Kidney Donation

What is a kidney donation?

A kidney donation is a type of surgery that removes one kidney (in case of a living donor) or both kidneys (in case of a deceased donor) and transplants them to someone whose kidneys don’t work anymore. People with one working kidney can still live long, healthy lives.

What does a kidney donation treat?

Donating a kidney helps the recipient manage kidney failure (renal failure). Kidney failure is when both of your kidneys stop working as they should — they’re part of your urinary system, and help filter waste products and excess water from your body, which leave your body through urine (pee).

Kidney function is also important in balancing your electrolytes, like potassium, sodium and controlling your blood pressure. That’s why people with kidney failure experience fluid/water retention, causing swelling (edema) in their legs and an accumulation of fluid in and around the lungs (pleural effusion) and the heart (pericardial effusion). This makes it difficult for the heart to function, causing heart failure. Potassium can reach a dangerously high level, causing fatal heart arrhythmia (abnormal heartbeat) leading to sudden cardiac arrest. This is why kidney failure is fatal without treatment. If you have kidney failure, you need dialysis to take over your kidney function or a kidney transplant.

How common is a kidney donation?

In 2022, surgeons performed more than 25,000 kidney transplants in the United States.

What are the types of kidney donation?

Kidney donations may come from a recently deceased or living donor. There are two kinds of living kidney donations:

• Living related. A living related kidney donation comes from a biological (blood-related) relative, such as a parent or sibling.
• Living unrelated. A living unrelated kidney donation comes from a friend or another person who doesn’t share a blood relation with the recipient.

Other types of kidney donation include:

• Directed kidney donation. In a directed kidney donation, you choose (direct) who receives your kidney.
• Paired kidney exchange. A paired kidney exchange requires two living donors and two recipients. All organ transplants work best when the donor and recipient have the same blood and tissue types. But if the donor and recipient don’t share the same blood and tissue types (aren’t compatible), the donor can give their kidney to someone else who is a match. In return, a family member or friend of the recipient donates a kidney to a family member or friend of the donor. A paired kidney exchange helps noncompatible donors find and pair with compatible donors using a nationwide kidney registry database (National Kidney Registry).
• Nondirected or altruistic kidney donation. In a nondirected or altruistic kidney donation, the donor doesn’t know the recipient. They unselfishly donate a kidney because they know it’ll help another person.

Who can be a living kidney donor?

You must meet several conditions to be a living kidney donor, including:

• Age. You must be at least 18 years old to donate a kidney. People under 18 aren’t adults and can’t give informed consent to donate a kidney. There isn’t an age limit for donating a kidney. People in their 90s have successfully donated a kidney.
• Physical examination. A healthcare provider will evaluate your physical health to ensure you’re capable of donating a kidney. A physical exam may include checking your overall health, medical history, biological family health history (including whether you have any biological family history of kidney disease), which prescription and nonprescription medications you’re taking, an assessment of your kidneys and other organ systems and various tests. Pregnant people can’t donate a kidney. You should have a body mass index (BMI) less than 35 and you shouldn’t smoke, vape or use other forms of tobacco. The goal of this health evaluation is to ensure you’re fit to donate.
• Psychological evaluation. A group of healthcare providers will evaluate you to ensure you’re physically and mentally able to donate a kidney. They’ll discuss potential causes of stress that may arise for you and your support system after a kidney donation, including recovery setbacks. Your evaluation usually includes psychiatrists and social workers. It may also include living donor advocates and bioethics professionals. A living donor advocate helps you understand what the procedure and recovery entails and ensures no one’s pressuring you to consent to the donation. A bioethics professional makes sure your personal beliefs and freedoms with regard to your health are respected.

In the United States, you can register to be a kidney donor through Donate Life America. In many states, you can also register through your local motor vehicle department.

Which tests will I need before I can donate a kidney?

A healthcare team may order the following tests before you can donate a kidney:

• Blood tests.
• Antibody tests.
• Age-appropriate cancer screenings, including a colonoscopy. People assigned female at birth (AFAB) may get a mammogram and Pap smear.
• Imaging tests, including X-rays and CT scans (computed tomography scans).
• Tests to determine your heart’s health, including an electrocardiogram (EKG), exercise stress test and echocardiogram.
• A urinalysis (urine test) to make sure your kidneys are healthy.
• A 24-hour blood pressure monitor.
• A pregnancy test. Pregnant people can’t donate a kidney.

