For people living with chronic kidney disease (CKD) or kidney failure, a transplant from a living donor can be life-changing. Living-donor transplants often last longer, work better, and allow patients to spend less time on dialysis.

But not everyone who wants to donate a kidney can safely do so. The donation process is designed to protect the donor’s health first, ensuring that surgery and recovery won’t put them at risk.

Whether you’re hoping for a living donor or considering becoming one yourself, understanding the reasons someone might not qualify can help you appreciate the process and the care that goes into every successful transplant.*

1. Serious Medical Conditions

The first priority in any living-donor evaluation is the donor’s safety. Some health conditions make kidney donation too risky, either during surgery or years afterward.

Common medical reasons that could disqualify someone include:

• Uncontrolled high blood pressure or diabetes
• Active cancer or a very recent history of cancer
• Serious heart or lung disease that makes anesthesia unsafe

However, these rules aren’t always absolute. In some cases, if a condition is well-controlled, doctors may still consider donation. Each transplant center evaluates potential donors individually.

Tip: The evaluation process is designed to protect both the donor and the recipient. If your loved one isn’t approved, it doesn’t mean they failed — it means their health is being protected.

2. Weight and BMI Considerations

Many transplant centers use body mass index (BMI) and other measures of body composition to assess donor safety. A very low or very high BMI can increase surgical and recovery risks, such as:

• Poor wound healing
• Higher infection risk
• Greater chance of developing diabetes or high blood pressure later on

Typical BMI categories:

• Underweight: Below 18.5
• Normal weight: 18.5–24.9
• Overweight: 25–29.9
• Obesity: 30 or higher

Some centers have strict BMI limits, while others take a more flexible approach, looking at overall fitness, lifestyle, and fat distribution.

If someone’s weight poses a short-term concern, doctors might suggest lifestyle changes before re-evaluating for donation.

3. Mental Health and Emotional Readiness

Donating a kidney isn’t just a medical decision; it’s also a deeply personal and emotional one. Every donor meets with a social worker or mental health professional as part of their evaluation.

The goal is to ensure the donor:

• Fully understands the risks and benefits
• Is donating voluntarily, without pressure or guilt
• Is mentally and emotionally stable, with adequate support and care

Having a mental health condition, such as anxiety or depression, does not automatically disqualify someone. What matters most is whether it’s being managed safely and whether the person feels confident and supported in their decision.

4. Support System and Recovery Needs

After kidney donation surgery, donors typically need four to six weeks to recover. During that time, it’s important to have a network of support, both practical and emotional.

A strong support system includes:

• Practical help: Someone to assist with meals, errands, and transportation after surgery.
• Emotional support: Friends or family who can help with stress, fear, or boredom during recovery.
• A clean, safe space: A comfortable home environment that minimizes infection risk and helps the donor heal smoothly.

Transplant teams may ask detailed questions about a donor’s recovery plan to ensure they have the help they need.

Reminder: Donation is never just about one person. It’s a team effort between the donor, doctors, and loved ones who make recovery possible.

5. Financial and Lifestyle Challenges

While donors don’t pay for the surgery or hospital stay, other costs can add up.

These may include:

• Lost wages (if the donor doesn’t have paid leave)
• Travel and lodging costs if the transplant center is far away
• Childcare or eldercare expenses during recovery

Financial hardship doesn’t automatically disqualify someone, but the transplant team may recommend waiting if donation would cause serious stress or instability.

The good news: there are donor assistance programs that can help cover travel, lodging, or lost wages. The National Kidney Foundation (NKF) and other organizations offer resources to support living donors and make the process more equitable.

What This Means for People Waiting for a Transplant

If you’re living with CKD or kidney failure, it can be discouraging to hear that a friend or family member wasn’t eligible to donate. But remember: the evaluation process protects both of you.

Doctors carefully assess every potential donor to make sure:

• The surgery won’t harm their long-term health
• The new kidney will have the best possible chance to succeed
• No one is under pressure or emotional strain

In many cases, even if one person isn’t eligible, others may be, or you may qualify for paired kidney exchange programs where willing donors are matched with other recipients across the country.

The Bigger Picture: Generosity and Safety

Living kidney donation is an extraordinary act of kindness and a carefully managed medical process. Each step is designed to balance compassion with safety, ensuring that both donors and recipients have the best outcomes possible.

If you’re thinking about a transplant, talk openly with your care team about how living donation works, what the requirements are, and what support systems exist for both you and your potential donor.

* National Kidney Foundation (October 21, 2025). “What Would Disqualify You From Donating a Kidney?”. kidney.org

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