Plain language summaries of research

This is a plain language summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.

What is unspecified kidney donation?

Unspecified kidney donation happens when a living person donates one of their kidneys to a stranger rather than someone they know, and it has been legal in the UK since 2006.

This type of donation has become more common in the UK since 2007, and now, about 8 to 10 out of every 100 living kidney donations that happen are to strangers.

When someone donates a kidney to a stranger, it can help more than just one person. The kidney can be used to start a 'chain' of transplants, meaning that several people who need kidneys can receive them because one person donated to a stranger.

Despite the benefits of this type of donation, there are still some negative attitudes and concerns around it.

 

About the research

Researchers wanted to find the answers to three main questions about unspecified kidney donation:

1. What do healthcare professionals think about this type of donation
2. What are the outcomes for people who donate a kidney to a stranger
3. What is the economic benefit (if any) of unspecified kidney donation?

 

What do healthcare professionals think of this type of donation?

The researchers talked to 153 healthcare professionals from all 23 kidney transplant centres in the UK. They found that most healthcare professionals support kidney donation to strangers, but there are still some challenges.

People they spoke to said they wanted more training about how to work with people who want to donate their kidney to a stranger. They also want clearer guidelines about things like age limits and psychological assessments. Some were worried about whether people who want to donate to strangers have an appropriate reason for wanting to donate.

 

What are the outcomes for people who donate a kidney to a stranger?

The researchers looked at 837 people who were considering kidney donation. Some of these people wanted to donate to family or friends, which others wanted to donate to strangers. They tracked these people for up to one year after their donation to see how they were doing physically and mentally.

They found that people who donated to strangers did just as well as those who donated to people they knew. Both groups had:

• Similar physical recovery after surgery
• Similar mental health and wellbeing
• Low levels of regret about donating
• Similar rates of withdrawal from the donation process

People who donated to a stranger were slightly more likely to experience negative reactions from friends and family, but this didn't affect their overall wellbeing or satisfaction with their decision to donate.

 

Does unspecified kidney donation save money for the NHS?

The researchers calculated the costs of supporting donors before, during, and after their donation. They found that it costs about the same to support someone who donates to a stranger as it does to support someone who donates to a family member or friend.

However, unspecified kidney donation can save the NHS money in the long run because:

• Each donation can start a chain that helps multiple people get kidney transplants
• People with kidney transplants need less dialysis treatment, which is expensive
• Kidney transplants generally cost less than keeping someone on dialysis long-term

Researchers calculated that if the UK increased kidney donation to strangers by just 10%, it could save the NHS at least £5 million.

 

What did donors say about their experience?

The researchers talked in depth with people who had donated to strangers or who had started the process but didn't complete it. They found some key themes:

Anonymity was important: People liked that they wouldn't know who received their kidney because it meant they wouldn't feel responsible for whatever happens after the donation. If the transplant didn't work well, they wouldn't feel guilty.

Family support mattered: People whose families supported their decision had better experiences. Those whose families were against the decision found the process more difficult.

Healthcare team relationships: People who went through with their donations felt like they were working as a team with the healthcare professionals. Those who didn't complete the process felt more distant from the healthcare team. 

Need for public awareness: Both groups felt that more people should know about kidney donation to strangers so it would be seen as normal and more acceptable.

Some people who wanted to donate a kidney to a stranger faced barriers, such as:

• Some healthcare professionals were uncertain about whether this type of donation was appropriate
• Family members sometimes strongly opposed the decision
• The process could take a long time, and some people withdrew during the assessment
• There wasn't always consistent support available at different hospitals

People who didn't complete the donation process sometimes experienced ongoing psychological distress and felt like they had 'unfinished business'.

 

The researchers' recommendations

Based on their findings, the researchers recommended:

More training and information: Healthcare professionals need better training and clearer guidelines about kidney donation to strangers.

Consistent approach: All transplant centres should follow similar processes and have clear policies, especially about age limits and psychological assessments.

More resources: Centres need more staff, particularly transplant coordinators, to properly support people who want to donate to strangers.

Ongoing support: People who start the donation process but can't complete it need ongoing support to help them cope with any disappointment or distress.

Better family involvement: Healthcare teams should help potential donors involve their families early in the process to build understanding and support.

 

What does this mean for the future?

This research shows that kidney donation to strangers is safe and beneficial. People who donate have good outcomes, and the practice can save money and help more people to receive life-saving kidney transplants.

With better training, resources, and support, more people could successfully donate kidneys to strangers and help to reduce the number of people waiting for kidney transplants. The research also highlights the importance of public education about organ donation to help this generous act become more widely understood and accepted.

The UK is one of only a few countries that allows this type of donation, and this research provides important evidence that other countries might use when considering whether or not to allow it.

This study represents the largest and most comprehensive research on kidney donation to strangers ever conducted. 

Read the full article

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Funding

This study was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme.

The original article

This is a summary of: Mamode, N. et al. Barriers to and outcomes of unspecified kidney donation in the UK: BOUnD, a mixed-methods study. Health and Social Care Delivery Research 2025;13: 20. Available at: https://doi.org/10.3310/RTEW9328