Kidney Failure and Living Donors: 6 Things You Need to Know
Chronic kidney disease (CKD) affects more than 35 million Americans, but the majority of these people have no symptoms. This is known as early-stage kidney disease. When CKD gets worse over time, it can contribute to a stroke, heart attack, or kidney failure—the last of these complications requires either dialysis or kidney transplant. Around 800,000 Americans have end-stage kidney disease (ESKD).
A kidney transplant is usually the preferred treatment for ESKD because it’s associated with better quality of life and lower risk of death compared to dialysis. However, only around half of all EKSD patients who were waitlisted for a transplant in 2016 received a kidney within five years (46.3%). In November 2024, more than 90,000 Americans were awaiting a match for a kidney transplant.
Living kidney donation can make a big difference for patients awaiting a transplant. There are slight risks for the donor, but these are outweighed by the benefit of dramatically improving and potentially extending the life of another human being. Deciding to be a donor, however, is a big decision and not one that should be taken lightly.
Transplant or Dialysis
While most people with CKD can go several years without noticing symptoms, those with ESKD require either a transplant or dialysis to maintain proper bodily function. When the kidneys fail, the body is unable to effectively remove waste products from the blood. A dialysis machine functions similarly to kidneys, removing blood from a vein and filtering it through a machine known as a dialyzer before returning it to the body.
Kidney transplant is a more effective solution. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), patients with a kidney transplant have lower adjusted mortality rates (74.3 per 1,000 person-years) than those receiving dialysis (187.7 per 1,000 person-years). Those who receive a kidney from a living donor are also generally better off than those who get one from a deceased patient; kidneys from living donors usually function as needed for 15-20 years, compared to just 7-10 years for those from deceased donors.
Donor Eligibility
Not everyone is eligible for living kidney donation. General criteria includes being at least 18 years old and having a body mass index lower than 35. Donors also shouldn't have any infectious diseases, cancer, diabetes, hepatitis, or high blood pressure. A transplant team conducts a thorough health examination on living kidney donor candidates before testing to see if they're a match for certain recipients. Matches occur when both the donor and ESKD patient have compatible blood types.
Directed and Non-Directed Donation
Directed and non-directed are the two primary types of living kidney donation. A directed donation is when the donor gives a kidney to a family member, friend, or someone they know. This is much more common than non-directed donation, which happens when a person anonymously donates a kidney to a stranger.
In some cases, even family members are not good matches for living kidney donation. A paired exchange can remedy this issue. This involves two incompatible donors gifting a kidney to each other's recipient, facilitated by the transplant team.
Plasmapheresis can also help patients accept a kidney, even when it isn’t a good match. This method, developed by the Johns Hopkins Comprehensive Transplant Center, is similar to dialysis and involves the use of a special machine to separate plasma from the blood. This process removes antibodies from the blood that would cause the patient’s immune system to attack the transplanted kidney. Patients undergoing plasmapheresis must also take immunosuppressive medications.
Benefits for the Recipient
People who receive a living kidney donation have a longer life expectancy and much more freedom than ESKD patients on dialysis. If they're able to find a preemptive transplant match, they can avoid going on dialysis altogether. Living kidney donations also have better compatibility rates, last longer, and can be timed more appropriately, when both the donor and patient are at their healthiest.
Risks for the Donor
Living donor kidney transplants typically only have minor health risks. While some prospective donors worry they may require dialysis in the future with only one healthy kidney, evidence suggests that a kidney donation doesn't significantly increase a person’s risk of future problems. In fact, living kidney donors have less than a 1% risk of kidney failure. Some studies have even found that kidney donors live longer than the average person—likely because, to be approved for donation, these individuals must be healthy.
Most of the risk involved in kidney donation is related to the surgery. As with any surgical procedure, there’s a risk of the area around the incision becoming infected, and donors will experience some pain and fatigue as they recuperate. Hernia and urinary tract infections (UTIs) are among the other short-term risks for kidney transplant.
Life after Donating
Most donors are able to leave the hospital within 48 hours after surgery and can return to work and physical activity within six weeks, during which time they see their transplant team for multiple follow-up evaluations. For the most part, donors are able to maintain their lifestyle without making any dramatic changes, although they should eat a healthy, balanced diet and limit alcohol consumption. Women who donate a kidney should wait at least six months and up to one year before trying to get pregnant.
The Best Gift You Can Give
For many, the rewards of kidney donation far exceed any risks or short-term inconvenience. Donating a kidney is a lifesaving, deeply altruistic action. Donors are giving the ultimate gift: the gift of life. They often find great satisfaction and deep meaning in donation. To learn more about kidney donation, go to the National Kidney Foundation website.