Donor Risks

Prospective donors are screened for blood-borne illness, obesity, hypertension, diabetes, kidney function, and other health conditions that make kidney donation riskier to the donor or to the recipient. Due to the screening process, living kidney donors are healthier than the general population, and they remain healthier after they donate. The vast majority of donors live healthy, normal lives essentially unaffected by the risks of donation.

However, while kidney donation is very safe there are still risks that all people considering donation should understand.

Short-Term Risks

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Chance of death during surgery

The risk of death in surgery is about 3 in 10,000, which is slightly higher than the chance of death during childbirth.

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Details & Source Information

Study:
Segev DL, Muzaale AD, Caffo BS, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA. 2010;303(10):959–966. doi: 10.1001/jama.2010.237.

Sample Size:
80,347 live kidney donors in the U.S. who donated between 1994 and 2009. A comparison group consisted of 9,364 people with no indications of kidney disease.

Focus:
Death during surgery and long-term survival of living kidney donors.

Relevant Conclusions:

  • Risk of death in surgery is 0.031% (3.1 in 10,000) for all donors.
  • Risk of death in surgery is 0.013% (1.3 in 10,000) for donors without hypertension.
  • Long-term life expectancy is the same as matched, healthy non-donors.
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Chance of complications from surgery

18% of donors experience some form of complication soon after surgery, which is more likely for older, obese, and hypertensive donors.

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Details & Source Information

Study:
Friedman AL, Cheung K. Early clinical and economic outcomes of patients undergoing living donor nephrectomy in the United States. Arch Surg. 2010; 145 (4): 356-362.

Sample Size:
6331 patients who donated between 1999-2005

Focus:
Living donor complications

Relevant Conclusions:

  • Kidney donation was associated with an 18.4% complication rate.
  • Reported complications included bleeding (4.3%), infection (4.2%); and respiratory, (4.5%), Gastro-intestinal, (6.1%) urinary (1.7%) tract complications.
  • Complications were most pronounced in older, obese, and hypertensive donors.
  • High volume hospitals (>50/year) were associated with significantly lower complication rates.

Long-Term Risks

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Chance of death later in life

Life expectancy among living donors is similar to or better than the general population.

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Details & Source Information

Study:
Ibrahim HN, Foley R, Tan L, et al. Long-term consequences of kidney donation. N Engl J Med. 2009;360:459-469.

Sample Size:
3698 kidney donors who donated from 1963 through 2007; 255 donors who donated from 2003 to 2007.

Focus:
To study the long-term consequences of living kidney donation.

Relevant Conclusions:
Survival and the risk of kidney disease in carefully screened kidney donors appear to be similar to those in the general population. Most donors had quality-of-life scores that were better than population norms.

Study:
Segev DL, Muzaale AD, Caffo BS, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA. 2010;303(10):959–966. doi: 10.1001/jama.2010.237.

Sample Size:
80,347 live kidney donors in the U.S. who donated between 1994 and 2009. A matched control group consisted of 9,364 people with no indications of kidney decease.

Focus:
Death during surgery and long-term survival of living kidney donors.

Relevant Conclusions:

  • Long-term mortality was similar or lower for live kidney donors than for the matched control cohort throughout the 12-year period of follow-up.

Study:
Fehrman-Ekholm I et al. Kidney donors live longer. Transplantation. 1997; 64 (7):976-8

Sample Size:
All living kidney donors (n=459) in Sweden between 1964 and 1994.

Focus:
Long-term survival rate of living kidney donors compared to non-donors

Relevant Conclusions:

  • Living donors had an increased survival rate 29% higher than the general population.
  • Better survival among donors was probably due to the fact that only healthy persons are accepted for living kidney donation.
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Chance of kidney failure later in life

The chance of kidney failure among living donors is lower than in the general population, due to screening. Compared to non-donors who would have passed screening to donate, donors have about a 1-1.5% total increased risk of developing kidney failure later in life, with differences across racial groups.

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Details & Source Information

Study:
Muzaale AD et al. Risk of end-stage renal disease following live kidney donation. JAMA. 2014; 311(6):579-586.

Sample Size:
Study included every kidney donors in the U.S. over 2 decades (96,000 people) compared against a group of non-donors of similar health.

Focus:
Studied whether living donors have an increased risk of developing kidney disease later in life.

Relevant Conclusions:

  • Findings reaffirmed the prevailing belief that lifetime risk of kidney failure is no higher than, and is actually lower than the general population. (90 in 10,000 vs. 326 in 10,000).
  • Compared to a similar group of healthy non-donors, increased lifetime risk was estimated to be less than 1%. (90 in 10,000 vs. 14 in 10,000).
  • The chance of kidney failure because of donation was highest among African-Americans (51 in 10,000) versus Hispanics (26 in 10,000) and Caucasians (23 in 10,000)

Study:
Kamal L, Serur D. Evaluation of Potential Living Kidney Donors. Current Concepts in Kidney Transplantation. 2012;30–54.

Sample Size:
various

Focus:
Meta-analysis of various studies focused on living donor risks.

Relevant Conclusions:

  • A meta-analysis of 46 studies each with an average sample size of 5,000 donors found no evidence of an accelerated loss of kidney function over that anticipated with normal aging.
  • The UNOS database has recorded since 1987 an incidence of about 0.04% of living donors who have been listed for kidney transplantation.
  • A study of 3,698 kidney donors from 1963 through 2007 showed that mortality of kidney donors was comparable to the general population.
  • A study of 255 donors from 2003 till 2007 found their mortality rate to be similar to the general population.

Study:
Gibney EM, King AL, Maluf DG, Garg AX, Parikh CR. Living kidney donors requiring transplantation: Focus on African Americans. Transplantation. 2007;84:647-649.

Sample Size:
All living donors who donated between 1993 and 2005 (51,308).

Focus:
Risk of kidney failure among African-American living donors.

Relevant Conclusions:

  • Between 1993 and 2005, 102 previous kidney donors developed kidney failure and were listed for kidney transplantation. Although African-Americans comprised 14.3% of all living kidney donors, they constituted 44% of donors reaching the waiting list.
  • This matches the 3-times increased chance of kidney failure that African Americans share in the general population
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Chance of hypertension during pregnancy

Kidney donation does not interfere with a woman’s ability to become pregnant. Female living donors do face an increased risk of hypertension during pregnancy (preeclampsia) that rises from 6% for pregnant non-donors to 12% for donors.

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Details & Source Information

Study:
Garg, AX et al: Gestational hypertension and preeclampsia in living kidney donors. N Engl J Med 2015: 372 (2).

Sample Size:
85 living donors; matched control group of 510 people.

Focus:
Preeclampsia during pregnancy for women who had previously donated a kidney.

Relevant Conclusions:
Most women had uncomplicated pregnancies after donation and there were no reports of maternal death, stillbirth, or neonatal death among the donors. Preeclampsia was 6% more common among living kidney donors than among the non-donors with similar health. The chance of preeclampsia for kidney donors were 12% vs 6% in the general population.

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Chance of developing kidney stones

There is no difference in the rate of kidney stones in donors compared to non-donors.

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Details & Source Information

Study:
Thomas SM et al. Risk of kidney stones with surgical intervention in living kidney donors. Am J Transplant. 2013 Nov;13(11):2935-44

Sample Size:
2019 donors were compared with 20,190 non-donors of similar health.

Focus:
To determine if living kidney donors have a higher risk for developing kidney stones.

Relevant Conclusions:
There is no difference in the rate of kidney stones in donors compared to non-donors.