Cross-over kidney donation
Here you will find an explanation of cross-over kidney donation and transplantation. This information is intended for donors and recipients.
What is cross-over kidney donation?
With kidney donation via the cross-over program, donors help patients through an exchange of the donor kidney.
Suppose you want to give a kidney to someone you know, but your kidney is not a good match for that person. You can still help them. Your kidney goes to another kidney patient, and in return, your acquaintance receives a kidney from another donor. This way, two kidney patients are helped after all.
Cross-over kidney transplantation takes place anonymously and on the same day.
This ensures fairness and protects privacy.
Good to know
- Cross-over kidney transplantation takes place anonymously and on the same day. This ensures fairness, increases safety, and protects privacy.
- Altruistic donors can also participate. These are people who want to give a kidney to help someone else without having a known recipient. Such a donation can help multiple people via a so-called domino chain, which ends with a kidney for someone on the transplant waiting list.
- The crossover computer program searches four times a year for suitable combinations between couples or between couples and altruists. This creates a national network of donors and recipients who help each other.
- Crossover is also possible for couples who are a direct match but want a better match or would like to help more kidney patients receive a kidney. The more couples that participate, the greater the chance of successful transplants.
- Children can also participate with their donor. Specific rules apply to them, which the doctor will discuss with you.
Who is crossover intended for?
1. For recipients
- A kidney transplant via the crossover program may be an option if:
You have someone you know who wants to donate, but their kidney is not a good match for you. - Your donor is a match, but you are looking for a better match together (for example, based on tissue characteristics).
- Your donor is a match for you, but you want to help more donor-recipient couples together who are not a direct match themselves.
Why it is useful:
The chance of a long-term successful transplant increases if there is a better match. Even if you have been on the waiting list for a long time or are difficult to match (for example, due to antibodies), the crossover program can offer more possibilities than donating directly or waiting for a kidney from a deceased donor.
2. For kidney donors
You can participate in kidney donation via the crossover program if:
- Your kidney is not a match for the recipient you want to donate to.
- Your kidney is a match for your recipient, but you want to help multiple people via crossover.
- Your kidney is a direct match, but you want to realize a better match for the person you know.
- You do not know anyone who needs a kidney, but as an altruistic donor, you want to help a kidney patient anonymously. And in doing so, perhaps make multiple donations possible.
Why it is useful
Through crossover, you not only help your own recipient but also others. You become part of a chain in which multiple people are helped. Some donors indicate that this gives them extra satisfaction.
What are the reasons there is no match?
Two reasons for 'no match' between donor and recipient:
- ABO incompatibility: blood types do not match.
- HLA incompatibility: there are antibodies against the donor's tissue characteristics (tested via a crossmatch).
Read also: living kidney donation
How does the crossover program work?
The crossover program is a national collaboration between all transplant hospitals, laboratories, and the Dutch Transplant Foundation (NTS). Four times a year, the crossover computer program searches for the best possible combinations between donors and recipients.
Sometimes the computer program finds a match immediately, sometimes it takes a number of rounds, and sometimes it is not possible to find a suitable match even in the crossover program.
The process step by step
- Medical examination: Both donor and recipient are extensively examined at the transplant hospital. Altruistic donors also undergo extensive screening. The crossover program is discussed during the preparation.
- Registration: Once you have been definitively approved for transplantation or donation, the transplant hospital registers you with the NTS.
- Matching round: Four times a year, a computer program searches for the best possible combinations.
- Crossmatches: The central laboratory tests whether the new combination is medically safe.
- Data exchange: Medical data of the donor is sent to the hospital of the new recipient.
- Final assessment: Donors are also assessed at the new recipient's hospital by the donation team, sometimes with additional examinations.
- Surgery planning: If everyone is approved, the surgeries are scheduled on the same day. This preferably happens within three months of approval.
Important to know
- If there is no match, you can participate again in a subsequent round.
- The donor surgery may take place in a different hospital than that of your known recipient.
- Sometimes a pair drops out after a match, for example due to illness or an abnormality in the crossmatch.
- The approval for a donor remains valid for one year.
Antibodies and the cross-match: what is being tested?
The blood of a kidney patient may contain antibodies against potential donors. The laboratory examines:
- whether the blood types are compatible.
- whether there are antibodies against tissue characteristics: the more antibodies, the more difficult it will be to find a compatible donor.
- cross-match: the tissue characteristics of the donor and any antibodies of the recipient are compared. If necessary, a test follows in which blood from the donor and recipient is mixed. No reaction = safe (negative): reaction = too risky (positive).
