What Is a Living Donor: Donation Types and Health Risks

A living donor is a person who gives an organ, part of an organ, or tissue to someone else while still alive. The most common form is kidney donation, where a healthy adult gives up one of their two kidneys, but living donation also includes portions of the liver, lung lobes, and bone marrow or blood stem cells. Unlike deceased donation, which relies on organs recovered after death, living donation allows transplants to be planned in advance and often produces better outcomes for the recipient. The practice carries real surgical and long-term health risks for the donor, though, and those risks vary considerably depending on what is being donated.

What Can a Living Donor Give

The kidney is by far the most commonly donated organ from a living person. Humans are born with two kidneys but can live a healthy life with one. After a kidney is removed, the remaining kidney compensates by increasing its filtration rate, eventually recovering to roughly 60–75% of the donor’s original two-kidney function.¹ Over the following months and years, the remaining kidney physically grows larger. One long-term study found that the remaining kidney’s volume increased from about 160 mL to about 176 mL over a decade, and creatinine clearance (a measure of kidney function) climbed from roughly half of its pre-donation level back up to about 83% of the original value after ten years.² How quickly and completely this compensation happens in the first weeks after surgery appears to predict how well the kidney performs years later.³

The liver is the second most common organ donated by a living person. Because the liver regenerates, a surgeon can remove a lobe and the donor’s remaining portion will regrow. The speed of this regrowth is remarkable: after a right-lobe donation, where roughly 60% of the liver is removed, the remaining portion can increase in volume by about 88% within just ten days.⁴ Regeneration is fastest in the first three months and then slows. By three months, right-lobe donors typically reach about 74–80% of their original liver volume.⁵ The volume continues to creep upward over years but rarely returns to the full pre-surgery size; one study following donors for four years found left-lobe donors reached about 91% of their original volume and right-lobe donors about 88%.⁶ Functional recovery lags behind the volume increase, meaning the liver may look close to its old size on a scan while its metabolic capacity is still catching up.

Living-donor lung transplantation is far rarer. Two donors each give one lobe to a single recipient, typically in cases of severe lung disease where a deceased donor organ is unavailable. Donors lose a lobe permanently since lung tissue does not regenerate. At one year after donation, lung capacity (measured by forced vital capacity) typically recovers to about 89% of the pre-surgery level, which is better than many donors initially expect.⁷ Most lung donors are discharged without long-term restrictions.⁸

Bone marrow and peripheral blood stem cell donation round out the picture. Marrow donation involves a needle aspiration from the hip bone under anesthesia and typically requires one to three days in the hospital. The most common complaint is pain at the collection site, reported by about 82% of donors, along with fatigue in roughly 59%. Peripheral blood stem cell donors receive injections of a growth factor for several days beforehand and then undergo a blood-filtering procedure; bone pain during the growth-factor injections occurs in about 97% of donors, but the median recovery time is only about a week, compared with three weeks for marrow donors.⁹ Serious adverse events are uncommon in both groups, and blood counts generally return to normal within a month.¹⁰

Types of Living Donation Arrangements

Not every living donor knows the person who will receive their organ. The most familiar scenario is directed donation, where a donor gives to a specific person, usually a family member or close friend. But there are other pathways that have expanded the donor pool considerably.

Non-directed (sometimes called altruistic or anonymous) donation involves giving an organ to a stranger. Research into who chooses this path consistently finds that these donors tend to have a strong personal set of values around helping others, often combined with some experience of illness in their own lives or families. Media stories about organ shortages trigger nearly half of non-directed donors to begin the process.¹¹ Early skepticism questioned whether anonymous donors were psychologically sound, but studies have found they are characterized by benevolence and independence rather than impulsivity, and that spiritual belief systems and genuine altruism are common motivators.¹²

Kidney paired donation (also called paired exchange) solves a common problem: a willing donor whose blood type or immune profile is incompatible with their intended recipient. In a paired exchange, two or more incompatible donor-recipient pairs swap donors so that each recipient gets a compatible kidney. These exchanges can grow into chains involving dozens of pairs. Even patients with very high levels of pre-formed antibodies against donor tissue have been successfully transplanted through paired donation programs, with one series reporting 100% patient and graft survival at a median follow-up of nearly two years among highly sensitized recipients.¹³

