Dangers of Kidney Donation

What kind of problems can you expect after donating your kidney?

Male patient lying in hospital bed in intensive care unit
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Kidney transplantation for patients with kidney failure is hands down the best treatment available and beats being on dialysis any day. Patients do better from a health and from a lifestyle standpoint. Unfortunately, patients often find the process confusing, shrouded in a cloud of myths and misperceptions. While it is understandable for kidney disease patients to be apprehensive, what about potential donors?

That altruistic person who might be called upon to give up her or his kidney?

Donating your organ is a big decision. Whatever your reasons might be behind the choice, the ultimate decision should be well-informed, backed by your education, counseling, research, and perhaps introspection.

Donor's Safety is Priority #1

Most people understandably worry about the health consequences of donating their organ. Even if you think you have no problem giving up your kidney to a loved one,  nephrologists, surgeons, and psychologists will assess the safety of doing so first. 

The typical situation is a patient with advanced kidney disease that I see in the office. The patient is accompanied by a family member who is eager to donate their kidney to the patient but is concerned about any potential health pitfalls. Assuming the potential donor has no major contraindications to kidney donation (these will include impaired kidney function, active infections, cancers, chronic lung/heart/liver/autoimmune disease, substance abuse, pregnancy, etc.), this is what they could expect:

Short-Term Risks

These are basically risks that can arise from the surgery for kidney donation, known as nephrectomy. Some of these would include:

  • Wound complications at the surgical site
  • Pneumonia
  • Fever
  • Lung collapse/atelectasis (this is reversible)
  • Death 

Death, as a complication of kidney donation surgery is, however, very rare.

As per a study published in JAMA in March 2010, this number was around 3 deaths for every 10,000 donors. 

Long-Term Risks

This is usually the more pertinent question. I will divide this issue into three basic questions:

  • Does kidney function decline faster after you donate a kidney?

Most potential donors are worried that they will develop kidney disease should they donate a kidney. This is a valid concern; however most studies that were done so far have not shown this to be true. Granted that in the initial few days after you donate a kidney, the total GFR, a measure of the kidneys' filtration capacity does go down. This is expected since anyone who donates a kidney is losing 50 percent of their total kidney mass.

However, the remaining kidney is pretty good about taking up the slack and undergoes an increase in size and filtration capacity. This phenomenon is called "compensatory hypertrophy". In other words, the GFR, which initially could have halved after kidney donation, typically increases to about 70 percent of baseline by two weeks after donation, and further increases to about 85 percent of baseline by about 2-6 years after kidney donation.

Over the long-term, the risk of developing kidney failure requiring dialysis for patients who donate one kidney is the same as it is for the general population!  

  • Would donating a kidney increase my risk of dying early?

The short answer is no. As per current data, the long-term survival of people who donate a kidney is the same as the general population (it is another matter of debate whether you can really compare kidney donors to the general population since the former are supposed to be healthier than the "general population"). We also do realize that long-term mortality data for donors are lacking. The conclusions could change as more data come in. 

  • Are there any other long-term health consequences that a potential donor needs to be aware of?

At this time, there is some unclear evidence that kidney donors could see themselves developing higher blood pressures, protein in the urine, or bone disease. However, whether these entities are clinically meaningful is a question that still needs to be answered since I have already emphasized that, in spite of these risks, kidney donation does not affect long-term survival.

As an upside, the risk of developing depression is usually lower in people who have donated a kidney when compared to the general population! This could have something to do with the altruistic nature of the deed; after all, not everyone is fortunate enough to give the gift of life.

On the flip side, some concerns have lately been raised about the development of fatigue and quality of life being affected after donation. There are studies that cover these issues. 

A Special Situation: Women Who Have Not Completed Child-Bearing

There is medical evidence available that there could be some negative consequences for women who want to get pregnant after donating a kidney. Studies have shown that such women could experience a  higher risk of developing diabetes or high blood pressure during pregnancy, as well as an increased risk of fetal loss. Hence, I usually recommend that women consider completing their family before donating a kidney.

Conclusion

Donating a kidney is all about informed decision-making. And you should be aware of the above information even if you are extremely willing or anxious to donate a kidney to a loved one. In today's age, we have the miracle of "paired-donation, or "chain-donation", so even if you are not a good match with the person you want to donate to, you could still help them by donating your kidney to an unrelated patient whose donor (who is in turn a good match for the person you want to donate to) will then donate their kidney to your loved one. This 'chain" can potentially go on forever, as exemplified last year by a sequence of 30 kidneys being transplanted, some of them by people who donated to total strangers! 

All said and done, for most eligible donors, the process of donating a kidney is safe, and most donors would not experience any higher risk of developing kidney disease or dying early. Most donors I have talked to feel an enormous sense of satisfaction and justified pride in what they did, and I have a huge amount of respect for them. They are one of those very few men and women who have truly bestowed life on a fellow human being. 

I would also like to quote the conclusions of the addendum to the UK Guidelines for Living Donor Kidney Transplantation (November 2015), which came out after two recent reports generated discussion about the safety and long-term outcome of living donor kidney transplantation. 

"It is important to put this increased risk in context. The overall risk of developing ESRD after kidney donation remains very low, occurring in less than one in 200 (0.5%) donors, and it remains much less than that of the general (unscreened) population. Compared to the general public, kidney donors have equivalent (or better) survival, excellent quality of life, and no increase in ESRD. The increased incidence of kidney failure among living kidney donors is almost exclusively due to genetic and immunological factors, most of which should be screened out by effective donor assessment.

It thus appears that living kidney donation remains a safe and acceptable surgical procedure. The above studies are important, however, in demonstrating that certain groups (e.g. black donors, younger donors, genetically related donors, donors to patients with immunological causes of renal failure, and overweight donors) have a higher risk of ESRD following donation." 

Further Reading:

We now have a mathematical model for Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate

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