There are different ways to donate. Even when blood groups do not match and form antibodies against the donor kidney.

• Direct donation
• Exchange programmes
• Blood groups incompatible
• Cross-match positive
• Anonymous donation

Direct donation

If you wish to donate your kidney, we will first look at whether transplantation is possible. Your donor kidney will need to be suitable for the recipient. A transplant will only be successful if your own kidney and your donor’s kidney show similarities in certain areas. The more similarities there are between the kidneys, the lower the chance of rejection.

Blood groups
If your blood group and the donor’s blood group are a match, the transplant has a higher chance of success: The below diagram shows which donor and recipient blood group are a match.

If the blood group does not match we will look at whether it is possible for you to donate through one of the alternative living donation programmes.

Cross-matching and tissue typing
If your blood group is a good match with the blood group of the recipient, we will carry out a crossmatch and tissue typing. During a tissue typing the markers on the outside of the cells of the donor are being checked. The recipient must not have antibodies against any of these markers on the cells of the donor. This is tested through a crossmatch. A negative result in the cross-match is desired. If the cross-match is negative, you can donate directly.

If the cross-match is positive direct donation is not possible. You can consider one of the alternative living donation programmes.

Exchange programmes

If you cannot donate your kidney to the recipient directly, there are other options to make the transplant possible. This could be a cross-over or ‘cross-over transplantation’ or a ‘domino-paired kidney exchange’.

Paired transplantation (cross-over programme)
Paired transplantation:

• The donor for pair A donates to the recipient of pair B
• The donor for pair B donates to the recipient of pair A

Your doctor will refer you to the programme as soon as you and your recipient have been medically approved and both give permission.

A computer programme is used to search for pairing options once every three months. The exchange can take place between pairs from different transplant centres in the Netherlands. The recipient will remain in their own transplant centre. As a donor, you will travel to the transplant centre where the recipient is being treated. The donations and transplants for both pairs are carried out on the same day. The whole procedure is anonymous. So you will not meet the person you are donating to.

Domino-paired kidney exchange
Not all pairs are helped in the exchange programme. So there is also a possibility that, as an anonymous donor, you will make multiple transplants possible.

• You donate anonymously to the recipient in a pair from the cross-over programme
• The donor from that pair gives to a recipient on the waiting list

These donation and transplant procedures also take place anonymously. So you will not meet the person you are donating to.

Blood group incompatible

If your blood group does not match the blood group of the one of your recipient, you may be eligible for a blood group incompatible kidney donation. This is called ‘ABO incompatible kidney transplantation‘. This usually means that the recipient is blood group O and the donor is blood group A or B.

Someone with blood group O will have antibodies to blood groups A and B. When a transplant is carried out, the antibodies to the donor’s blood group will need to be removed from the blood of recipient. Otherwise, the kidney will be rejected immediately. The recipient will need to undergo a special treatment, to filter the blood. If the antibodies against the foreign blood group are reduced by this treatment, you can donate your kidney to your recipient. If the number of antibodies remains too high after the treatment, a blood group incompatible transplant will not be possible.

Cross-match positive (desensitisation programme)

Unfortunately, direct donation or the exchange programme are not good ways to find a suitable kidney for everyone. Due to the presence of antibodies, the chance that the new kidney will be rejected can be very high. This will be demonstrated by an unsuccessful cross-match. In this case, the unsuccessful cross-match is not due to different blood groups. Through the desensitisation programme, it is possible to remove the antibodies from the blood of the recipient. This is also known as a ‘positive cross-match transplant’. This will require the recipient to undergo a special treatment one to two weeks before the transplant. After this treatment, the cross-match will be carried out again. If the chance that the kidney will be rejected is minimal, the transplant can go through. Desensitisation is a similar, but more difficult, method to ‘blood group incompatible transplantation’. At present, this method is only carried out at the Erasmus MC in Rotterdam.

Non-directed donation

As a donor, you can give one of your kidneys to someone you do not know. This donation will take place anonymously. The donation to someone on the waiting list is called a non-directed donation. You cannot give a preference for a specific group of recipient.