Risks of Living Kidney Donation: Current State of Knowledge on Outcomes Important to Donors

Abstract

In the past decade, there have been increasing efforts to better define and quantify the short- and long-term risks of living kidney donation. Recent studies have expanded upon the previous literature by focusing on outcomes that are important to potential and previous donors, applying unique databases and/or registries to follow large cohorts of donors for longer periods of time, and comparing outcomes with healthy nondonor controls to estimate attributable risks of donation. Leading outcomes important to living kidney donors include kidney health, surgical risks, and psychosocial effects of donation. Recent data support that living donors may experience a small increased risk of severe CKD and ESKD compared with healthy nondonors. For most donors, the 15-year risk of kidney failure is <1%, but for certain populations, such as young, black men, this risk may be higher. New risk prediction tools that combine the effects of demographic and health factors, and innovations in genetic risk markers are improving kidney risk stratification. Minor perioperative complications occur in 10%-20% of donor nephrectomy cases, but major complications occur in <3%, and the risk of perioperative death is <0.03%. Generally, living kidney donors have similar or improved psychosocial outcomes, such as quality of life, after donation compared with before donation and compared with nondonors. Although the donation process should be financially neutral, living kidney donors may experience out-of-pocket expenses and lost wages that may or may not be completely covered through regional or national reimbursement programs, and may face difficulties arranging subsequent life and health insurance. Living kidney donors should be fully informed of the perioperative and long-term risks before making their decision to donate. Follow-up care allows for preventative care measures to mitigate risk and ongoing surveillance and reporting of donor outcomes to inform prior and future living kidney donors.

Keywords: Aftercare; Health; Health Expenditures; Insurance; Kidney Failure, Chronic; Living Donors; Living donation; Nephrectomy; Patient-centered care; Registries; Renal Insufficiency, Chronic; Salaries and Fringe Benefits; kidney; outcomes; quality of life.

Figure 1.

The KDIGO framework to accept or decline donor candidates compares projected lifetime risk of kidney (quantified as the aggregate of risk related to demographic and health profile and donation-attributable risks) to a transplant program's threshold of acceptable risk. Reproduced from reference , with permission.

Figure 2.

Applying knowledge on outcomes important to donors can inform current counseling and next steps for research and policy. Infographic prepared for this perspective by Heather Hunt, JD, in collaboration with Alvin Thomas, MSPH.