How safe is donation?
If you are thinking of donating a kidney, it is important to consider your decision carefully. One of the most frequently asked questions is, “How safe is it to live with one kidney?” After all, most of us are born with two! Donor safety is a priority. Regardless of the need for kidneys, donation is not acceptable if the donor is put at excessive risk of harm, so every effort is made to minimise the chance of problems. Being a healthy person is not the same as being a suitable donor. For example, you may have been born with only one kidney and only discover this when you put yourself forward for tests. This would obviously prevent you donating a kidney, but it does not mean that you are not healthy.
Donation is not risk-free. Your medical team will discuss the main risks with you as you go through the process and you will need to consider these carefully when deciding whether you wish to be a donor.
This information does not cover detailed medical questions; it is designed to give you general information about donating a kidney based on the advice of medical professionals and currently accepted guidance in the UK, from the research that is available to them. Your healthcare team will discuss risk with you in more detail and on an individual basis, particularly if there are certain concerns about you or your recipient because of your lifestyle, medical history or demographic, as risk must be considered on an individual basis based upon your individual circumstances.
It is also important to note that research in this area is continually evolving and it is not possible to cover every eventuality. Not every possible consequence of donation has been fully researched.
There are two main aspects to the question of how safe donation is for the donor: the operation itself, and living with one kidney.
Donating a kidney requires a major operation under general anaesthetic. No operation is risk-free, so it is important to make sure that you are fit and well beforehand so that the risks to you are as low as possible. (See The donor operation). It is very difficult to describe risk in a way that means something to everyone, but we usually say that the risk of dying from donating a kidney is one person in 3,000. This is similar to the risk of dying from having an appendix removed.
There are a number of other risks linked with the operation itself, such as infection, bleeding and pain. As with any surgery, there can be other less common and unexpected complications.
However, one of the benefits of being a kidney donor is that you go into the operation in good health, and the transplant team will know a great deal about you from the assessment that you have been through. This helps them to anticipate any problems, discuss them with you and to deal with them better should they happen.
Every transplant centre in the UK performs transplantation of kidneys from living donors, and one in every three kidney transplants is from a living donor – around 1000 such operations are performed in the UK each year. This means that the donor operation is much more common than it used to be and surgeons are very experienced in removing kidneys safely.
Living with one kidney
Again, this information is designed to give you general, rather than detailed, information about risk.
It is generally considered very safe to live with one kidney and your clinical teams will outline the main risks to you, which include the most common and the most severe risks, as well as the main risks for your own particular circumstances.
It is important to note that studies into the long-term effects of donating a kidney are on-going.
You can check the latest professional guidelines on the British Transplantation Society website here should you wish to. The current Living Donor Kidney Transplantation Guidance was published in June 2018. The guidelines are aimed at clinical teams but you can discuss any aspect of these further with your coordinator should you wish to.
It is important to be aware that every donation carries risks and it is not possible to cover every eventuality when considering risk. However, some of the most notable post-donation research indicates the following:
- Some studies have indicated that there is a slightly higher chance of a small increase in your blood pressure or the amount of protein in your urine as a result of having one kidney. However, these are checked at annual follow-up and, if found, can be treated.
- The overall risk of developing significant disease in your remaining kidney after donation is low, occurring in fewer than one in 200 (0.5%) donors, and it is much less in kidney donors than it is in the general (unscreened) population (because kidney donors are, of course, pre-screened to ensure they are healthy).
- Compared to the general public, most kidney donors have equivalent (or better) survival, excellent quality of life, and no increase in end-stage renal disease (ESRD – kidney disease).
- However, some studies have indicated a slightly increased incidence of ESRD post-donation among certain groups, in particular, black donors, younger donors, donors genetically related to their recipients, donors related to recipients with immunological causes of their renal failure, and overweight donors. However, the risk is still lower than that of the general (unscreened) population.
- Whilst most women have uncomplicated pregnancies after donation, there is a slightly increased risk of gestational hypertension or pre-eclampsia.
- It is also important to be aware that, although generally risks across the board are very low, every individual is different and it is not impossible for a number of other uncommon complications to occur. For example, although rare, on-going fatigue and persistent pain have been reported by small numbers of the thousands of living donors.
When considering donation, it is important for donors to think about how they might feel if something unlikely or unusual were to happen to them, and to discuss these concerns with their clinical team as part of the assessment process.
Please be aware that these studies have made some units more cautious about accepting younger donors and, as such, younger people may be asked to consider waiting a few years before donating. If you are denied the opportunity to donate and you still wish to pursue it, you can always seek a second opinion from another unit.
After donation, you will be invited back for check ups soon after your surgery and then annually. Other than these annual checks, the same policies and procedures apply to you as they would apply to any other NHS patient – you will not receive any preferential treatment as a result of donating a kidney. However, in the extremely unlikely event that you need a transplant yourself later in life, you will be offered additional priority on the transplant waiting list within certain criteria.
Risks for the recipient
How safe is living donation for the recipient of a kidney? Quite simply, living donor kidneys are the ‘Rolls-Royce’ of kidney transplants, because we know that the kidney has come from someone in the best of health, and the operation will have been planned under the best possible circumstances. All recipients are fully informed about the risks by their healthcare teams. There is no doubt that the potential benefit to the recipient far outweighs the risk to the donor.
Transplantation is an uncertain business, and there are no guarantees of success, but living donation has all the right ingredients to create the best opportunities for a good outcome for the recipient. It truly is the gift of life.
- Could I be a living-donor FAQs Courtesy of NHS Blood and Transplant
Other useful resources
- UK Guidelines for Living Donor Kidney Transplantation and any updates and addendums can be found on the British Transplantation Society website