What is it Like to be a Living Kidney Donor?

Kidney donation can save lives. But making the decision to donate a kidney can be complex. There is a careful, thorough evaluation process, and not everyone can donate, no matter how much they may want to.

Typically, humans have two kidneys, which filter the blood and remove waste in the form of urine. They are bean-shaped organs, located on either side of the spine, toward the back. When one kidney is damaged, the other kidney can often do the work of both.

However, when a person has severe kidney disease, this may no longer be possible. That’s where kidney donation comes in.

Donating a kidney can have great rewards for both the donor and the recipient.

In basic terms, kidney donation involves giving a healthy kidney to a person with a kidney that no longer functions well. The healthy kidney is surgically removed from the donor. It is then transplanted into the recipient.

Donating a kidney can have great rewards for both the donor and the recipient. The procedure can save or extend the life of a person with end stage kidney disease. And donors often feel good knowing that their kidney is helping another person live.

Kidney donation is the most frequent type of living organ donation, and the need is great. According to the Organ Procurement and Transplantation Network, there were almost 89,000 people on kidney transplant waiting lists as of January 2023. During 2022, about 25,500 transplants were performed.

Donated kidneys can come from living or deceased donors. This article focuses on what living donors must consider when weighing their decision to donate and what they might expect from the donation process.

Directed and nondirected donations

Sometimes people donate a kidney to a specific person they know, such as a relative, friend, or co-worker. This is called a directed donation.

It is also possible to donate a kidney to an unknown person. This is called a nondirected donation.

Considerations to make before donating a kidney

Donating a kidney is a big decision. Fortunately, there are lots of people to help. Transplant centers have professional staff who can assess the donor’s health, their finances, their support system, and their feelings about donation. Staff are also available to answer questions and coordinate the donation process.

The donor’s health

It’s important for kidney donors to be in good health, for both the surgery and for the time afterward, when they have only one remaining kidney. Sometimes, health issues prevent a person from donating. These may include:

Kidney disease
Heart disease
Lung disease
Blood vessel disease
Cancer
Diabetes
Obesity
High blood pressure
Hepatitis
HIV
Mental health conditions
Disorders related to alcohol or drug use

Finances, expenses, and insurance

Kidney donation can have financial implications, too. While the recipient’s health insurance usually covers some or most of the donor’s medical expenses related to the donation, other expenses may not be covered.

For example, a donor may need to travel to a distant hospital, stay in a hotel, and pay for meals. They will likely lose some time from work as they recover, which may or may not be paid time off. And they may need to arrange for caregivers to tend to children or other family members while they recover.

Donors should look into their insurance coverage options as well. Some donors have trouble getting affordable health, disability, or life insurance after a kidney donation.

Employment and military service

Having one kidney may limit career options. Fields like police work and firefighting may not allow people with one kidney to hold certain positions. Similarly, having one kidney may limit a person’s options for military roles.

The evaluation process

Before a person can donate a kidney, a team of specialists conducts a thorough evaluation process.

Before a person can donate a kidney, a team of specialists conducts a thorough evaluation process. They ensure that a person is healthy enough to have surgery and can manage life with one kidney afterward. They also make sure the donor is in good mental health, understands all aspects of donation, and is making the donation willingly.

If the team finds that a potential donor is not suitable, they will not allow the donation to happen.

Donors should also know that kidney donation is completely voluntary. Donors can change their minds at any time during the process.

Medical evaluations

Donor evaluation includes extensive medical testing. A specialist may start by taking a medical history, asking questions about the donor’s overall health, past illnesses, surgical procedures, and family medical history. A physical examination is also done.

Next, the donor has a variety of medical tests, which may include:

Kidney function tests
Heart function tests
Lung function tests
Blood tests
Urine tests
Chest x-rays
Electrocardiogram (EKG)
Skin cancer screening
Colonoscopy
Mammogram and Pap smear (for women)
Prostate exam (for men)

Finding a match

Doctors sit at a desk reviewing paperwork

Before any donation happens, the transplant team needs to make sure that the donor and recipient are a match. They need to find out whether the donor’s kidney will function well in the recipient’s body.

