Medical implications

Medical Implications and Risks of Kidney Donation

From the instruction booklet for living kidney donors, The National Center for Transplants, Israel’s Ministry of Health

As a rule, the human body can continue to function properly for years even with a single kidney. However, it is important to also note the risks of kidney donation. These risks may be direct or indirect, health-related or economic. Despite many years of experience in the field, it is still difficult to anticipate all the implications of the donation. The known consequences will be presented below. The purpose of this chapter is not to deter the donor from making the donation, but to make sure that he is aware of these details before making the decision to donate a kidney.

A. Prior to donation

The tests required of kidney donors generally require some absences from work or school, despite best efforts to concentrate the testing into one or two days.

Candidates for donation should know that during the evaluation, medical problems that were not previously known may be discovered. The attending physician or the team responsible for the diagnosis will make sure to update the donor on the findings. In some cases, the candidates were indeed found to have previously unknown medical conditions that were subsequently treated. Not every condition prevents donation; however, newly-discovered conditions may require further clarification, and sometimes certain findings will preclude the possibility of donation. The tests themselves sometimes involve discomfort.

B. Risks and complications in donation surgery

As with any surgical procedure, there may be complications that appear after surgery. Data published in the professional literature shows that 10-30% of kidney donors may develop some complications after surgery. Most complications are mild and do not leave a permanent defect or disability. In rare cases surgery or other intervention is needed.

Mortality from anesthesia during surgery is about 1 in 3000, similar to any other surgery. Donors from whom a kidney is taken are at risk for postoperative complications as with any similar surgery performed under general anesthesia, such as pneumonia, pulmonary embolism and bleeding. But since kidney donors are very healthy, these complications are rare.

C. Medical consequences and risks after kidney donation

In most kidney donors there is a gradual increase in the function of the remaining kidney as compensation for the loss of function of the donated kidney. The kidney will grow slightly and reach about 70% – 80% of the function of the two kidneys together from before the donation. Taking a kidney from a healthy person does not usually affect life expectancy.

Articles that have appeared in recent years and relate to studies examining kidney donors have found a slight increase in the risk of kidney failure over the long term of 20 years or more. The reasons for this are mainly kidney disease that was not discovered at the time of donation as a result of diabetes or obesity, familial kidney disease or other types of kidney disease. This is one of the reasons why comprehensive preparatory tests are performed to check the health status of the donor in order to reduce the risk as much possible. But keep in mind that in the event that the only kidney is damaged (say due to severe direct injury from an accident, kidney stones or a tumor), the donor will not have another kidney to compensate for this loss. In these cases the donor will need dialysis or a kidney transplant.

In addition, there is sometimes a slight increase in blood pressure or protein excretion in the urine after donation. The incidence of these symptoms is slightly higher relative to their prevalence in the general population (i.e., in those with two kidneys), so medical follow-up is important for living donors.

After kidney donation there is no impairment of fertility in women or men, but the risk of pregnancy complications after a kidney donation is slightly higher. Female kidney donors should take this risk into account. All doctors recommend that altruistic donors who wish to donate a kidney, do so after they have completed bearing children.

It is important to know that sometimes, despite careful preparation for transplant surgery, there is still the risk, although slight, that the kidney will not succeed in functioning in the transplant recipient, and there may even be rare situations where the transplant recipient will not survive the process. In such cases donors should understand that they did as much as possible to help, and that the sacrifice was not in vain despite the unexpected result.

Please note: important information regarding military service in the IDF:
After kidney donation, the military medical profile drops to 64 permanently. It is important that combat soldiers on active duty take this into account when considering donation.

Scientific Articles

  • In January of 2009, The New England Journal of Medicine printed an article detailing a comprehensive research study that examined thousands of kidney donors from the last few decades and found indisputable evidence that the health of kidney donors was not harmed in the slightest!  Research has proven that kidney donation does not change the donor’s life expectancy nor does it increase the risk of developing kidney disease or other health problems. A person can live a normal, active life with one kidney. Research has indicated that one kidney is sufficient to maintain a healthy body. After recovery from the operation, a donor can work, drive, exercise and take part in sports, and continue with his usual activities, including military service.  Read the full article.
  • In February 2016, The New England Journal of Medicine printed an article detailing a comprehensive research study that compared a group of kidney donors to a group of very healthy people. The results of the study showed that kidney donors were less healthy than the group of very healthy people. Read the article in the New England Journal of Medicine
  • These two articles represent two different schools of thought.  In order to analyze the results and in order to help one make a decision, we asked Dr. Keren Tzukert, a specialist in nephrology, at Hadassah Medical Center, Ein Kerem, Jerusalem to  explain to the lay person the implications and considerations. (The original article was written in Hebrew)..

Articles about pregnancy after kidney donation

See the articles Pregnancy and Birth After Kidney Donation: The Norwegian Experience and Pregnancy Outcomes After Kidney Donation.  Both of these articles are from the American Journal of Transplantation.