Living Donor Surgery and Risks

What are the risks of surgery?

It is quite normal for a donor and the donor's family to have fears and concerns about potential complications. This might be felt by some as reluctance to donate, yet it is natural reaction to a major surgery. Potential donors should speak openly with the transplant team about these fears. All conversations between the living donor and the transplant team and the results of medical testing will be kept confidential.
Both laparoscopic and open surgery has different benefits and risks, which potential donors should discuss with the transplant team.
The surgery involves the same level of risk for the donor as any other major surgery. The majority of complications following surgery are minor and may cause a longer hospitalization. The risks associated with surgery and donation should be discussed with your transplant team, and include:
  1. Pain. You will receive medication for pain after the surgery.
  2. Infection. An infection can delay the healing process or cause scarring or other problems. If the wound from the surgical incision becomes infected, it will be treated with antibiotics. Antibiotics are powerful medicines that fight bacterial infections.
  3. Pneumonia. Surgery increases the risk for pneumonia (an inflammation of the lungs caused by bacteria or a virus). You will be asked to cough and breathe deeply during your recovery period. Taking a deep breath and coughing forces air to the bottom of your lungs, which helps to expand them and lessens your risk for pneumonia.
  4. Damage to the kidney. There is a possibility that the kidney could become damaged during the surgical procedure. Every attempt will be made to minimize this risk.
  5. Blood Clotting. You will be encouraged to move around as soon as you can after surgery. This will stimulate blood circulation to help prevent blood clots.
  6. Collapsed lung. The kidney is close to the lung, and the pleura (the space around the lung) may be inadvertently opened during surgery. If this happens, the lung may collapse. The doctors would then insert a tube into the chest to expand the lung.
  7. Urinary tract infection. This is an infection of the bladder or kidneys. It can be treated with antibiotics.
  8. Allergic reaction to anesthesia. Anesthetics are drugs that prevent pain. During the evaluation process, the transplant team will try to identify any allergies you might have. If you have an allergic reaction to anesthesia, the doctor will take immediate action to correct the problem.
  9. Death. There is always a risk of death with any major operation. However, the risk of death from surgery for living kidney donors is very low. Living donors undergo careful pre-operative testing and evaluation to make sure they are healthy enough for surgery. In one study of over 80,000 living kidney donors, death from surgery was 3.1 per 10,000 donors. This rate has not changed for the last 15 years.

What does the operation involve?

In general, you will be given a general anesthetic in the operating room. You will be asleep and will not feel any pain during the surgery. In most cases, you and your recipient will be in adjacent operating rooms. One of your kidneys will be carefully removed and transplanted in the recipient. Typically, the surgery takes 3–5 hours with time in the recovery room afterward for observation. Removing your kidney may be done by laparoscopy or open surgery. The surgery to remove a kidney is called a “nephrectomy.”

What are the different types of surgery?

A kidney can be removed in either of two ways, the traditional open surgery or the laparoscopic technique. Your transplant team can provide you with information about the different types of surgery.
Laparoscopy is the preferred method for kidney donor transplants. It involves the use of a laparoscope (wand-like camera) that is passed through a series of small incisions or “ports” in the abdominal wall (stomach). It is used to view the abdominal cavity and remove the kidney through a small incision. The advantages of laparoscopic surgery include shorter recovery time, shorter hospital stay, smaller incisions, and fewer post-operative complications. Laparoscopic surgery takes special skills to perform and is not available at all hospitals. Also, whether you can have laparoscopic surgery depends on your medical condition and overall health.
Some donors may not be able to have laparoscopic surgery because of previous surgeries or anatomical variations. These variations are generally detected during the testing process, in which the potential donor would be notified that they would not be a candidate for laparoscopic donation. Some scheduled laparoscopic donations must be converted to the open technique during the surgery process.
Open nephrectomy is also done under general anesthesia and is a more invasive procedure. The surgeon makes a cut (incision) in the abdomen or in the side of the abdomen. A rib may need to be removed to perform this procedure. After the kidney is removed, the incision is closed with stitches.
Your transplant center can give you the most current medical information about the surgical process. They will help you determine what is best for you.

What should I do if I have concerns about surgery?

It is quite normal for you and your family to have some fears about the operation and possible complications. You should speak openly with your transplant team about any fears or concerns you have. You should also learn the risks of surgery in addition to long term risks of living donation.  All conversations between you and the transplant team will be kept confidential. The results of your medical tests will also be kept confidential.

How long will I need to recover?

This depends on which type of surgery you have, but most people are in the hospital three to seven days after surgery. However, everyone is different and the rate of recovery will vary greatly among individuals. Ask your transplant center for their best estimate of your recovery time.
After leaving the hospital, most people will feel tenderness, itching, and some pain as the incision heals. Most kidney donors can return to normal activities after four to six weeks, depending on the physical demands of their daily living and work tasks. Heavy lifting should be avoided for about six weeks following surgery. You may not be able to drive for up to two weeks.
Make sure to see your primary care practitioner regularly for follow-up care, and have your urine, blood pressure, and kidney function (GFR) checked yearly.

Living donation & COVID-19

Find answers about living donation during the COVID-19 outbreak here.

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NKF Cares is a free, confidential hotline with trained professionals ready to answer your questions or concerns. Our peer-mentoring program, NKF PEERS, connects anyone affected by kidney disease with an informed and supportive mentor who has already been through the process.