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. Then 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 still helped.
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 guarantees fairness, increases safety, and protects privacy.
- Altruistic donors can also participate. These are people who want to give a kidney without a known recipient in order to help someone else. 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.
- Four times a year, the cross-over computer program searches for suitable combinations between pairs or between pairs and altruistic donors. This creates a nationwide network of donors and recipients who help one another.
- Cross-over is also possible for pairs who are a direct match, but who want a better match or would like to help more kidney patients get a kidney. The more pairs participate, the greater the chance of successful transplantations.
- Children can also participate with their donor. However, specific rules apply to them, which the doctor will discuss with you.
Who is cross-over intended for?
1. For recipients
- Kidney transplantation via the cross-over program can be an option if:
You have someone you know who wants to donate, but his or her kidney does not match you well. - Your donor is a match, but together you are looking for a better match (for example, in terms of tissue characteristics).
- Your donor is a match for you, but together you want to help more donor-recipient pairs who are not a direct match themselves.
Why it makes sense:
The chance of a long-term successful transplantation increases when 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 cross-over program can offer more possibilities than direct donation or waiting for a kidney from a deceased donor.
2. For kidney donors
You can participate in kidney donation via the cross-over program if:
- Your kidney does not match the recipient to whom you want to donate.
- Your kidney does match your recipient, but you want to help multiple people via cross-over.
- Your kidney is a direct match, but you want to achieve a better match for your acquaintance.
- You do not know anyone who needs a kidney, but as an altruistic donor you want to anonymously help a kidney patient. And in doing so, perhaps make multiple donations possible.
Why it makes sense
Via cross-over, you not only help your own recipient, but others as well. You are part of a chain in which multiple people are helped. Some donors indicate that this actually gives them extra satisfaction.
What are reasons for not having a 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).
Also read: living kidney donation
How does the crossover program work?
The crossover program is a nationwide 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 within 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. During the preparation, the crossover program is discussed.
- Registration: Once you are 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 are sent to the hospital of the new recipient.
- Final assessment: Donors are also assessed in the hospital of the new recipient by the donation team, sometimes with additional tests.
- Surgery scheduling: Once everyone is approved, the surgeries are scheduled on the same day. This preferably takes place 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 the one you are familiar with.
- Sometimes a couple drops out even after a match, for example due to illness or an abnormality in the crossmatch.
- Approval for a donor remains valid for one year.
Antibodies and the crossmatch: what is being tested?
The blood of a kidney patient may contain antibodies against potential donors. The laboratory investigates:
- 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 matching donor.
- crossmatch: 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 as a result of a previous transplantation, pregnancy, or blood transfusion.
What does participation mean for donors?
If you participate as a donor in the crossover program, there are a number of differences compared to a direct donation.
What you can expect
- Donation in another hospital: you undergo surgery in the hospital of the patient who receives your kidney.
- Additional examinations possible: the receiving hospital may request supplementary medical examinations, even if you have already been approved in your own hospital.
- Other surgical technique: the surgeon's approach 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 falling through: sometimes a combination between donors and recipients is cancelled due to medical reasons or illness of a participant. You then decide whether you want to participate again in the 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 either.
All steps are aimed at guaranteeing safety, anonymity, and fairness for all participants. The donation and transplantation teams are fully committed to protecting your anonymity. We also trust that you will help respect this anonymity.
Do you still want to share something with the recipient? Then you can leave an anonymous message via your living kidney donation coordinator.
Can I (continue to) be on the waiting list as a patient?
Yes. Your kidney specialist will check whether it is useful to also have an active spot on the waiting list for a kidney from a deceased donor, in addition to participating in the cross-over program.
- You will be set to 'not callable' while the matching round is running. Does the cross-over not yield a match? Then the transplantation team will ensure that you become 'callable' again, i.e., placed 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 the cross-over program?
Is there still no match after multiple attempts within the cross-over program? Then there are sometimes additional options with a donor from the cross-over 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 physician will discuss which options are possible in your situation.
What are additional 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 high levels of antibodies.
- Long time on dialysis (> 2 years)
Your physician will discuss the possibility of a blood-type incompatible transplant (ABO-incompatible transplantation). In this procedure, you receive a kidney from a donor with a blood type that is not directly compatible. This requires special pretreatment (with medication and sometimes a filtration treatment). If a kidney with a matching blood type is not available, ABO-incompatible transplantation is better than waiting for a kidney from a deceased donor.
- Long time on dialysis and many antibodies against tissue antigens (HLA)
If you are highly sensitized (PRA ≥ 85%), you are 'difficult to match'. Your physician can consult with the laboratory to see whether a transplant is still possible despite antibodies against a donor's tissue antigens (HLA-incompatible). This increases your chance of getting a kidney, but requires a tailored approach and specialist consultation.
Costs and reimbursements
The medical costs directly related to the donation are fully reimbursed. You do not have to pay your mandatory deductible for this. Other costs may also be reimbursed:
- Travel expenses: public transport or car mileage (including an escort during hospital admission);
- Hotel accommodation (if necessary due to a long travel distance);
- Domestic help or childcare:
- Income you lose as a self-employed person due to the donation if you are not insured for this.
Conditions do apply to the reimbursements. Discuss this with the social worker or coordinator and ask for the living donation expense reimbursement form.
Follow-up care and monitoring
After donation for donors:
- Donors are monitored within three months in the hospital where they underwent surgery.
- After that, annual or biennial check-ups take place at your own hospital or with your general practitioner (kidney function, blood pressure, urine)
After transplantation for recipients:
- For the first year, recipients remain under follow-up care at the hospital where the transplantation took place.
- After the first year, the referring hospital from before the transplantation resumes care. This is done in close collaboration with your transplant center.
More information and contact
General questions:
Questions about expense reimbursements?
Questions about your personal (medical) situation?
- Please 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.