By deciding to donate a kidney, you could literally save someone's life. But is it the right choice for you?

While some people may ponder this question after reading about kidney disease or just thinking about ways to make the world a better place, it's most likely to be top of mind when someone you know is in (or headed for) kidney failure. Maybe they have asked if you'd consider donating a kidney, or maybe that person has just started hinting about the need for a donor. Either way, you need to figure out how to respond.

How should you handle such an intense request? And should you actually give up an organ?

These are hard questions, and no one expects you to answer on the spot. In fact, the National Kidney Foundation discourages people in need of a transplant from flat-out asking, "Will you give me a kidney?" "We encourage people to tell their story and talk about what getting a kidney would mean rather than just asking outright," says Joseph Vassalotti, MD, the foundation's chief medical officer.

In the event that you do get caught off-guard by a direct request, "I would certainly say take your time to think about it," says Jason Nothdurft, a volunteer for the National Kidney Foundation. How much time you need is very personal and will depend on a variety of things. Don't feel bad about saying you need a few weeks, or longer, to mull it over and do some research.

Nothdurft himself became a donor 3 years ago, when, at age 27, he donated a kidney to the stepfather of a close friend. He heard about the situation through Facebook and immediately reached out and offered to get tested. While he has "no regrets," he notes that kidney donation is definitely not for everyone. Here are a few key things to consider.

What's your relationship to the recipient?

You could give a kidney to a total stranger, and some people do. Or, as in Nothdurft's case, simply hearing about a specific patient who needs a kidney, even if it's not someone you know well, might be enough to motivate you.

But most people find it easiest to sign up for such a "selfless" act when the person in need is their parent, child, partner, or close friend. After all, by helping this person stay alive, you're keeping him or her in your life. It may also make things easier on you in the long run if you've been driving this person to dialysis or helping with their care in other ways.

How's your health?

Willingness aside, not everyone can be a kidney donor. While most people can live a normal life with just one kidney, it's not equally safe for everyone to try.

Potential donors must be in good health, and be free of kidney disease, cancer, type 2 diabetes, and a host of other issues. You have to be strong enough to make it through surgery and anesthesia. And you have to have two kidneys to begin with: "You might be walking around with one kidney and not know it, since some people are born with only one," Vassalotti says. Although that issue is somewhat rare, you'll need an imaging test to find out.

You'll also need to find out if you're a good match for your recipient. The first step in that process is a simple test to see if you’re a blood type match.

How do you feel about hospitals and surgery?

Most kidney donation procedures are now done laparoscopically, meaning a surgeon will get to the organ inside your body through tiny cuts. But it's still major surgery, and you’d get general anesthesia, which means you wouldn’t be “awake” for it. The procedure usually takes about 3 hours, and most donors stay in the hospital for 2 to 3 days afterward.

What's your pain tolerance?

It’s normal to have some pain after surgery. How bad it hurts (even with pain meds) varies a lot from person to person.

"My recovery was relatively painful," Nothdurft says. "I was slated to go home 2 days after surgery, but my doctor ended up having me stay an extra day to make sure we had the right types and levels of pain medications."

While most people don't have severe pain (at least not after the first few days), it's common to feel uncomfortable for a few weeks. To help you heal and make complications, such as hernias, less likely, your doctor may advise you to limit physical activity. "My doctor didn't want me to go up and down stairs a lot, so I put a bed in my living room," Nothdurft says.

You should also expect some scarring, Vassalotti says.

Are you willing to live with one kidney?

Most healthy people have no trouble living with one kidney. You'll probably have a catheter in for a day or two after surgery, but after that, you should urinate normally. That said, "you lose 50% of your kidney function the moment one is removed," Vassalotti says.

The good news: The remaining kidney actually works harder and better. Within a few weeks, it should be able to do about 70% of the work that two kidneys usually do, Vassalotti says.

Once you've fully recovered, you probably won't feel any different. But you will need to take some precautions that people with two healthy kidneys don't need to worry about.

Nothdurft, for example, was advised to limit his use of pain relievers that doctors call NSAIDs (including aspirin, ibuprofen, and naproxen), because they could damage the kidney. He also sees his doctor regularly to make sure that his blood pressure is well-controlled, since high blood pressure (hypertension) is closely linked with kidney problems. 

You'll also have to ask yourself how comfortable you are with fact that you'll no longer have a kidney to spare, should you or a loved one eventually develop kidney disease.  

What's your financial/job situation?

Generally speaking, the recipient's health insurance should cover your screening tests, surgery, and follow-up care. But you may have extra expenses, such as gas, tolls, and parking as you go back and forth between your home and the transplant center, notes Nothdurft. Another donor he knows also had to factor in airfare, since the donor lives in New Jersey but his recipient resides in California.

You also need to consider how flexible your job is. Will your company allow you to take off several weeks for the surgery and recovery? And assuming you don't have unused vacation or sick days to burn, can you afford to not get paid for about a month?

"I was very fortunate to have a job that allowed me to take time off and to have a good financial situation so that I could pay bills while I was out of work," Nothdurft says.

How strong is your support system?

You may not be the "sick" one, but after going through surgery, you're going to need some TLC. While Nothdurft was recovering, family and friends came to his house to bring him meals and keep him company. Having both logistical and emotional support is really important, so make sure you have a strong network. Talking to friends and family members before you decide can help you get a sense of whether they'll be there for you throughout the process. 

If you're leaning even slightly toward becoming a donor, Vassalotti says it makes sense to visit your recipient's transplant center of choice and find out if your blood type is a match. You may also want to meet with a mental health counselor at the center; the hospital may actually require it as part of the screening process. Connecting with someone who's been in your shoes may help, too. The National Kidney Foundation (kidney.org) can put you in touch with a trained peer mentor who's served as a donor.

Deciding to be a donor is up to you. Getting screened doesn't lock you into anything, and you can delay or backtrack at any point.

"The entire evaluation process is confidential," Vassalotti says. If you find out that you're a match but decide not to go through with it, the recipient never has to know your results. The transplant center can even give you an easy out (such as a medical disclaimer) if you'd like one.

Ready to give the green light? Nothdurft is confident he made the right choice. "Knowing you're doing something so selfless really changes your life," he says. "If I could do it again, I absolutely would." 

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