Kidney donation is a profound act of generosity that provides a life-saving option for individuals suffering from end-stage renal disease. The process focuses almost entirely on the safety of the donor, as the donation is an elective surgery for a healthy person. Becoming a living kidney donor involves a rigorous, multi-stage evaluation process designed to protect the donor’s long-term health while maximizing transplant success.
Preliminary Eligibility Requirements
Initial requirements focus on general health and age to establish physical fitness and informed consent. Prospective donors must be at least 18 years old and capable of making a voluntary decision, ensuring the act is non-coerced and free of financial incentive. While there is no strict upper age limit, older candidates require more extensive testing to confirm their heart, lung, and remaining kidney function are robust enough for the procedure.
Specific medical conditions represent absolute exclusions because they significantly increase the health risk for the donor. Active cancer, uncontrolled hypertension, and Type 1 or Type 2 diabetes generally disqualify a candidate. Conditions like HIV and Hepatitis C also prevent donation, as they can compromise the donor’s long-term health or be transmitted to the recipient.
Body Mass Index (BMI) is an important screening tool, with many centers preferring a BMI below 35 due to the increased risk of surgical complications and long-term health issues. Candidates who are overweight may be asked to lose weight before being approved for the surgery. The donor must be in excellent health, with a healthy remaining kidney function, typically a Glomerular Filtration Rate (GFR) of 90 mL/min or greater, to proceed.
The Comprehensive Donor Evaluation
Once a candidate meets the initial criteria, they move on to a comprehensive evaluation, which can take several weeks to months. This phase involves detailed medical tests to confirm the candidate is fit for surgery and that the remaining kidney can handle the full workload after donation.
Detailed blood work includes ABO blood typing and tissue typing (HLA matching) to assess compatibility with the recipient. Cross-matching checks if the recipient has antibodies that would immediately attack the donor’s kidney, leading to rejection. Laboratory tests also screen for kidney function, liver abnormalities, infectious diseases, and conditions like glucose intolerance. Imaging studies, such as a CT scan or MRI, map the donor’s renal anatomy and blood vessels to help the surgical team plan the safest procedure.
A psychological evaluation is performed by a licensed professional to ensure the donor is mentally capable of giving informed consent and is motivated by altruistic reasons. This counseling assesses the donor’s emotional readiness, support system, and ensures the decision is free of pressure or financial incentive. Financial counseling clarifies that the recipient’s insurance typically covers all donor testing and surgical costs. However, the donor is responsible for non-medical expenses like travel and lost wages.
The Surgical Procedure and Recovery
The procedure to remove the kidney, known as a donor nephrectomy, is almost always performed using a minimally invasive laparoscopic technique. This method utilizes a videoscope and specialized instruments inserted through small abdominal incisions, which reduces scarring and post-operative pain compared to traditional open surgery. The kidney is removed through a slightly larger incision, typically three inches long, often located near the belly button.
Laparoscopic surgery allows for a quicker recovery time and a shorter hospital stay, typically lasting only one to two days. Patients are encouraged to walk soon after the procedure to aid recovery. Most donors can return to work within two to four weeks, though physically demanding jobs may require four to six weeks of recovery time.
For the first four to six weeks, donors are instructed not to lift anything heavier than 10 to 20 pounds to allow incision sites to heal fully. Full recovery, where a donor feels completely back to normal, can take up to three or four months. Immediate risks associated with the surgery include pain, infection, blood clots, or the rare necessity to convert the procedure to open surgery.
Life After Donation
Living with one kidney is generally safe and does not shorten a donor’s life expectancy, as the remaining kidney compensates by increasing its workload. Donors typically experience a permanent 25 to 35 percent decrease in overall kidney function, known as hyperfiltration, but this is sufficient to maintain a healthy life. Long-term monitoring is mandatory, requiring follow-up appointments at two weeks, six months, one year, and then annually for at least two years.
Long-term health outcomes show only a slightly increased risk for certain conditions compared to the general population. This includes a small chance of developing mild proteinuria or hypertension years after donation, though the risk of future kidney failure remains very low, below one percent. Female donors are advised to wait six months to one year before becoming pregnant due to a slightly elevated risk for gestational hypertension or preeclampsia.
Donors are advised to maintain a healthy lifestyle, including proper hydration and a balanced diet. While most physical activities can be resumed, donors are counseled to avoid high-impact or contact sports that carry a significant risk of direct trauma to the remaining kidney. Although the recipient’s insurance covers the donation, coverage for the donor’s ongoing long-term medical follow-up is a separate consideration addressed during financial counseling.