Q&A on Living Donation

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What is the recovery period and when can the donor return to normal activities?

The length of stay in the hospital will vary depending on the individual donor's rate of recovery and the type of procedure performed (traditional vs laparoscopic kidney removal) although the usual stay is 4 to 6 days. Since the rate of recovery varies greatly among individuals, be sure to ask the transplant center for their estimate of your particular recovery time.

After leaving the hospital, the donor will typically feel tenderness, itching and some pain as the incision continues to heal. Generally, heavy lifting is not recommended for about six weeks following surgery. It is also recommended that donors avoid contact sports where the remaining kidney could be injured. It is important for the donor to speak with the transplant staff about the best ways to return as quickly as possible to being physically fit.

Click here for detailed statistics on short-term complications from living donation (as reported to the United Network for Organ Sharing).

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How does living donation affect the donor?

People can live normal lives with only one kidney. As long as the donor is evaluated thoroughly and cleared for donation, he or she can lead a normal life after the surgery.

When the kidney is removed, the single normal kidney will increase in size to compensate for the loss of the donated kidney.

The American Academy of Pediatrics, American Academy of Family Physicians and the Medical Society of Sports Medicine have suggested that people with one kidney avoid sports that involve higher risks of heavy contact or collision. This includes, but is not limited to, boxing, field hockey, football, ice hockey, Lacrosse, martial arts, rodeo, soccer and wrestling. This may also include extreme activities such as skydiving. Anyone with a single kidney who decides to participate in these sports should be extra careful and wear protective padding. He or she should understand that the consequences of losing a single kidney are very serious.

Donors are encouraged to have good long-term medical follow-up with their primary care doctors. A urinalysis (urine test) and blood pressure check should be done every year, and kidney function should be checked every few years, or more often if an abnormal urinalysis or blood pressure is found. Click here for a fact sheet on "Living With One Kidney".

Living donation does not change life expectancy, and does not appear to increase the risk of kidney failure. In general, most people with a single normal kidney have few or no problems; however, you should always talk to your transplant team about the risks involved in donation. Some studies report that living donors may have a greater chance of developing high blood pressure. It is recommended that potential donors consult with their doctor about the risks of living donation.

Pregnancy after donation is possible but is usually not recommended for at least six months after the surgery. Living donors should talk to their physician about pregnancy and have good pre-natal care.

Some branches of military service, police and fire departments will not accept individuals with only one kidney (see usmilitary.about.com/library/weekly/aa082701e.htm) for general information about Military Enlistment Standards). In addition, if you are already in military service, certain new service career options may not be available to you. If you are currently in one of these fields, or if your future plans include these career choices, you should check to see if living donation would affect your eligibility for that particular field.

See also http://kidney.niddk.nih.gov/kudiseases/pubs/solitarykidney/

After donation, living donors often report a wide range of mixed emotions, from joy and relief to anxiety to depression. The process of getting through the evaluation and surgery can be so time-consuming that donors do not always have time to process everything they are feeling. It is normal for these emotions to come to the forefront after the donation and transplant take place.

Living donors generally rate their experience as positive. Different studies indicate that between 80-97% of donors say that in retrospect, they would have still made the decision to donate.

However, concerns about the recipient's outcome (as well as the donor's recovery) can contribute to feelings of anxiety, and may donors report a feeling of "let down" afterwards. Feelings of depression among living donors are not uncommon, even when both donor and recipient are doing well.

While extensive data on these issues is lacking, some studies have reported the following psychological outcomes:

• Less than 1% regretted the decision
• 3 to 10% reported depression
• 10% reported “family conflicts”
• 7% reported anxiety disorders
• 16% concerned about negative financial consequences of donation
• 3 to 15% concerned about a negative impact on their health

Living donors who are struggling with these issues are encouraged to:

1. talk to the transplant hospital's Transplant Social Worker for advice
2. seek professional counseling or other outside help to manage difficult emotions, and
3. talk with other living donors who can be particularly supportive if they have experienced the same feelings.

The NKF's Email Groups and Message Board are good places to find support from other living donors.

For more information about post-donation outcomes, visit this page

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What are the long-term risks of donation?

You will also have a scar from the donor operation- the size and location of the scar will depend on the type of operation you have.

Some donors have reported long-term problems with pain, nerve damage, hernia or intestinal obstruction. These risks seem to be rare, but there are not currently any national statistics on the frequency of these problems.

In addition, people with one kidney may be at a greater risk of:

• high blood pressure
• Proteinuria
• Reduced kidney function

For more information, visit the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) website

You should discuss these risks with your transplant team, and ask for center-specific statistics related to these problems.

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Are there any dietary restrictions prior to, or after donation?

If the donor is overweight, he or she may need to lose weight before the transplant. If the donor eats large quantities of protein, that could be an issue as well. But those are more general health issues, and not related to living donation per se.

Check with the transplant center to see if they recommend any dietary changes. If you are in good health, there will probably not be any specific dietary restrictions.

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Will I be able to obtain insurance coverage after donation?

If your health remains stable, you shouldn't have problems in obtaining health or life insurance.

However, there have been some instances in which living donors had difficulty changing insurance carriers after the donation, due to higher premiums or a pre-existing waiting period.

Talk to the financial counselor and social worker at the transplant center to find out if donation will affect your health or life insurance coverage.

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What if I donate, and need a kidney later?

This is something potential donors should discuss with the transplant team. Talk to your transplant team about any pre-existing condition or other factors that may put you at a higher risk of developing kidney disease, and consider this carefully before making a decision about donation.

There have been some cases in which living donors needed a kidney later- not necessarily due to the donation itself. It is considered a potential risk of donation. As of 1996, UNOS policy gives four extra points on the waiting list to living donors.

Pregnancy after donation is possible but is usually not recommended for at least six months after the surgery. Living donors should talk to their physician about pregnancy and have good pre-natal care

There have been two studies on pregnancy after kidney donation published by the American Journal of Transplantation.

Reisaeter AV, Røislien J, Henriksen T, Irgens LM, Hartmann A. Pregnancy and birth after kidney donation: the Norwegian experience. Am J Transplant. 2009; 9: 820-824. Epub 2008 Oct 6.
Available at: http://www.medscape.com/medline/abstract/18853953

This study in Norway compared post donation births to the general population. It showed that there were no dramatic differences between post donation births and those of the general public. However, the increase of blood pressure and loss of kidney function in donors may predispose for hypertensive pregnancy disorders, preeclampsia and other complications. Previous kidney donation is not detrimental to the course and outcome of future pregnancies, though pregnancies in kidney donors should be monitored carefully.

Ibrahim HN, Akkina SK, Leister E, et al. Pregnancy outcomes after kidney donation. Am J Transplant. 2009; 9: 825-834.
Available at: http://www.medscape.com/medline/abstract/19353771

This study compared post donation births to the predonation births of the living donors in the study. While the results showed that bad pregnancy outcomes post-donation were similar to the general population, they were not as good as predonation pregnancy outcomes of the same people. This particular study states that the outcomes of kidney donor pregnancies are generally favorable. However; postdonation pregnancies were associated with a lower likelihood of full-term deliveries and a higher likelihood of fetal loss. Postdonation pregnancies were also associated with a higher risk of gestational diabetes, gestational hypertension, proteinuria and preeclampsia.

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