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Afterward...
Perhaps the most common question of a potential kidney donor is, "What are the long-term consequences to my health of living with one kidney?"
Because living kidney donation has been practiced for more than 40 years, research has been conducted on the long-term effects of donation on the donor. In general, these studies have shown very little negative impact.
Here's a digest of some of the research results:
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Najarian, et al., 1992. This study of 57 donors 20 or more years after donation measured renal function, blood pressure, and proteinuria (an excess of protein in the urine) compared to their siblings. The donors showed no significant differences in health.
The study also assessed the risk of mortality from the donation process by surveying members of the American Society of Transplant Surgeons. The results yielded a mortality rate estimated to be 0.03%.
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Undurraga, A, et al., 1998. A study of 74 donors showed adequate renal function when compared to a control group. A slightly higher incidence of high blood pressure, proteinuria, and microhematuria (excess blood in the urine) was identified.
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Fehrman-Ekholm, I., 1997. This Swedish study evaluated the life span of living kidney donors. Of 430 people who donated between 1964 and 1994, 41 died from 18 months to 31 years following donation. The causes of death included cardiovascular disease, cancer, injury or accidents, gastrointestinal disease, alcoholism, and other diseases. None died of kidney disease. The study also concluded that the survival rates of donors were 29% higher than the general population, possibly due to the careful selection of donors based on their health (i.e., donors tend to be healthier than the general population.)
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McCune, TR, et al., 2004. This study shares the results of a program by the South-Eastern Organ Procurement Foundation tracking the experiences of living donors. Information is collected using questionnaires at the time of donation, then after three months, six months, and annually thereafter. The study reported the following findings:
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Donors relied on employer-provided paid time off (vacation and sick leave) for recuperation, but but the average donor also required 12 weeks of unpaid leave before returning to work.
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Donors had out-of-pocket expenses for transportation, lodging, and childcare.
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Anti-depressants were prescribed for about 11% of donors.
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About 5% of donors were treated for hypertension.
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Nearly 38% of donors reported experiencing complications from the donation, with 7.6% of the complications being serious enough to require hospitalization or surgery.
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Ramcharan and Matas, 2002. This study updates the findings from the first study above (Najarian, et al.), looking at health of 773 living donors 20 to 37 years after donation. Of the group, 84 had died, three of renal failure. Of the living donors, three had abnormal kidney function and two had undergone transplantation. The remaining donors had normal kidney function. The rates of proteinuria and hypertension were comparable to the general population. The study concludes that most kidney donors have normal kidney function 20 to 37 years following donation. Some donors do experience renal dysfunction or failure.
These studies and others like them strongly suggest there are few if any health consequences from donating a kidney. However, some precautions naturally are in order. For example, you may need to limit or give up activities that could damage your remaining kidney, such as rough contact sports (boxing or American football). Pregnancy for the most part is not a problem following donation, but a female should let the obstetrician know they have only one kidney so kidney function can be monitored.
As noted above, some studies have shown a slightly higher risk of high blood pressure and proteinuria. These risks can be managed and monitored through regular physical exams, blood tests, and urine tests. Interestingly, Switzerland established a living donor registry in 1993 to track living donors and to ensure they are regularly examined by their personal physician for blood pressure and renal functions. No such registry or post-operative protocols exist in the U.S. or other countries.
Here's additional information on living with one kidney from the National Kidney and Urologic Diseases Information Clearinghouse.
Stay healthy by following normal sound health practices and have an annual physical to monitor your health.
You should also consider your psychological health after
donation. For example, some living donors on LDO report feeling
depressed after donation. This feeling may be the result of fatigue
following surgery, renewed demands on you by family and work while you
are still recovering, or the sudden letdown following a major life
event that had been marked by lots of energy, anxiety, and attention
from others. A medical research study showed that nearly 11% of living
donors were prescribed anti-depressants following donation.
Your mood can also be influenced by what happens to the
recipient of your donated kidney. The recipient may reject the organ or
may die despite the transplant. It's natural to go through a grieving
process in this circumstance. A perspective on coping with the problems
your recipient may endure can be found on this web page.
If your feelings of sadness persist, get professional help.
If you donated to a spouse, family member, or friend, the nature of your relationship with that person may change. You or the recipient may feel guilt, indebtedness, conflict, or regret and experience manipulation and other destructive behavior. Seek professional counseling if your relationship becomes dysfunctional.
