised and how the computer programme should run.

What happens if you are offered a kidney? 

If your name is on the top of the computer-generated list, your transplant centre will be contacted by NHS Blood and Transplant. Your transplant team will check the donor information and your details to see whether the organ is a good match for you or not. Not all organs are suitable for all patients.

If your transplant centre thinks the organ offer is suitable, you will be contacted by telephone.

In the meantime, specialist surgeons (the National Organ Retrieval Service) will travel to the donor’s hospital to remove the donor’s organs. Donated organs are flushed with a special fluid to help preserve them, then packed in a box with fluid and ice.

Can offers be declined? 

Yes. If you feel the organ has an unacceptably high chance of failure or other major problems, you can decline the offer and wait for another organ.

Your transplant team can also decline the offer if they feel the organ is not suitable for you.

Your transplant team may want to talk to you over the telephone about the organ’s suitability. Or they may prefer to speak to you in person about any issues when you come in to the transplant centre. Sometimes, the final decision about whether an organ is suitable for you can only be made once the organ arrives at the transplant centre.

If the organ offer is declined, it will usually be offered to another patient.

Learn more about accepting or declining an offer

National criteria for offering kidneys

All transplant teams in the UK must follow the national criteria for selecting patients suitable for a kidney.

View the national criteria for selecting kidney transplant patient (POL184)

Sometimes, patients with other serious illnesses might need a combined type of transplant. For instance, some patients with diabetes and kidney failure might be suitable for a kidney and pancreas transplant.

View the national criteria for combined kidney and pancreas transplant (POL 185)

More information

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