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Comment by dickfickling | Hacker News Reader

I’m scheduled to donate one of mine to a stranger in a few weeks. Similar story here—saw Scott Alexander’s story, did some research, decided it was something i had to do.

I’m donating through the national kidney registry, which means that I (and five close family members) will pop to the top of the transplant list if I ever need one.

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How long do you stay at the top of a transplant list?

My spouse recently had a kidney removed due to cancer (she's fine, caught it early).

If she ever needs a new kidney I've been hoping I'm compatible, we share the same blood type. However, if I can give up my kidney to move her permanently up the list, that's worth considering for me.

You'll want to confirm before you donate -- it depends on what hospital/organization you're donating through. In my case, I'm prioritized for being a donor and five of my family members are also prioritized. If a one of those family members receives a kidney out of need then I am still prioritized (effectively giving me/my family two kidneys for the price of one). Note that you can designate five family members to be prioritized, but only the first one in need will be prioritized.

This stays in effect as long as the NKR exists -- there's no expiry.

If you need to donate to your wife and aren't compatible, separate from the NKR vouchers, there are "kidney exchange" programs where pairs of people in that situation are matched with each other. So you'd donate to someone else, and at the same time someone would donate to your wife. Actually calculating the match among all those pairs is a fun NP-hard optimization problem.

It's a match-criteria-based list, so you stay at the top until you die or receive a matching transplant. If you are at the top of the list but don't match an available organ, the organ goes down the list to the highest match that can be brought to an operating room in time.

Edit: Geography is important too. The kidney can only survive outside of a (cardiovascularly-functioning) body for minutes at a time. If you are at the top of a list but the kidney is across the country and you don't have access to a private jet, it's going to someone else. This is the "loophole" that Steve Jobs used to get a liver transplant - Since he had a fleet of private jets available to him, he could be simultaneously listed for transplant on multiple lists.

The National Kidney Registry’s system is such an interesting safety net

Just want to say thank you.

So you're depositing into some sort of kidney bank?

No, organs for transplant can't be stored that way. They can only exist outside of a functioning human body for a handful of hours; they measure the times in minutes.

Fresher kidneys are ideal, but I don’t think it’s quite this tight.

In my case my kidney went on a flight from Seattle to North Carolina overnight and wasn’t transplanted until morning.

If it were so important I would imagine they’d fly the recipient out to me (or vice versa) so that the surgery could be concurrent

Was yours a living donor or deceased donor? In my case, they brought several recipients of different organs together in the same hospital so that the transplants could be carried out quickly. This was a deceased donor case though, so they may have had a tighter window to meet.

I was the donor, not the recipient

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