Commentary on Risks of Living Kidney Donation

Introduction

In this evidence-based nephrology review, Lentine et al. (1) discuss the growing evidence regarding short- and long-term risks of living kidney donation. Adopting a patient-centered approach to characterizing and prioritizing these risks, the authors identify four potential risk categories: (1) kidney health (including risk of ESKD and progressive GFR decline), (2) surgical risks (including perioperative morbidity and mortality), (3) psychosocial risks (including health-related quality of life and stress), and (4) financial risks (including direct and indirect nonmedical costs). Information on these risks is essential for informed decision making and consent for donation. We summarize their findings as follows.

• The risk of ESKD after kidney donation is similar to that of the general population but significantly higher than the risk among healthy nondonors.

• The risks of long-term CKD and ESKD are greater among black donors compared with white donors, analogous to the disparity in these outcomes among the general population.

• Several prediction tools have been developed to estimate the long-term risk of ESKD for a potential kidney donor on the basis of demographic and clinical factors.

• Perioperative mortality after live kidney donation is very low at roughly three patients per 10,000 donations within 90 days.

• Perioperative complications of any severity occur in roughly 17%–18% of donations, with major complications affecting 2.5%–3.0% of live donors.

• On average, live donors experience no decline in psychosocial health after kidney donation, although a minority (<20%) of donors do report new mood disturbances or fear of kidney failure within 2 years.

• Most living kidney donors incur some direct financial costs from donation, including costs related to travel, lost time from work, and dependent care. Financial concerns of donors are greater among younger and lower-income individuals.