How Donors Are Screened

Becoming a living donor involves one of the most thorough medical evaluations you can undergo. The screening is designed to protect you, not the recipient. Transplant programs look at kidney function, blood pressure, blood sugar, body composition, cardiac health, and psychological readiness, among other things. In one registry analysis, the most common reasons for turning down potential kidney donors were medical issues unrelated to kidney disease (about 25% of denials), followed by risk to the donor’s own future kidney health (about 19%), and the candidate simply withdrawing from the process (about 15%).¹⁴

Screening criteria vary by center and have evolved over time. Programs have generally become more accepting of donors with well-controlled high blood pressure; as of 2017, about 65% of U.S. transplant programs would consider a candidate whose blood pressure was managed with a single medication, compared with only 41% in 2005. Most programs draw the line at a body mass index above 35, and a blood sugar test indicating prediabetes is a common exclusion criterion. Smoking is rarely an outright disqualifier, but most programs require donors to stop for at least four weeks before surgery.¹⁵

Every transplant center that performs living-donor surgery is expected to have an independent living donor advocate, a person whose sole responsibility is looking out for the donor’s interests rather than the recipient’s. This advocate assesses whether the donor has given truly informed consent, watches for signs of coercion, and holds what has been described as a narrow “veto power” to stop a donation that raises concerns about the donor’s well-being.¹⁶

Surgical Risks of Kidney Donation

Most kidney removals from living donors are now done laparoscopically, with about 94% of U.S. procedures using either standard laparoscopic or robotic techniques. Perioperative mortality is extremely rare, estimated at about 0.03%.¹⁷ In a national study of nearly 15,000 donors, about 17% experienced some form of perioperative complication, though most were minor. The most common issues were gastrointestinal problems, bleeding, and respiratory complications. Major complications (those requiring intensive care or a return to the operating room) affected about 2.5% of donors.¹⁸ A multicenter Canadian cohort found a similar overall complication rate of 13%, with the vast majority classified as minor; the most common intraoperative issue was organ injury, and the most common postoperative problem was ileus (a temporary slowdown of bowel function).¹⁹

Robotic-assisted donor nephrectomy is increasingly popular and may offer slight advantages once the surgical team gains enough experience. A meta-analysis comparing robotic and standard laparoscopic approaches found that, once surgeons moved past the learning curve, robotic procedures had shorter operating times, shorter hospital stays, lower rates of conversion to open surgery, and fewer overall complications.²⁰ The average hospital stay after robotic donation is about four days.²¹

Surgical Risks of Liver Donation

Living liver donation is a bigger operation with higher complication rates than kidney donation. The donor typically gives the right lobe, which is larger. Biliary complications — leaks or narrowing of the bile ducts — are the most frequent serious problem. A large review found that biliary complications occurred in about 6.6% of liver donors, with 75 out of roughly 830 affected donors needing a second surgery, and one donor death attributed to a biliary complication.²² In a single-center analysis of 176 liver donors, the most common serious complications among right-lobe donors included bile leaks, intra-abdominal bleeding, and pleural effusions. The volume of liver removed and certain lab markers after surgery were the best predictors of who would experience a significant complication.²³

From the recipient side, a meta-analysis of more than 9,400 living-donor liver transplants found that biliary strictures developed in about 22% of recipients and bile leaks in about 14%. The strongest predictor of stricture was an initial post-transplant bile leak.²⁴ These numbers are higher than for deceased-donor liver transplants, a trade-off that reflects the more complex anatomy involved when only part of a liver is transplanted.

Long-Term Health After Donating a Kidney

The question donors ask most often is whether giving up a kidney will shorten their life or lead to kidney failure down the road. The best available evidence is reassuring. A landmark study tracking more than 3,600 kidney donors over decades found that kidney failure developed at a rate of 180 cases per million person-years, compared with 268 per million per year in the general population. Survival among carefully screened donors was similar to that expected in the general population.²⁵ An important caveat: donors are screened to be healthier than average before they give, so comparing them directly to the general population may overstate their safety. But even analyses that try to account for this “healthy donor” effect have not found dramatically elevated risks.

Hypertension is common after kidney donation, as it is in the general aging population. Among donors who developed high blood pressure, one study found the risk of progressing to kidney failure was not meaningfully increased compared with donors who remained normotensive.²⁶

Long-Term Health After Donating Part of the Liver

Liver donors face a somewhat different long-term picture. Major complications occur in roughly 2–8% of donors, and evidence on what happens beyond the first year is still limited.²⁷ Incisional hernias are surprisingly common, developing in up to 20% of donors, and about 27% report chronic pain at some point. On the other hand, nearly 80% return to work within three months, and physical quality of life typically returns to baseline within six to twelve months.