How hard is it to find a kidney donor match?

Most people wait an average of three to five years on a kidney transplant list. But you may wait longer. A kidney donor match is most likely to occur between biological relatives. A match between a parent and child is at least a 50% chance. Biological siblings have a range of compatibility. Some are a perfect match, while others aren’t compatible at all.

What happens during kidney donation surgery?

A kidney donation care team typically consists of:

• A urologist or a transplant surgeon.
• An anesthesiologist.

The anesthesiologist will sedate you with general anesthesia. You’ll be asleep, won’t move and won’t feel any pain during the procedure. The anesthesiologist will usually review your health records before surgery to ensure you won’t have any problems with anesthesia. After you’re asleep, a provider will insert a Foley catheter to drain any pee from your urinary bladder. The catheter will remain in place during surgery and for 24 hours after surgery to monitor your urine output.

A radical nephrectomy is the name of the procedure to remove your entire kidney. The urologist typically removes a kidney. They usually use a minimally invasive laparoscopic approach. A laparoscope is a thin, metal surgical tool with a light and camera at the end. During a laparoscopic radical nephrectomy, the surgeon will:

1. Use a sharp surgical knife (scalpel) to make three to five small cuts (incisions) in your side. The incisions are usually less than an inch (2.5 cm) each.
2. Insert a laparoscope into an incision. The laparoscope shows video on a monitor near the operating table.
3. Using the monitor as a guide, insert tiny instruments through an incision and remove the kidney.
4. Close the incisions with dissolvable stitches or staples.

In some cases, the urologist may need to use an open approach to perform a radical nephrectomy. During an open radical nephrectomy, the surgeon will make one single incision of about 8 to 12 inches (20 to 30 cm) in your side. With a larger incision, the surgeon has a better view and more access to the surrounding access. Less than 5% of all nephrectomies use an open approach.

After removing your kidney, your care team will transport it to the kidney recipient. The kidney recipient is usually in a nearby operating room in the same hospital. Another surgical team will operate on the recipient and complete the transplant.

How long does kidney donation surgery take?

A kidney donation surgery usually takes two to three hours.

What happens after kidney donation surgery?

After kidney donation surgery, the care team will:

• Cover your surgery site with bandages to reduce bleeding.
• Stop putting anesthesia into your body. You’ll wake up after a few minutes, but you’ll likely feel groggy.
• Move you to a recovery room and monitor your overall health and recovery from surgery.
• Manage your pain and ensure you’re getting IV fluids until you’re fully awake and can drink safely. They’ll slowly introduce you to food as you can tolerate it. They’ll also ask you to walk as early as possible. Walking helps your body recover faster after surgery.

Most people stay in the hospital for two to three days. You may feel pain, tenderness or itching in your incision site(s) for a few days. It’s also common to feel fatigue the first few weeks after a kidney donation.

Once the care team determines that you no longer require monitoring, they’ll let you go home (discharge you). You’ll need a family member or friend to drive you home. It’s a good idea to have someone help take care of you for at least a week after donating a kidney.

Schedule an appointment with the transplant surgeon and a doctor who specializes in treating kidney conditions (nephrologist) in the first week after discharge. You must schedule appointments with your transplant team for the first two years after your donation. Your appointments occur at six-month, 12-month and 24-month intervals. You must also schedule follow-up appointments with your primary care physician (PCP).

What are the benefits of a kidney donation?

Many living kidney donors find it rewarding to donate a kidney to a loved one. It can be challenging to see a family member deal with kidney failure symptoms and dialysis. By donating a kidney, you can see your loved one’s symptoms improve firsthand as they return to the everyday activities they used to enjoy before their kidneys stopped working. They also no longer need dialysis.

Some people who receive a kidney from a deceased donor have mixed feelings because they know that someone had to die for a kidney to become available. It’s helpful to remember that many donor families feel a sense of comfort and peace knowing that their loved one’s death can help others.

There are also benefits to kidney recipients. The main benefit of a kidney donation for a recipient is that it helps treat kidney failure. A successfully transplanted kidney filters waste products and excess fluids from your blood. You also won’t need to continue dialysis.

