Do You Keep Your Old Kidneys After a Transplant? | UK Explained

In the UK, kidney transplants usually add a new kidney rather than removing the old ones. Learn why most transplant patients keep their original kidneys and when removal is needed.

This is one of those questions that comes up again and again. It’s asked in lectures, on placement and whenever organ donation is mentioned.

If someone is getting a new kidney, it feels logical to assume the old ones must be removed first. New organ in, old organ out. But that isn’t usually how kidney transplants work in the UK.

In most cases, the patient’s original kidneys are left exactly where they are. The donated kidney is added rather than swapped and it’s placed in a different location, usually low down in the abdomen where it can be connected to blood vessels and the bladder. The original kidneys stay in place, even if they no longer function.

Because of this, many people who have had a kidney transplant technically have three kidneys. It sounds strange, but it’s completely normal within UK transplant practice. This approach is standard across NHS transplant centres and applies to both living donor and deceased donor transplants, following guidance from NHS Blood and Transplant. Old kidneys are only removed if there is a clear medical reason to do so. This is uncommon, but may happen in situations such as repeated severe infections, very large polycystic kidneys, ongoing bleeding, suspected cancer or rare cases where blood pressure is directly affected by the native kidneys.

The confusion often comes from how we think about transplants in general. With organs like hearts or lungs, replacement is the norm. Kidneys are different. Kidney transplantation is usually additive rather than a straight replacement, and that detail is often missed.

So in short, kidney transplants in the UK usually involve adding a new kidney and leaving the original kidneys in place. Removal of native kidneys is not routine and only happens when there is a specific clinical reason.

For further reading visit Kidney Transplant Surgery, NHS Blood and Transplant.