Living kidney donation involves a healthy individual giving one of their kidneys to someone with kidney failure, offering a life-saving treatment alternative. Living donor kidneys function more quickly and last longer than kidneys from deceased donors, often for 15 to 20 years. A living donation can reduce or even prevent the recipient’s need for dialysis, leading to healthier lives. It also allows for the transplant surgery to be scheduled at a convenient time for both the donor and recipient, optimizing health conditions.
Surgical Complications
Donating a kidney involves a major surgical procedure, and like any surgery, it carries inherent risks. Donors typically experience pain at the incision site, which is managed with medication, and receive a pain block before surgery. There is a risk of infection, including wound infections or pneumonia, which can be mitigated post-surgery.
Additional surgical risks include blood loss, which may require blood transfusions, and the formation of blood clots. Donors may also experience allergic reactions to general anesthesia or injury to surrounding tissues or other organs during the kidney removal.
The surgical approach commonly used is laparoscopic nephrectomy, involving three or four small incisions, which leads to less pain, shorter hospital stays, and a faster recovery. Approximately 3% of living kidney donors experience surgical problems, and 1.7% may require re-hospitalization. The risk of death from living kidney donation surgery is low, estimated at 0.03% to 0.06%, or roughly 3 in 10,000 donors.
Potential Health Changes After Donation
After donating a kidney, the remaining kidney compensates by increasing its workload and size to maintain kidney function. Donors experience a 20% to 30% decrease in overall kidney function, as measured by the glomerular filtration rate (GFR), immediately following the donation. This function usually stabilizes over many years.
Despite the remaining kidney’s compensation, donors may have an increased risk of developing certain health conditions over the long term. Some individuals with one kidney may develop high blood pressure or proteinuria (protein in the urine). Studies indicate that hypertension and albuminuria may be more prevalent among donors in the decade after nephrectomy.
The lifetime risk of developing kidney failure is also elevated for living kidney donors compared to healthy individuals who have not donated. For instance, the lifetime risk of kidney failure for the average person is estimated at about 3.26%, or 326 in 10,000. For healthy non-donors, this risk is approximately 0.14%, or 14 in 10,000. In contrast, the risk for those who have donated a kidney is around 0.9%, or 90 in 10,000. This represents an increased risk of about 76 in 10,000 when comparing donors to healthy non-donors. Regular follow-up care is recommended for all living kidney donors to monitor their kidney function, blood pressure, and other health indicators.
Non-Medical Considerations
Living kidney donation can present non-medical challenges for donors. Psychologically, while many donors report positive feelings of satisfaction and a sense of purpose, some may experience emotional difficulties. These can include feelings of anxiety or depression, particularly in the recovery period.
A small percentage of donors (0-10%, median 3%) have reported regret over their decision to donate. Emotional challenges can also arise from the dynamics of the donor-recipient relationship, especially if the recipient’s transplant is not successful, which can lead to increased anxiety or lower life satisfaction for the donor. The psychological impact can be complex, and some donors may require post-donation psychological support.
Financial considerations also play a role, as donors may incur expenses not covered by insurance. These can include lost wages due to time off work for surgery and recovery, travel costs for medical appointments, and lodging expenses. Some studies indicate that nearly a quarter of donors have reported financial hardship due to donation-related costs, with higher expenses sometimes linked to worse mental health-related quality of life in the initial months following donation. Social adjustments may also occur, impacting relationships with the recipient, family, and friends.