A recent investigation published in JAMA, a peer-reviewed medical journal published 48 times a year by the American Medical Association, reveals that the mortality risk among living kidney donors is significantly lower than previously estimated by clinicians.
This longitudinal study tracked three decades of living kidney donations, concluding that as of 2022, the mortality rate is fewer than one in every 10,000 donors within three months post-surgery.
Historically, transplant centers have relied on outdated data, which suggested a mortality risk of three per 10,000 living donors, to counsel donors regarding potential fatal complications. "The last decade has rendered the operating room significantly safer for living donors," stated Dr. Dorry Segev, vice chair of the Department of Surgery at NYU Grossman School of Medicine and co-author of the study.
The NYU research team analyzed U.S. records from over 164,000 living kidney donations between 1993 and 2022, identifying 36 post-operative fatalities. The highest risk was observed among male donors and those with a history of hypertension. Since 2013, only five such deaths have occurred, attributed to U.S. transplant centers adopting minimally invasive kidney removal techniques and improved renal artery hemostasis methods, according to Dr. Segev, who attributes the enhanced safety of living transplants primarily to these new surgical techniques.
He advocates for updated guidelines to reflect this improved safety, potentially increasing interest in living donation. Often, transplant recipients are more concerned about the risks to their donors than the donors themselves, he explained. "For them, it's even more reassuring to allow their friends or family to donate," Dr. Segev remarked.
Each year, thousands die awaiting organ transplants, despite many individuals being capable of donating one of their two kidneys or a portion of their liver—the only organ that regenerates. Organs from living donors tend to have superior longevity. With nearly 90,000 individuals on the U.S. kidney transplant waiting list, securing a living donor not only reduces the lengthy wait but also improves patient survival post-transplant, as organs from living donors generally outlast those from deceased donors.
In the previous year, only 6,290 of the more than 27,000 kidney transplants in the U.S. were from living donors, marking the highest count since pre-COVID times. Israel reported stability in transplant surgery numbers last year, although a slight decrease in kidney transplants from living donors was noted—297 in 2023 compared to 319 the previous year. Conversely, the number of living donor liver lobe transplants doubled: 16 compared to seven the prior year, with 14 from familial donors and two from unrelated donors.
Safety is not the sole barrier to living donation, as many patients hesitate to ask. Although the recipient's insurance covers medical expenses, some donors face costs such as travel or lost wages during recovery. Dr. Amit Tevar from the University of Pittsburgh Medical Center, uninvolved in the study, emphasized, "Over time, this procedure has become safer, and potential donors need to be aware of this. However, there are also long-term risks, including whether the donor's remaining kidney will suffice for their lifetime."
The risk of a donor experiencing kidney failure later is minimal, influenced by factors such as obesity, hypertension, smoking, and a family history of kidney disease. Risk calculators assist physicians in assessing the likelihood of future complications for potential donors. "There is no medium- or high-risk donor—you either meet the criteria or you don't," Dr. Tevar described the decision-making process for accepting or rejecting a potential donor. Once, young adults were considered the ideal living donors, but Dr. Segev notes a shift toward older donors, as predicting their likelihood of living with one kidney tends to be more precise.