Explainer · 7 min read

What happens when you get tested.

The full process, step by step. No surprises, no fine print. Here's exactly what you're signing up for when you start the conversation.

People hesitate to start the donor screening process because they think it commits them to surgery. It doesn't. Screening is a conversation, then a series of tests, then more conversations. At every step you can say "this isn't for me" and that's the end of it.

Here's what each step actually involves, in the order you'd encounter it at Ascension St. John in Tulsa.

Step 1: The first contact

Time: 10–30 minutes. Your house, your phone.

You either call 918-744-2925 or fill out the online referral form. Either way, what happens next is the transplant program reaches out to you. They send a short health history questionnaire — basic stuff like your age, your weight, any major medical conditions, any medications you take.

This is where most disqualifiers show up. If you have uncontrolled diabetes, active cancer, certain heart conditions, or kidney problems of your own, the team will tell you upfront. Better to find out now than after three months of testing.

If your initial answers look good, they schedule you for blood work.

Step 2: Blood and tissue typing

Time: 30 minutes at a lab. Cost to you: nothing.

This is the first in-person step. You go to a lab, they draw blood, you leave. The blood tells them your blood type, your tissue antigens, and whether you have any antibodies that would cause problems.

This is also where, in the old single-pair model, most people got eliminated. ("Sorry, you're not a match.") In paired donation, your blood type doesn't have to match John's specifically. It just has to be healthy and compatible with someone in the APKD pool. The algorithm finds your match.

Step 3: Medical workup

Time: 1 to 2 full days at the hospital. Sometimes spread across multiple visits.

This is the deep dive. The transplant program needs to be absolutely sure that donating a kidney won't hurt you. That means:

• CT scan of your kidneys, to look at the anatomy and confirm you have two healthy kidneys that work properly
• Chest X-ray
• EKG, sometimes a cardiac stress test for older donors
• 24-hour urine collection to measure kidney function precisely
• Detailed health history reviewed by a transplant physician
• Physical exam
• For women, current mammogram and pap smear are usually required
• For everyone, cancer screening appropriate to your age (colonoscopy for some)

If anything in this workup shows a problem, the program will tell you. Sometimes the problem disqualifies you. Sometimes it's something you can fix and try again later. Either way, you get accurate information about your own health that you can use whether or not you ever donate.

Step 4: The psychological and social evaluation

Time: An hour or two, sometimes split across two visits.

This part is required and it's not a formality. You'll talk with a transplant social worker and possibly a psychologist. They're checking that:

• You're making the decision freely, not under pressure from family or anyone else
• You understand what you're agreeing to
• You have a stable support system for recovery
• You're not being paid or coerced (illegal)
• You have a financial plan for the days you'll be off work

One important thing the team offers: if at any point during the screening you decide you don't want to continue, they will give you a confidential medical reason to share with family or friends. You don't have to explain your withdrawal to anyone if you don't want to. That protection is built in.

Step 5: The independent donor advocate

Time: 30 to 60 minutes.

Federal law requires that you meet with someone whose only job is to look out for your interests as a donor — not John's, not the hospital's, not even the transplant team's. This person walks you through every risk again, makes sure all your questions are answered, and confirms you actually want to proceed.

This is your last formal off-ramp before the chain match itself.

Step 6: Matching and scheduling

Time: Weeks to a few months.

Once you're cleared as a donor, your information goes into the APKD national pool. The algorithm runs constantly, looking for chains that include you. When a chain forms that involves you as a donor and includes John (or someone who can free up a donor for John), you'll get a call.

You'll have time to confirm. The surgery will be scheduled, usually 2 to 6 weeks out.

Sometimes the chain falls apart at the last minute because someone else withdrew. That's normal. The algorithm reshuffles and finds a new chain. You can be in multiple potential chains over months before one actually proceeds.

Step 7: Surgery day

Time: 3 to 4 hours in the OR. Hospital stay: 2 to 3 days.

The surgery is laparoscopic in nearly all cases. Three or four small incisions, plus one slightly larger one (about 3 inches) where they remove the kidney. You're under general anesthesia. You wake up in recovery, sore but okay.

Most donors are walking the same day. Eating solid food by the next day. Discharged within 72 hours.

What happens to your kidney? It's transported, sometimes hundreds of miles, to wherever your matched recipient is. The chain transplants are usually coordinated so that all the surgeries happen on the same day or within a 24-hour window.

What testing actually costs you

Medical costs: zero. The recipient's insurance covers your testing, surgery, hospital stay, and follow-up. This is federal law.

What you might still face:

• Time off work — 2 to 4 weeks at minimum, longer for physical jobs
• Travel to the testing center if you're not local
• Childcare during surgery and early recovery
• Out-of-pocket medications for pain management

The National Living Donor Assistance Center provides grants for donors who can't easily absorb these costs. The transplant social worker will help you apply if you qualify.