Understanding the risks
Every operation carries some degree of risk and although giving away a kidney is a unique type of surgery with potential challenges, serious complications are very rare. There are lots of people at the hospital you can talk with if you have any concerns.
- Education nurses are specialist nurses who are experienced in discussing the physical and emotional impact of what happens when you donate. You can talk about your concerns, anxieties, request for more information and ask questions.
- Peer supporters offer support to kidney patients and potential living kidney donors.
- Kidney Patients Association supports kidney patients and provides information.
Potential donors should appreciate that the risks associated with donation, in the short, medium and long-term, are never zero. The assessment process is designed to ensure that the risks for you are acceptable, and that you understand them fully.
Anaesthetic
Complications due to anaesthetic issues are rare, particularly in people who are live donors as they have had a thorough work-up. If you’re medically fit, you’ll come into the operation ‘well’ as opposed to being sick (unlike most people who need an operation). If there are any possible concerns then an anaesthetic consultant will see you well in advance of the surgery.
The Operation - bleeding
The kidneys sit beside the major blood vessels and organs such as the colon, pancreas, lungs and spleen and there is the potential for damage during removal of the kidney. There’s also a small possibility of bleeding occurring but this can be generally seen at the time and brought under control very quickly by the surgeon.
Spleen
Very rarely but occasionally the donor may need a blood transfusion or to go back to theatre. Spleen – moving the spleen out of the way to reach the kidney can lead to bleeding which ultimately requires removal of the spleen (splenectomy). Splenectomy weakens the immune system, so in the very unlikely event that this happens you should take lifelong antibiotics.
Gut/bowel
Moving the bowel out of the way to reach the kidney very rarely causes it damage. Sometimes this is not obvious until a few days after the donor operation, and requires further surgery.
In very exceptional circumstances this will mean creating a temporary colostomy (bag on wall of abdomen for faeces) for a few months to rest the bowel until it can be safely repaired.
Lung
The pleura (the space around the lung) may be inadvertently be opened during surgery. If this happens, the lung may collapse. The surgeon would then insert a tube into the chest to allow recovery.
Short-term risks
These are the risks that could occur around the time of the operation and shortly afterwards.
These complications are mentioned because they are serious but fortunately they are exceptionally rare.
Worldwide, there are reports of a person donating a kidney having died because of a serious complication and it’s estimated that this happens once in every 3,000 cases. This is comparable to the risk of dying with having surgery to remove the appendix.
Pain
Rarely, some donors have persisten discomfort.
Irritable bowel symptoms
It is common for the bowel to take a day or two to work after the operation.
Occasionally some people notice that their bowel habit does not return back to normal with ongoing subtle change toward constipation and/or diarrhoea. While such symptoms can be annoying there is not any serious underlying disease. There may be medications and dietary alterations which will help.
It is common for a change in bowel habit in the early days following donating a kidney.
Hernia
A bulging of the tummy may occur where there has been a cut into the abdominal wall muscle. This may complicate any surgery in this area. Again this is irritating rather than sinister, but where it causes distress or discomfort an operation to repair this will often be effective.
Testicular discomfort
Very infrequently, some men who have donated will experience discomfort in the testicle on the side the kidney has been removed. This can happen as the vein from the testicle joins the vein from the kidney that has been removed.
This means a little more blood than usual accumulates in the testicle, and this can be uncomfortable for the first month or two following surgery.
Typically this discomfort does settle with time, but it may take some months. There have been cases of persistent pain.
Medium-term risks
Medium-term means in the first few months the following can be a problem, but remember, only a small number of donors have any issues in this period.
Considerations
Anything else that will affect one kidney in general, will affect both kidneys.
Although diseases can occur ‘out of the blue’ and cause kidney failure, it really will be unexpected given that you will have gone through a thorough assessment process before donating.
However, nothing is impossible, and in the unlikely event that you did develop a problem with your kidneys, its more likely that you would need dialysis treatment sooner than if you still had both kidneys.
Future test results
Your kidney blood tests will not be as good after you have given a kidney as they were before. But, as long as the results are stable, there’s no protein leak in the urine, and your blood pressure is good, it’s nothing to worry about.
Although another doctor may tell you that you have chronic kidney disease, this is based on the assumption that you have two kidneys – and to have this level of function with two kidneys means there must be something wrong with them.
Try to remember that you could donate a kidney because the consultant concluded that you have a good kidney (or they wouldn’t have gone ahead with the operation). Your kidney blood tests are worse, not because there is a problem with your kidneys, but because you have one rather than two.
After you donate, we recommend that you have your blood pressure, urine (to check for protein), and kidney blood tests, checked once a year. Usually this will be organised by the hospital team, but it may be arranged together with your local GP.
Having one kidney
There are two situations when it would be very helpful to still have a second kidney.
The first is if your kidney is injured, for example in a road traffic accident. The second is if you develop cancer in your one kidney. Fortunately, both of these scenarios are uncommon – it’s likely that you have heard of someone with breast, or prostrate, or bowel, or lung cancer but quite probably you haven’t heard of someone with kidney cancer.
If it happened that your single kidney was affected by trauma or cancer than you would have priority on the UK transplant list yourself. GOLD are not aware of anyone who has needed a transplant themselves after donating.
Long-term risks & Considerations
Long-term risks happen several years after donation.
Giving a kidney doesn’t mean you’ll never have other medical problems. There’s a very strong link between blood pressure and the kidney, so if you have just one kidney, it’s important to have good or very good, not just average, blood pressure.
Doctors would prefer to start blood pressure lowering tablets earlier rather than later in someone with only one kidney. If the blood pressure is well controlled, it won’t have any harmful effects on your kidney function in the long-term.
Psychological risks
Clearly there are huge benefits of live kidney donation for recipients and donors. It can be a rewarding and positive experience for those who see a close friend or a member of their family regain the ability to live life to the full again. Removing their need for fluid and dietary restrictions, giving them more free time and taking away the hassle of dialysis, brings direct benefits to the donor’s family, work and social life.
However, although most living donor kidney transplants work very well, as with everything in life, it doesn’t always go according to plan.
If you give a kidney and it doesn’t work, or only functions for a short time, it can be very difficult to cope with this. It’s important that anyone who is going to donate a kidney considers this possibility in advance, and feels ready to go ahead. In some cases clinicians know that because of the illness of the recipient, the kidney is unlikely to last a long time, and they will be honest about this with you from the start of the process.