Those who receive a kidney from a living donor reap other benefits, including:

• Longer organ life. Living donor kidneys can last 15 to 20 years. Kidneys from a deceased donor function for about 10 to 15 years.
• Faster kidney function. A kidney from a living donor starts working quickly after a transplant because it’s out of the donor’s body for only a short period. If you receive a kidney from a deceased donor, you may need dialysis until the transplanted kidney starts to work.
• Less risk of rejection. A kidney from a biological family member is often a better genetic match than a kidney from a stranger. There’s less risk of your body’s immune system rejecting the kidney.

Living donation surgery is also an elective surgery. That means the surgical date is set, and the kidney recipient is well-prepared for surgery.

Does donating a kidney take time off your life?

Studies show that donating a kidney doesn’t decrease the lifespan of living donors. Donating a kidney also doesn’t increase your future risk of kidney failure.

What happens if you donate a kidney and then need one?

On the rare chance that kidney failure occurs at any point in your life after you donate a kidney, living organ donors are at the top of the donation list. You’ll receive a kidney transplant quickly.

How successful is kidney donation surgery?

Kidney transplants have a high success rate. Studies show the survival rate for kidney recipients is:

• Greater than 90% after one year.
• Greater than 85% after three years.
• Nearly 80% after five years.
• Nearly 70% after 10 years.

What is the downside of donating a kidney?

Like any surgery, donating a kidney has surgical risks, including:

• Blood clots.
• Bacterial infection.
• Anesthesia complications.
• Bowel obstruction.
• Pneumonia.
• Hernia.
• Nerve damage during open surgery.
• Scarring.

You’ll also lose some kidney function after a kidney donation. This sounds scary. However, after surgery, your remaining kidney will get bigger and stronger to compensate.

What are the side effects of living with one kidney?

Side effects of living with one kidney are rare, but may include:

• High levels of protein in your pee (proteinuria).
• A lower estimated glomerular filtration rate (eGFR). Your eGFR measures how much blood your kidneys filter.
• High blood pressure (hypertension).
• High blood pressure during pregnancy (preeclampsia).

Most donors adopt a healthy lifestyle after donation. This positively impacts their overall health.

What is the recovery time?

Most people can resume their usual activities about four to six weeks after a kidney donation. After surgery, you shouldn’t:

• Drive for at least two weeks.
• Get pregnant for at least a year.
• Do any heavy lifting for at least six weeks. You shouldn’t lift anything heavier than 10 pounds, which is around the same weight as a gallon of milk.

When can I go back to work or school?

Most people who donate a kidney can return to school or working in an office setting in a few weeks. If you have a more physically demanding job, you may need four to six weeks before you can return to work. A healthcare provider can give you a better idea of your timeline.

When should I call a healthcare provider?

Schedule regular follow-up appointments with your care team to examine your incisions. A healthcare provider can usually remove staples or permanent stitches after a few weeks.

Contact a healthcare provider right away if you have any of the following symptoms shortly after donating a kidney:

• Heavy bleeding at your incision sites.
• Signs of infection, including discolored drainage, a bad odor coming from your incision sites or a fever over 100 degrees Fahrenheit (38 degrees Celsius).
• Blood in your pee (hematuria).
• Feeling dizzy or lightheaded.
• Difficulty pooping.

How much money do you get if you give away your kidney?

You don’t get any money if you donate a kidney. It’s illegal to receive money in the United States and most other countries to donate a kidney. Living donors generally donate to help a loved one or someone in need.

Who covers the cost of a living kidney donation?

The transplant recipient’s health insurer covers the medical costs that occur with a kidney donation. However, insurance may not cover nonmedical expenses, which may include:

• Missed work.
• Transportation.
• Lodging.
• Childcare.

A note from Cleveland Clinic

Deciding to donate a kidney is a big decision, and the process of becoming a donor can take time. You must go through extensive tests to make sure the donation won’t compromise your health. And you must be fully aware of the risks and complications that may arise after donating a kidney. Still, many people willingly and proudly go through the process to save a loved one’s life and celebrate their new, healthy chapter.

Talk to a healthcare provider if you have any questions. They can help you decide if you’re a good candidate to donate a kidney and discuss your risks.