This determination is made with compatibility tests:

Blood typing. The donor and recipient must have compatible blood types.

Tissue typing. This blood test determines whether the donor and recipient have compatible white blood cells.

Crossmatching. For this test, a specialist mixes blood from the donor with blood from the recipient. If the recipient’s cells attack the donor’s cells, then the donor and recipient are not compatible. The recipient’s body would be unlikely to accept the new kidney.

What happens if there is no match?

There may be times when a donor and recipient are not a compatible match. This does not mean that the donation process can’t continue. Some transplant centers participate in paired exchanges.

Here’s an example of how paired exchanges work:

Imagine that Donor A and Recipient A are not a compatible match. This means that Donor A’s kidney would not work well in Recipient A’s body. The transplant team learns of Donor B and Recipient B, who are also not a compatible match.

Through medical testing, the team may find that Donor A’s kidney would be a match for Recipient B. And Donor B’s kidney would be a match for Recipient A.

If all parties agree, there could be a swap. Recipient A would receive Donor B’s kidney. And Recipient B would receive Donor A’s kidney.

Kidney donation surgery

Kidney donation surgery takes about 3 to 5 hours. Donors are given general anesthesia and are asleep through the entire procedure. The kidney recipient may be in a nearby operating room so that the kidney can be transplanted as quickly as possible.

Kidney donation surgery can be done in 2 ways:

Laparoscopic surgery

For laparoscopic surgery, small incisions are made in the patient’s abdominal wall. These incisions are called ports, and they provide an access for surgical tools and a camera that allows the surgeon to see inside the body. Using the tools, the surgeon removes the kidney through one of the ports.

Laparoscopic surgery has become the preferred approach for kidney donation. Patients generally have shorter recovery times and fewer complications when the kidney is removed this way.

Open nephrectomy

Nephrectomy is the medical term for the surgical removal of the kidney. During an open nephrectomy, the surgeon makes one incision in the abdomen. (This incision is longer than the incisions made during laparoscopic surgery.) The kidney is removed through this incision, which is then closed with stitches. In some cases, a rib may need to be removed to get the kidney out.

Possible complications of kidney donation surgery

Kidney donation surgery is quite safe. However, as with any surgery, there can be risks and complications, such as the following:

Reactions to anesthesia
Pain
Infections
Hernia
Intestinal obstruction
Kidney damage
Blood clots
Collapsed lung

There is also a very low risk of death from surgery.

Donors are encouraged to ask their care team about the likelihood of complications and how they might be managed.

Recovering after kidney donation surgery

After donation surgery, patients may stay in the hospital for a few days. Those who have complications may need to spend more time in the hospital.

During recovery, patients may feel some pain, tenderness, or itching at the incision site. These symptoms should subside as the wound heals.

Patients should be prepared to take it easy at home (and avoid heavy lifting) for about 6 weeks after surgery. Typical day-to-day activities can usually be resumed in 4 to 6 weeks. Driving may be restricted for about 2 weeks.

Doctors will give specific instructions about an individual’s recovery period.

Life after kidney donation

After recovering from surgery, most donors go back to life as usual. The remaining kidney compensates for the one that has been removed.

However, it’s important to keep the remaining kidney protected. Athletes may need to stop playing contact sports, like football, hockey, and boxing. Donors who do play sports should take precautions and wear protective gear.

It’s also critical for donors to have regular checkups with a doctor to make sure that the remaining kidney is working well. In addition, kidney donors may be at higher risk for future kidney problems, diabetes, nerve damage, high blood pressure, and obesity. So routine medical care is essential.

Coping with emotions after kidney donation

Once surgery is over and the donated kidney is transplanted, many patients feel relieved — and good — that their surgery is over and their gift is helping another person live.

But there can be other emotions as well. Some donors worry that their donated kidney will not work as expected. They may feel bothered if the recipient does not take care of their health after surgery. They may feel anxious about their own health and worry about what will happen if their remaining kidney becomes damaged or fails.

All of these emotions are natural. Donors are encouraged to reach out to their kidney care team for support. Specialists can answer questions and put them in touch with other professionals who can help, such as therapists. It may also help to talk to other donors, who have been through a similar experience.