Living kidney donation is an act of altruism that provides a life-saving option for individuals with end-stage renal disease. This procedure involves a healthy person undergoing major surgery to remove one of their two kidneys. While the practice is highly successful, it is not without potential dangers that prospective donors must fully understand. Risks span the immediate surgical period, the subsequent years of living with a single kidney, and the non-physical burdens of the experience. A comprehensive assessment of these hazards is necessary for informed consent.
Acute Risks During Surgery and Recovery
The most immediate dangers of living kidney donation are the acute risks associated with the surgical procedure, known as a donor nephrectomy, and the initial recovery phase. The operation requires general anesthesia, which carries potential complications such as adverse reactions, respiratory problems, or post-operative nausea and vomiting.
The surgery is most often performed using a minimally invasive laparoscopic technique. It involves the risk of bleeding that might necessitate a blood transfusion or, in rare instances, require conversion to a traditional open surgery. Minor complications, such as a wound infection, post-operative pain, or temporary nerve injury, occur in an estimated 10% to 20% of cases.
More serious complications, including injury to surrounding organs or a blood clot forming in the legs or lungs, occur in less than 3% of donors. Donor mortality, while extremely rare, is a possibility with any major surgery. The risk of death within 90 days of the procedure is fewer than one in every 10,000 living kidney donors.
The recovery period typically lasts between six weeks and six months. During this time, donors may experience persistent pain, fatigue, or the development of a hernia at the surgical site where the kidney was removed.
Long-Term Health Outcomes for the Donor
A donor’s primary long-term health consideration is the effect of living with a single kidney. After the removal of one kidney, the remaining organ compensates for the loss by increasing its filtration rate, a process called hyperfiltration. This restores the overall kidney function to approximately 70% of the pre-donation level, generally allowing the donor to maintain a healthy life without significant restrictions.
The increased workload on the solitary kidney can lead to a slightly elevated long-term risk of certain conditions compared to non-donors. One potential danger is the development of hypertension, or high blood pressure, which some studies show may occur at a slightly higher rate or earlier in life for donors. A small increase in proteinuria, the presence of protein leaking into the urine, is also observed in some donors and indicates mild kidney stress.
The most significant long-term concern is the risk of developing End-Stage Renal Disease (ESRD), which requires dialysis or a transplant. For the average healthy donor, the cumulative 15-year risk of kidney failure remains very low, less than 1%. Research indicates the risk for donors is slightly higher than for non-donors. One study estimated the cumulative incidence of ESRD at 15 years to be 30.8 per 10,000 donors compared with 3.9 per 10,000 in matched non-donors.
Specific populations, such as Black donors, have been identified as having a higher absolute risk of ESRD post-donation, similar to the higher baseline risk observed in the general population of the same race. Given these potential long-term changes, lifelong medical monitoring, including annual check-ups to track blood pressure and kidney function, is necessary for all donors.
Navigating Psychosocial and Economic Burdens
The dangers of donation are not limited to physical health, as the process can introduce psychosocial and economic burdens. Emotionally, while most donors report satisfaction, a minority may struggle with anxiety, depression, or a change in self-perception after the surgery. These mental health challenges can be intensified if the recipient’s transplant fails or if the recipient dies, leading to feelings of grief or emotional distress.
Financial consequences can also be a concern. Donors may incur out-of-pocket expenses for travel, accommodation, and childcare during the evaluation and recovery phases. The most common economic burden is lost wages during the typical four-to-six-week recovery period, which may not be fully covered by sick leave or other benefits.
A serious concern involves potential difficulties with insurance. Although federal and state laws generally protect donors from losing or being denied health, life, or disability insurance solely because of the donation, some donors still report encountering issues or higher premiums. Addressing these non-medical stressors is a necessary part of the long-term support required for a living kidney donor.