Antibodies can develop due to a previous transplant, pregnancy, or blood transfusion.
What does participation mean for donors?
If you participate in the cross-over program as a donor, there are a number of differences compared to a direct donation.
What you can expect
- Donation in another hospital: you will be operated on in the hospital of the patient who receives your kidney.
- Additional examinations possible: the receiving hospital may request additional medical examinations, even if you have already been approved in your own hospital.
- Different surgical technique: the surgeon's procedure may differ slightly between hospitals. This will be discussed with you in advance.
- Waiting for a match: the program searches for suitable combinations four times a year. Sometimes it takes a while before a suitable combination is found.
- Risk of withdrawal: sometimes a combination between donors and recipients is dropped due to medical reasons or illness of a participant. You then decide whether you want to participate again in a next round.
Important: How do we ensure anonymity?
The entire procedure is anonymous. You do not know who receives your kidney and you will not come into contact with other donors or patients.
All steps are aimed at ensuring safety, anonymity, and fairness for all participants. The donation and transplant teams are fully committed to protecting your anonymity. We also trust that you will help to respect this anonymity.
Would you still like to share something with the recipient? You can leave an anonymous message via your living kidney donation coordinator.
Can I (remain) on the waiting list as a patient?
Yes. Your kidney specialist will determine whether it makes sense to be on an active spot on the waiting list for a kidney from a deceased donor in addition to participating in the crossover program.
- You will be set to 'not callable' while the matching round is running. Does the crossover not yield a match? Then the transplant team will ensure that you are set back to 'callable', or on an active spot on the waiting list.
- This temporary pause does not affect your waiting time.
If there is no match, what then?
Sometimes no suitable combination is found during a round. This is no reason for discouragement:
- You can participate again in a next round;
- Your doctor will discuss whether additional treatments are possible;
- Your participation will be reviewed if your medical situation changes.
What are alternatives and additional possibilities within cross-over?
Is there still no match after several attempts within the crossover program? Then there are sometimes additional possibilities with a donor from the crossover program:
- Transplantation with blood types that do not match (ABO-incompatible transplantation), after special pretreatment.
- Transplantation despite antibodies against the donor (HLA-incompatible transplantation), only possible after consultation with your kidney specialist.
Your doctor will discuss which options are possible in your situation.
What are extra options via cross-over?
Sometimes, despite participating in the cross-over program, it is not possible to find a suitable match. You may still be eligible for a transplant via cross-over. This can be especially important for patients who are difficult to match, for example due to many antibodies.
- Long-term dialysis (> 2 years)
Your doctor will discuss the possibility of transplanting across blood groups (ABO-incompatible transplantation). In this case, you receive a kidney from a donor with a blood group that is not directly compatible. This requires special pre-treatment (with medication and sometimes a filter treatment). If a kidney with a compatible blood group is not available, ABO-incompatible transplantation is better than waiting for a kidney from a deceased donor.
- Long-term dialysis and many antibodies against tissue characteristics (HLA)
If you are highly immunized (PRA≥85%), you are 'difficult to match'. Your doctor can check with the laboratory whether a transplant is still possible despite antibodies against a donor's tissue characteristics (HLA-incompatible). This increases your chance of a kidney, but requires customization and specialist consultation.
Costs and reimbursements
The medical costs directly related to the donation are fully reimbursed. You do not have to pay a mandatory excess for this. Other costs can also be reimbursed:
- Travel expenses: public transport or car kilometers (including a companion during hospital admission);
- Hotel stay (if necessary due to long travel distance);
- Household help or childcare:
- Income you lose as a self-employed person due to the donation if you are not insured for this.
There are conditions for the reimbursements. Discuss this with the social worker or coordinator and ask for the form for the reimbursement of living donation expenses.
Follow-up care and check-ups
After donation for donors:
- Donors are checked within three months at the hospital where they were operated on.
- After that, annual or biennial check-ups take place at your own hospital or with your GP (kidney function, blood pressure, urine)
After transplantation for recipients:
- Recipients remain under the care of the hospital where the transplantation took place for the first year.
- After the first year, the referring hospital from before the transplantation takes over care again. This is done in close cooperation with your transplant center.
More information and contact
General questions:
Questions about expense reimbursements?
Questions about your personal (medical) situation?
- Contact your kidney donation or transplant center or attending nephrologist.
- See contact details for transplant hospitals
Would you rather talk to someone?
- Your doctor, transplant coordinator, or social worker will be happy to help you further.