What are the risks?

All operations are associated with some risk and although giving away a kidney is a unique type of surgery with potential challenges, serious complications are very rare. 

Physical risks

Short-term

1. Short-term – i.e. around the time of the operation:
   1. Anaesthetic: Complications due to anaesthetic issues are rare, particularly in people who are live donors as they have had a thorough work-up and come into the operation ‘well’ as opposed to being sick (unlike most people who need an operation). If there are any possible concerns then our experienced anaesthetic consultant will see you well in advance of the surgery.
   2. The Operation: The kidneys lie 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 is 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.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 involve creation of 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 doctors would then insert a tube into the chest to allow recovery.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 is estimated that this happens once in every 3000 cases. This is comparable to the risk of dying with having surgery to remove the appendix
   3. After the operation: Pain – most people feel sore after an operation but pain will be kept to a minimum using a variety of methods including giving painkillers directly into a vein and by tablets.

Nausea – a surgical procedure or sometimes anaesthetic or pain killing drugs can lead to nausea in some people. This generally settles very quickly and tablets or injections can help if necessary.Infection (chest, wound, urine) – with very careful attention to hygiene and sterility infection is uncommon but an antibiotic will be given if required. The donor will be strongly encouraged to stop smoking in advance of surgery and to breathe deeply to reduce the chances of developing a chest infection. A wound infection can delay the healing process or cause scarring.Blood clot in leg / chest – To minimise the risk of clots, a machine that massages the legs will be put on immediatly after the operation.  The donor is encouraged to walk around as early as possible after the operation and will also be given injections to keep the blood thinner.Skin numbness – the superficial nerves in the skin are inevitably cut during an incision. Some numbness over the wound is very normal and while it may feel ‘funny’ it is not harmful and usually resolves (although this can take up to a few months).

Medium-term

2. Medium-term – i.e. 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
   1. Pain: rarely some donors have persistent discomfort
   2. 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.
   3. 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.
   4. 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.

Long-term

3. Long-term – i.e. years after donation. Obviously giving a kidney does not exempt you from developing other medical problems that you would have developed in any case. There are a few that are worth considering in particular:
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   1. High blood pressure. Approximately a quarter of the population in NI has high blood pressure so it is unsurprising that quite a number of donors also develop this. However there is a very strong link between blood pressure and the kidney, so if you have just one kidney it is important to have good or very good, not just average blood pressure. We 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 then it will not have any detrimental effect on kidney function in the long term.
   2. Kidney function. Your kidney blood tests will not be as good after you have given a kidney as they were before. However provided the results are stable, there is no protein leak in the urine, and your blood pressure is good this is not of concern. 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. However, if you have donated we know that you have a good kidney (or we wouldn’t have gone ahead with the operation) and your kidney blood tests are worse not because there is a problem with your kidneys but because you have one rather than two.
   3. 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 team here in the City hospital, but it may be arranged in conjunction with your local GP.

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 is 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. But we have never had to use this arrangement!

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. Nothing is impossible however and in the unlikely event that you did develop a problem with your kidneys there would obviously be a higher chance that you would need dialysis treatment sooner than if you still had both kidneys.

Any potential donor must 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 acceptably low.

The level of risk that any one individual is prepared to take may vary (e.g. a father may accept a higher risk in order to see his child live and grow normally off dialysis, than someone giving to a relative with whom they are not particularly close). The long-term risks are clearly different for someone who is 25 years old compared to someone who is 65 years old. Your own individual risk will be discussed very honestly with you as you go through the process. At any stage if the risk / benefit ratio no longer seems favourable to you or to us then the process will be halted.

Psychological risks

Clearly the stakes are very high in live kidney donation. It can be a hugely positive experience for someone if they see a close friend or a member of their family be able to live normally. Removing their need for fluid and dietary restrictions, giving them more free time and taking away the hassle required to go through dialysis often brings direct benefits to the donor in terms of family and social life. Please click here to read of some donors experiences.

However, although the vast majority of 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, but it doesn’t work or only functions for a short time, it can be very difficult to cope with this. It is important that anyone who is going to donate a kidney considers this possibility in advance, and feels ready to go ahead. In some cases we know because of the illness of the recipient, that the kidney is unlikely to last a long time, and we will always be honest about this with you in advance.

Occasionally the donor may feel a sense of anti-climax after donating, when all the attention seems to switch to the person who got the kidney. This may be particularly true when the donor and recipient do not have a close personal relationship. Often a person who donates a kidney has never been in hospital or had an operation before and may struggle with the discomfort or with being unable to immediately resume normal activity.

These negative feelings can be normal, and usually resolve fairly quickly as the donor recovers and returns to their normal life. We have a very experienced psychology support team who have proven to be very helpful to the tiny number of donors who have needed some additional support after donation.

Conclusion

The safety of the donor is paramount for the living donor transplant team. Although the risks associated with giving a kidney are never zero, we will proceed unless its in your best interests. Having discussed all the risks, it is crucial to remember that it is very possible to live well for a long time with one kidney. The very first live kidney donor in NI was Gladys Wilson, who gave her identical twin sister a kidney in 1961 when she was 31 years old. Having lived a full and normal life, with only being in hospital four times in total, she passed away over 50 years later from lung cancer.

Gladys Wilson

Gladys Wilson, the first living kidney donor in NI and one of the first in the UK, donated a kidney to her identical twin in 1961. This photograph was taken when she was 80 years old, and she lived a full and normal life for over 50 years after donating

Gladys Wilson, the first living kidney donor in NI and one of the first in the UK.