One curious long-term finding involves platelet counts. About 10% of liver donors still have lower-than-normal platelet levels two to three years after donation, and this pattern persists in studies with follow-up as long as eleven years. Researchers suspect this may relate to incomplete regeneration of the liver’s internal blood vessel architecture, potentially causing mildly elevated pressure in the portal vein, but the clinical significance is still unclear.²⁸

Psychological Outcomes and Donor Regret

Most living donors report that giving an organ was a positive experience. Across quantitative studies, quality of life after kidney donation tends to remain the same as or improve from pre-donation levels. Rates of regret are consistently low. In a U.S. study of more than 800 donors, about 2% reported regretting their decision. A Swedish long-term follow-up put the figure below 1%. A German study, by contrast, found that 24% had some form of regret, suggesting that how and when you ask the question matters.²⁹

Qualitative research reveals a more complicated picture than the low headline regret numbers suggest. Some donors describe simultaneously regretting the donation and still being willing to recommend it to others, a nuance that standard survey questions can miss.³⁰ Anxiety and depression do affect a small minority of donors: about 6% screen positive for anxiety and about 4% for depression. One strong risk factor for depression is the recipient’s transplant failing, which makes intuitive sense. Interestingly, regret and depression don’t overlap as much as you might expect; they appear to be somewhat independent experiences.³¹

Financial and Insurance Concerns

In the United States, the recipient’s insurance typically covers the donor’s surgery and initial medical expenses. But that coverage often does not extend to lost wages, travel costs, childcare, or the longer-term follow-up care a donor might need. These out-of-pocket costs create real barriers, and expert consensus panels have called for standardized reimbursement of lost wages, employment protections, and better education for donors and providers about what financial support is actually available.³²

Insurance discrimination is another worry. While the Affordable Care Act prohibits health insurers from denying coverage based on a preexisting condition like having donated an organ, the rules around life insurance and disability insurance are far less protective. Protections vary widely by state. The Living Donor Protection Act, which would prevent life and disability insurers from penalizing organ donors, has been introduced in Congress but has not yet become law.³³ This gap is a genuine concern: some research has found that difficulty obtaining or changing life insurance is a risk factor for post-donation regret.

Why Living Donation Matters for Recipients

Living-donor kidneys consistently outperform deceased-donor kidneys. A large UK cohort study found that at five years, the rate of graft failure was about 5.6% for living-donor recipients versus about 11.6% for deceased-donor recipients, a roughly six-percentage-point difference that widened further over time. Living-donor recipients also gained an additional four months of graft survival over a seven-year period.³⁴ These advantages hold even for older recipients. A European registry analysis of elderly transplant patients found that deceased-donor kidneys were associated with two to three times the risk of graft failure compared with living-donor kidneys.³⁵

For lung donation, an interesting finding reinforces the value of the living-donor approach: the lung capacity gained by the recipient at one year significantly exceeded the capacity lost by each donor, a result attributed to the transplanted lobes expanding to fill the recipient’s chest cavity.³⁶

Ethical Safeguards and Global Concerns

The voluntary nature of living donation is the ethical foundation the entire system rests on. The independent donor advocate, described earlier, is one institutional safeguard. But beyond individual transplant centers, organ trafficking and transplant tourism remain serious global problems. Extreme poverty, armed conflict, forced migration, and corruption in health-care systems all create vulnerable populations who may be coerced or tricked into selling organs.³⁷ The Declaration of Istanbul, first adopted in 2008 and updated in 2018, is the main international framework calling on governments, professional organizations, and health-care workers to combat these practices through legislation and enforcement.³⁸

In legitimate donation programs, the screening process itself serves as a guard against exploitation. Psychosocial evaluations probe for financial desperation, external pressure, and unrealistic expectations about what donation will involve. The fact that psychosocial or economic concerns account for a meaningful share of donor denials — roughly 10–11% in one registry — shows that these evaluations are catching more than just medical problems.¹⁴ Bone marrow donor registries add another layer by tracking side effects and complications systematically; even relatively uncommon donor characteristics like sickle cell trait have been studied to confirm that donation remains safe across different populations.³⁹