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Donor

Short-term risks to the donor

The short-term risks of kidney donation are directly related to the surgery. Any major surgery carries the following risks:

  • Allergic reactions to the anesthetic: This risk is generally less than 2% of cases. It is usually avoided by careful screening for allergies before the surgery.
  • Collapsed lung: Since the kidney is located near the lung, there is a risk of puncturing the lining of the lung during the surgery, causing collapse of the lung. The lung may re-inflate on its own. Sometimes a tube needs to be inserted into the chest to inflate the lung. The risk is generally less than 2%.
  • Blood clots: After any surgery, blood clots can form in the veins of the legs and travel to the lungs. The risk of blood clots can be reduced by wearing compression stockings, taking blood thinners and getting out of bed and walking as soon as possible after surgery.
  • Bleeding: There is a risk of bleeding associated with any surgery. The risk is relatively low with kidney donation. Bleeding can sometimes occur inside the abdomen. This can make the surgery take longer. If there is a lot of bleeding you might need a transfusion. The Ottawa Hospital has a blood conservation program. This allows you to bank your own blood before the surgery in case you need a transfusion. If you want more information, talk to the transplant coordinator.
  • Infections: After surgery there is a risk of infection in the surgical wound or the urinary tract or the lung.  This risk is usually 5% or less. Infections can usually be treated with antibiotics. Coughing and breathing exercises can help prevent lung infection.
  • Pain and discomfort: All patients experience some pain and discomfort after surgery. This can be treated effectively with pain medication. You will have a PCA pump connected to your IV while you are in hospital.
  • Risk of death: There is always a risk of death with any major surgery.  With living kidney donation, the risk of death is very low at 0.03%. That is only 3 persons out of every 10,000 living donor surgeries.

Long-term risks to the donor

There is good evidence that living with one kidney has little impact on your overall health, including lifespan. One healthy kidney provides more than enough filtering function to clean your blood. Living with one kidney does not generally cause any serious health problems, although research is still needed to determine the long-term medical risks. There is good evidence for the following:

  • High blood pressure: There is a slightly increased risk to develop high blood pressure. This can happen over several years. The risk is difficult to measure, but it is probably about 10%.
  • Protein in the urine: In some donors small amounts of protein may be excreted into the urine from the remaining kidney. Protein would not normally be present in the urine. This can occur over several years. It is unclear if this finding is significant over the long term. If protein levels in the urine reach a certain level, a doctor will prescribe medication to control the amount and prevent any kidney damage. The risk is less than 10%.
  • Decreased kidney function: There is an overall reduction in kidney function. This does not seem to increase the risk of developing kidney failure in healthy individuals. The remaining kidney grows with time. It is able to take over some of the work the donated kidney used to do.

Research suggests that kidney donation does not affect your ability to obtain life insurance. However, this is a consideration you may wish to discuss further with the health-care team.

Psychological risk and benefits to the Donor
Psychological benefits to the Donor Psychological risks to the donor
Donating a kidney to help another person live can be very rewarding. Most donors say that their overall psychological health stayed the same or even got better. Many report higher self-esteem. Most kidney donors describe unchanged or improved relationships with their recipients, spouses, family members and children. Some donors might feel pressured to donate a kidney by family members or friends. Nobody should feel pressured to donate. It is important that family members, friends and the health-care team respect the wishes of both the donor and recipient at all times.
There tends to be a lot of attention focused on the donor before the transplant surgery. After the surgery, the focus may shift and be directed more at the recipient. Some donors find it difficult to deal with this shift in focus.
Donors may not be prepared for the small chance that the kidney might not work once it is transplanted. This can happen because of rejection, or other medical or surgical reasons. This could lead to feelings of anger or depression.
Donors may notice a change in their body image after the surgery. This is usually because of the scars. This can cause some donors distress.

These risks can lead to depression or anxiety. They can affect social relationships, and potentially cause strain with your spouse, partner, family members, friends or the recipient. The psychological risk can be minimized by making sure you understand these possible outcomes. It can help to talk about them with your family, the recipient, or friends as appropriate. The Living Donor transplant team will support you. We will make sure you get regular follow-up after the surgery, where these issues can be discussed.

Recipient

Risks and Benefits to the Recipient
Benefits to the Recipient Risks to the Recipient
The success rate of living kidney donation is high. One year after surgery, between 90-97% of transplanted kidneys are working at a level that makes dialysis unnecessary. Most kidney transplant recipients need a combination of medications to prevent rejection. These medications can cause side effects like stomach upset, diarrhea, weight gain, easy bruising, and higher risk of developing diabetes, and a higher risk of serious infections. Some of the medications are also associated with a higher risk of developing certain cancers, especially skin cancer, later on. These possible side effects are carefully reviewed with the recipient before the transplant.
When a kidney transplant is working well, the recipient does not need dialysis. Their overall wellbeing tends to improve. Many recipients notice improvements in their energy level, appetite, sleep, mood, and sexual function. In some cases, the transplanted kidney can be damaged by the same condition that caused kidney failure in the first place. This will eventually leading to the need to go back on dialysis.
A successful transplant can let the recipient resume normal daily activities. Things like work, exercise, travel, and other activities that were not possible while on dialysis are possible again. Overall, transplant patients seem to have a better quality of life and live longer compared to people who are on dialysis. Typically, a kidney from a living donor will work for 15-20 years. Rarely, the transplanted kidney fails to ever function. This means the recipient will need dialysis. Surgical complications, rejection or damage to the kidney around the time of surgery can cause the transplanted kidney to fail.
Death of the recipient is a rare complication of living donor kidney transplant surgery. As with any major surgery, it can happen.

When a kidney transplant does not go as well as hoped, it can be devastating for both the donor and recipient. This does not in any way minimize the generous gift that the donor has given to the recipient. The transplant team at TOH is committed to supporting patients and their families during these difficult times, regardless of the outcome.