Kidney Donation

What is kidney donation?

Kidney donation involves giving one kidney to someone whose kidneys don’t work anymore. This condition is known as kidney failure, or end stage renal disease (ESRD)

During a kidney transplant procedure, a surgeon implants a donated kidney into someone who needs it. A donated kidney may come from a deceased or living donor.

What do the kidneys do?

Most people are born with two kidneys. (Rarely, some people have just one.) These organs, located in the back of your abdomen, are part of the urinary system. They help your body filter waste products and excess water from your blood. Your body releases these wastes into the urine.

Who might need a donated kidney?

Kidney failure or ESRD occurs when both kidneys stop working. People with kidney failure need dialysis to take over kidney function or a kidney transplant.

More than 90,000 Americans need new kidneys. There is a shortage of organs as more patients go into renal failure than kidneys are available. The United Network for Organ Sharing (UNOS) oversees a national waitlist for organ transplants. Patients need to get on this waitlist in order to get a kidney. The order of the list is based on patients’ time on the list or their time on dialysis. The longer you are on the list or on dialysis, the higher you are on the list.

What causes kidney failure?

Diabetes and uncontrolled high blood pressure (hypertension) are the top causes of kidney failure. Other causes include:

• Autoimmune diseases, such as lupus.
• Chronic (returning again and again) urinary tract infections (UTIs).
• Genetic diseases (conditions you’re born with), such as polycystic kidney disease.
• Nephrotic syndrome.

What is living kidney donation?

Most of us have two kidneys, but we only need one to survive. A living donor is a healthy person who has undergone extensive testing and agrees to donate one healthy kidney to a ESRD patient. The person who receive the organ (recipient) is often a family member, loved one, friend or even sometimes a stranger.

What are the types of living kidney donation?

There are two kinds of living kidney donation:

Living related (blood related): Donation from parents and sibling.

Living unrelated: Donation from friends or from person who isn’t related by blood to the recipient.

Different types of kidney donation include:

• Directed: You choose who gets your donated kidney.
• Paired kidney exchange: Organ transplants work best when the donor and recipient have the same blood type or tissue type. If you and the recipient aren’t a compatible match, you can donate your kidney to someone else who is a match. In return, a family member or friend of the recipient donates a kidney to your loved one.
• Nondirected or altruistic: You don’t know the person who gets the donated kidney. Instead, you choose to help someone unconditionally.

Who can be a living kidney donor?

You must be at least 18 years old to donate a kidney. You’ll undergo an extensive evaluation which includes a physical and mental health evaluation, several blood tests and imaging procedures. You’ll meet a group of healthcare providers which in some cases may include a physician, social worker, independent living donor advocate and a bioethics professional. The evaluation ensures you’re physically and mentally able to donate a kidney.

Tests may include:

• Blood and antibody tests.
• Cancer screening tests, such as colonoscopies.
• EKG (to check heart function).
• Urinalysis. CT scan to check which kidney you can donate.
• 24-hour blood pressure monitor.

What can I expect during kidney donation surgery?

Surgeons typically remove a donated kidney using a minimally invasive laparoscopic procedure. Surgery to remove a kidney (called a nephrectomy) may take two to three hours. Your surgeon will:

• Make several small abdominal incisions.
• Insert a laparoscope (small tube with a light and video camera) into an incision.
• Use tiny instruments to remove the kidney through an incision.
• Close the incisions with dissolvable stitches.

Some cases are done “open” (go through the side) if there are anatomic issues, but this happens in less than 5% of the surgeries.

Often your kidney recipient will be in a nearby operating room in the same hospital. Another team of surgeons operates on the recipient.

What can I expect after kidney donation surgery?

You’ll stay in the hospital for two to three days. You may experience pain, tenderness or itching at the incision sites for few days. Fatigue is also common in the first few weeks.

Most people resume their usual activities within four to six weeks. After surgery, you should not:

• Drive for two weeks.
• Get pregnant for at least one year.
• Lift anything heavy for six weeks.

You should expect to do follow-ups with the team for two years.

What are the risks of being a living kidney donor?

Like any surgery, kidney donation carries the risk of surgical complications like blood clots and others, but these risks are low. You will lose a certain percentage of your kidney function after donation. This sounds scary, but after the surgery your remaining kidney will get bigger and you won’t notice any difference.

Donating a kidney doesn’t increase your future risk of kidney failure. However, if kidney failure occurs for whatever reason, UNOS has a priority system that ensures living organ donors are at the top of the waitlist and get it quickly. This happens very rarely.

Other risks of kidney donation include:

• Bowel obstruction.
• Pneumonia.
• Hernia.
• Nerve damage (when surgeon uses open technique).

What are the benefits of living kidney donation?

It can take up to three to five years for someone on the kidney transplant waitlist to get a kidney from a deceased donor. During this time, they’re on dialysis. Sometimes, a person’s health declines, making them ineligible for a transplant. A living donor can cut this wait time.

People who receive a kidney from a living donor reap other benefits:

• Less risk of rejection: A kidney from a family member is often a better genetic match than a kidney from a stranger. As a result, there’s less risk of organ rejection.
• Longer organ life: Living donor kidneys can last 15 to 20 years. Kidneys from deceased donors function for about 10 to 15 years.
• Faster function: A kidney from a living donor begins working quickly after transplantation because it’s out of the body for a short time. Some people who get kidneys from deceased donors may need dialysis until the transplanted kidney starts to work.

Who covers the cost of living kidney donation?

The transplant recipient’s health insurer covers medical costs associated with donation. But insurance may not cover nonmedical expenses like missed work, child care, transportation and lodging. Be sure to check with your insurance company about exactly what’s covered.

A note from Cleveland Clinic

Donating a kidney can save someone’s life, but it’s a big decision. Your healthcare provider can help you decide if you’re a good candidate for donation and discuss your risks. Extensive test are done to make sure your health won’t be compromised. The surgery is relatively safe.

You can register to be an organ donor at Donate Life America (see References). In many states, you can also register through your local motor vehicle department.