The question of whether a person diagnosed with Systemic Lupus Erythematosus (SLE) can donate a kidney is complex, and the answer is generally no. Lupus, a chronic autoimmune disease, is widely considered an absolute contraindication for living kidney donation due to the unacceptable risks it poses to the donor’s long-term health. This exclusion is based on the medical principle that a live donor procedure must pose minimal risk to the healthy individual giving the organ. While transplantation centers evaluate each potential donor individually, the systemic nature of lupus introduces a level of risk that violates this safety requirement.
Understanding Lupus as a Systemic Condition
Systemic Lupus Erythematosus is an autoimmune condition where the immune system mistakenly attacks healthy tissues and organs throughout the body, leading to widespread inflammation. This systemic attack can affect various parts of the body, including the joints, skin, brain, heart, lungs, and, significantly, the kidneys. The inflammation caused by this immune response can damage the small blood vessels in the kidneys responsible for filtering waste.
When lupus specifically targets the kidneys, the condition is known as lupus nephritis. Lupus nephritis damages the glomeruli, the filtering units within the kidney, which can result in symptoms like protein or blood in the urine, swelling, and high blood pressure. About 50% of adults and up to 80% of children with SLE will develop this complication, which can eventually lead to end-stage renal disease (ESRD) requiring dialysis or a transplant.
Even if a person with lupus is currently in remission and has no apparent kidney damage, the underlying autoimmune disease remains active. The disease process that causes lupus nephritis is still present and could flare up at any time. Because the disease has the potential to affect the kidney, a physician cannot guarantee that the organ being donated is truly healthy or that the remaining kidney will be safe from future damage. Donor safety is the priority for transplant centers.
Specific Eligibility Concerns for Living Donors
Living kidney donor evaluation is a rigorous, multi-step process designed to ensure the donor is at minimal risk before and after the donation surgery. A core requirement is that the donor must be free of any underlying medical conditions that could significantly increase their risk of developing kidney failure or other serious health problems. Autoimmune diseases, including SLE, are generally considered absolute exclusion criteria for living kidney donation.
The presence of lupus introduces uncertainty regarding the long-term function of the remaining kidney. Transplant programs exclude candidates with conditions like diabetes, uncontrolled hypertension, and active malignancy because these represent pre-existing threats to kidney health. Lupus falls into this category of conditions that introduce a heightened risk of future renal failure.
Furthermore, many individuals with SLE require chronic medications, such as immunosuppressants or corticosteroids, to manage their condition. The need for long-term immune suppression complicates the post-operative care and monitoring of a donor. The entire evaluation process is based on the principle of “do no harm,” and the presence of a chronic, systemic, and potentially organ-damaging condition like lupus violates this principle.
Risks to the Remaining Kidney and Long-Term Health
The primary concern is the risk posed to the single remaining kidney after the donation procedure, known as a uninephrectomy. When one kidney is removed, the remaining kidney compensates by increasing its workload, a process called hyperfiltration. This means the single kidney must filter the entire volume of blood, leading to increased pressure within the organ’s filtering units.
For a person with a healthy immune system, the remaining kidney typically manages this increased stress without developing long-term failure. However, for someone with SLE, this hyperfiltration stress could potentially trigger or accelerate the onset of lupus nephritis in the remaining kidney. The increased pressure and workload make the kidney more vulnerable to the inflammation and damage characteristic of a lupus flare.
If lupus nephritis were to develop in the single remaining kidney, the donor would be at a greater risk of progressing to end-stage renal disease (ESRD). The donor would then require dialysis or a kidney transplant themselves. The long-term safety concerns for a donor with lupus are too high to permit donation.