ENFor a foreign patient, a kidney transplant in Germany is in practice possible only from a living donor who is close to them. Eurotransplant allocates kidneys from deceased donors within its member countries, and patients from abroad are listed only in isolated cases. On dialysis, the real question is whether you will be accepted.
Below: who may donate under German law, the assessment, the operation and first weeks, life on immunosuppression, and the options if a transplant is impossible.
Who may donate under German law
A kidney may go to a chosen recipient only if donor and recipient are close. Section 8 of the German Transplantation Act names relatives up to the second degree, spouses, registered partners, fiancés and others with an evident special bond. Donors must be adults and pass a psychosocial assessment. Paid donation is banned. The same rules apply to a liver transplant in Germany.
Before surgery the centre needs a written opinion from a living donation commission set up under state law, in Hamburg at the regional medical chamber. A doctor not involved in transplants, a lawyer and a psychologist check for involuntary consent or organ trading, normally hearing donor and recipient in person; well-founded concerns rule surgery out.
Next comes compatibility: blood group, tissue antigens and antibodies against the donor; the crossmatch tests whether the recipient’s antibodies attack the donor’s cells. A blood group mismatch need not end the matter: after preparatory treatment (desensitisation), German centres do such transplants too. A recent reform also lets incompatible pairs swap kidneys and permits anonymous donation; the centre decides who qualifies.
Assessing the donor and the recipient
The donor is examined longer and more strictly, since a healthy person faces surgery with no medical benefit to themselves: each kidney’s function, the kidney vessels on MR or CT angiography, 24-hour blood pressure, metabolism, urine, infections, heart and lungs, age-based cancer screening and a psychological consultation.
For the recipient the question is whether they can cope with surgery and years of immunosuppression. Doctors check the heart and vessels, including the pelvis and legs, and look for infections and hidden inflammation, even in the teeth; a urologist assesses the bladder, and ultrasound shows the patient’s own kidneys.
None of this can be hurried, and its length depends on the results: tests run in stages, each only after the previous one found no obstacle, and some are repeated. The centre must be sure the donor decided freely and understands the risks, and surgery waits for the commission’s opinion.
The operation and the first weeks
The donor kidney is usually removed laparoscopically through small incisions, then placed low in the recipient’s abdomen and connected to their vessels. The recipient’s own kidneys normally stay unless they cause infections or high blood pressure, or contain a tumour.
The team then watches urine output and blood tests. If the kidney starts working only after days or weeks (delayed graft function), dialysis continues meanwhile. The first weeks are spent near the centre for frequent tests and dose adjustments.
Partner departments as examples, not a ranking: the Department of General, Visceral and Transplant Surgery at Essen University Hospital, headed by Professor Ulf P. Neumann, transplants kidneys, including from living donors, and kidney transplantation is part of the III. Medical Department of University Medical Center Hamburg-Eppendorf, headed by the nephrologist Professor Tobias B. Huber.
Immunosuppression and life after the transplant
Immunosuppression means daily, lifelong drugs that stop the immune system destroying the new kidney. Without them the body attacks it as foreign, which is rejection, so missed doses are dangerous. Early rejection shows in blood tests and is treated by adjusting the drugs.
Side effects to know: infections are harder to fight off, blood pressure, cholesterol and blood sugar may rise, and cancer risk grows over the years, so a dermatologist checks the skin annually. Drug levels are measured on a schedule, before the next dose, to check the dosing.
Most donors live with one kidney without complications, but donation is not without consequences: the law requires late effects to be explained beforehand. Donors avoid heavy lifting for the first weeks and should stop smoking for good; annual follow-up is required by German law.
When a transplant is not possible
For many patients the answer will be no. Reasons include no suitable living donor, too high a surgical risk from heart or other organ disease, uncured cancer, an infection immunosuppression would worsen, or inability to keep to treatment.
The discussion then turns to better dialysis: its regimen and complications, vascular access prepared in good time, anaemia and calcium and phosphate balance (see dialysis in Germany and cost of dialysis in Germany). A German centre’s written assessment still shows what is possible at all.
Frequently asked questions
Can a foreign patient receive a kidney from a deceased donor in Germany?
As a rule, no. Eurotransplant allocates kidneys from deceased donors among patients on its member countries’ waiting lists, and the transplant centre decides whether to register a patient from abroad. In a Council of Europe survey published in 2021, less than 1% of recipients of deceased donor organs were non-residents.
Can a donor be found in Germany or paid?
No. Organ trading is banned in Germany and punishable for brokers, doctors and anyone who lets a purchased organ be transplanted into them. Anonymous donation is now legal, but the donor has no say in who receives the kidney, so a stranger’s kidney cannot be arranged for you.
Does the donor have to travel to Germany with the patient?
Yes. The same German centre assesses and operates on the donor, and the commission normally hears them in person. The donor then spends a few days in hospital and the first weeks recovering. Annual follow-up is mandatory, so agree with the centre how it will work back home.
How AlenMed organises treatment
After you get in touch, a medical translator prepares the reports, dialysis records, blood group and tissue typing, donor details and proof of kinship. The departments say whether they will take the case and on what conditions; an estimate can be requested then (see cost of a kidney transplant in Germany). Medical visa papers are prepared in parallel.
AlenMed works with 86 partner hospitals in 38 cities and 345 doctors; the company office is in Munich. A coordinator books appointments for patient and donor, interprets at consultations and the commission interview, and keeps the long assessment on schedule.
This material is for information only and is not an offer. The treatment plan is decided by a doctor at an in-person appointment.