Live Renal Donors – Risk Discussion
Live Renal Donors – Risk Discussion
Hello, and thank you for coming forward as a potential kidney donor. It’s important that you, as the donor, understand the risks following living kidney donation and that this process is undertaken voluntarily, under no financial, psychological, or physical pressure from anyone. This is important and legally governed under the Human Tissue Act, and a breach of this is a criminal offense.
The following video will consist of the pros and cons of living donor kidney transplantation. You can keep this video for future reference to watch with your family, and a letter will be sent to you following the clinic to summarize the key points.
My name is Dr. Madlin Vernon. I’m a consultant nephrologist, and I’m also the transplant lead here at Leeds Teaching Hospitals. The information we will discuss today is based on a summary of both national and international follow-up data on living donors. This is good-quality data with follow-up between 20 and 30 years.
We know that living kidney donation is the gold standard treatment for an individual with renal failure. The one- and five-year graft survival rates in Leeds from living donors are 97% and 90%, respectively, versus 94% and 84% from deceased donors. This means that kidneys donated by living donors are, on average, likely to last longer, with the average being around 20 years. If the recipient is not yet on dialysis, there is also the advantage that the operation can take place before the need for dialysis, which can be detrimental to overall health, particularly if the recipient is on dialysis for more than six months.
Although transplantation from a live kidney donor is the best treatment we can give a patient with kidney failure, this is not the same thing as guaranteeing it will be a success. Overall, one in 50 live kidney donor transplants fail within the first few months following surgery, and we sometimes do not establish a cause for this. In Leeds, the surgery is keyhole, and recovery is fast, but we suggest you take six weeks off from work. Any monetary loss to the donor can be reimbursed by the NHS—please speak to your live donor coordinator for more information on this.
Following completion of investigations on the living donor assessment pathway, the donor will be seen by a surgical colleague who will go through any additional risks of surgery and anaesthesia.
Live kidney donors are selected groups of individuals. They are healthy individuals who would donate one of their kidneys. Their health is well preserved; however, we would need to do monitoring—what we call a health MOT—every year. Their physical activities and well-being are generally reported as very positive.
There are minor risks with donating a kidney. About one in 3,500 individuals may experience mortality, meaning a risk of death. This data has been consistent over a few decades now. What that means is, for every 3,500 individuals donating a kidney, one may sadly die. However, the life expectancy—how long you live your life—is not majorly different compared to the general population.
There are also other minor risks around the operation. These include risks of hospital-acquired infections, mainly around your wound, chest, or urinary tract. Some individuals are also at an increased risk of clots, such as in the calf muscles, which can very rarely cause a pulmonary embolism. We do take a lot of care to reduce these risks.
The other risks we observe when we follow individuals after donating kidneys are as follows. As people age, about one in five individuals in the general population will require medications for high blood pressure to reduce serious medical problems such as heart disease and stroke. The need for such medication is slightly higher in individuals who have donated their kidneys—about one in four kidney donors eventually need some form of blood pressure medication.
Some kidney donors may also develop a protein leak from the single kidney that occasionally requires specific treatment. Recent studies have also shown an increased risk of developing gout, a painful inflammatory condition of the joints.
Very rarely, individuals who donated kidneys may experience kidney failure. The most recent comparison of healthy individuals—3,000 people—against the same number of live donors with an average age of 40 showed that, over 25 years, about 150 individuals in the healthy group and 180 individuals in the donor group would have died. One person in the healthy group would have developed kidney failure compared to five to ten individuals in the donor group. This means there is a five- to ten-times increased relative risk of kidney failure, but your absolute risk remains less than 1%.
Please note there is other evidence suggesting any modest long-term worsening of a live donor’s health does not leave them any worse off than the general population. However, if kidney donors develop kidney disease in their single kidney, the rate of progression of kidney failure is faster than having two kidneys.
Pregnancy following living kidney donation has an overall outcome similar to non-donors, but there are certain risks requiring careful planning and antenatal care in the renal obstetric clinic. From a maternal health perspective, there is an increased risk of preeclampsia, a pregnancy-specific condition that can affect different organs and give rise to high blood pressure, renal problems, and protein in the urine.
Every pregnancy carries a risk of preeclampsia, but it is increased in those with one kidney or kidney disease. Generally, we can reduce this risk by prescribing aspirin from 12 weeks of pregnancy to continue throughout the pregnancy. Preeclampsia can occur from 20 weeks of gestation, and the treatment is delivery of the baby, which may lead to prematurity depending on the gestation when delivered.
There is also a risk of worsening renal function and development of high blood pressure needing treatment during pregnancy. Fetal issues can include small growth for gestational age. Regular growth scans will be required. Should a pregnancy be considered, we can discuss further in a dedicated renal obstetric clinic. Women who have donated a kidney would be followed up in that clinic during their pregnancies.
We have learned from previous live donors that they sometimes find it upsetting to be on a hospital ward with people who may be seriously unwell. This can be worse if it is the first experience a live donor has as a hospital patient. It is wise to be prepared for this, and we do not have a way to manage this differently. You will most likely be the most well person on the ward following your operation, and we would only expect you to be in hospital for one to two nights before being discharged.
Live donors have sometimes felt left out of the process after surgery, partly because of the intense medical follow-up received by the transplant recipient. Live donors themselves do not require such intense follow-up. They are reviewed by the live donor coordinator team by telephone during the first week following surgery. They are then seen in the clinic at six weeks post-surgery by the surgical team. It is important to be aware of this shift in focus in advance.
Following the six-week review, the donor will have lifetime annual follow-ups by the coordinator team. This annual appointment focuses on blood pressure, kidney function, risk of protein leak in the urine, and general lifestyle measures and well-being. Please be assured that the live donor team will always be contactable throughout your assessment and post-donation to answer any queries or concerns you may have.
Thank you for taking the time to watch this video and for coming forward as a potential live donor. Volunteering to donate a kidney is a wonderful thing to do, but it is also an important decision, and there are many things for you to consider. We hope this video has been informative, and we wish you all the best with your ongoing assessment. We are here to support you every step of the way.