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This blog aims to make "evidence-based medicine" understandable to the lay person
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Saturday, August 31, 2013

Is it safe for me to donate a kidney? What kind of problems can I expect?

This is one the commonest questions that I get as a nephrologist. 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 you have a donor who is willing to donate you their kidney and is fit to do so (I covered the steps involved in kidney transplantation and the prerequisites for a potential donor here), the donor as well as you would need to be aware of what donation entails, and what, if any, future health consequences can they expect. So 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:
Image courtesy of Stuart Miles/ FreeDigitalPhotos.net


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 a more pertinent question. I will divide this issue in to three basic questions:


  • Does kidney function decline faster after you donate a kidney?
Most potential donors are worried that they themselves will develop kidney disease should they donate a kidney. This is a valid concern; however most studies 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. 


  • 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 or bone disease. However, whether these entities are clinically relevant is a question that still needs to be answered, since I have already emphasized above that 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.


A SPECIAL SITUATION: WOMEN WHO HAVE NOT COMPLETED CHILD-BEARING

These 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 thirty kidneys being transplanted, some of them by people who donated to total strangers! Here is the link for that it-restored-my-faith-in-humanity news article!  

All said and done, for most eligible donors, the process of donating a kidney is extremely 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. My job as a nephrologist is to be their advocate when they are being considered as potential donors, and reassure them of the safety of their actions once they have donated.  

Veeraish Chauhan, MD, FACP, FASN

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