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Risk of living kidney donation

Krista L Lentine, MD, PhD
Section Editor
Daniel C Brennan, MD, FACP
Deputy Editor
Alice M Sheridan, MD


The number of patients awaiting kidney transplantation has steadily increased over time. The gap between allograft supply and demand continues to widen despite initiatives to expand the use of nonstandard deceased-donor allografts.

The increased use of organs from living donors is one strategy that addresses the need for transplants. However, rates of live kidney donation have declined 17 percent from 2004 to 2014 [1]. This trend is predominantly due to a decline in living, related donation. Although unrelated kidney donations have increased since 2007, the increase is not sufficient to compensate for the decline in living, related donation [2].

Recipients of allografts from living donors enjoy a significant graft survival advantage over those who receive deceased-donor grafts. In addition, living-donor transplants may be performed with minimal delay and controlled scheduling, which permits pre-emptive transplantation (transplantation prior to dialysis) or transplantation early in a recipient’s course of renal failure. (See "Risk factors for graft failure in kidney transplantation" and "Dialysis issues prior to and after renal transplantation".)

However, donor nephrectomy exposes the donor to risks associated with surgery. In addition, some studies have suggested that live kidney donation may confer small but measurable increases in the risks of hypertension, preeclampsia, gout, and end-stage renal disease (ESRD).

In February 2013, the Organ Procurement and Transplantation Network (OPTN) implemented policy requirements for all living kidney donor recovery hospitals in the United States in order to promote consistency in the informed consent, medical and psychosocial evaluation, and follow-up of living donors [3]. In 2014, these requirements were incorporated within global polices for living donors. These policies define the minimum general and kidney-specific requirements for the evaluation and acceptance of living kidney donor candidates. These requirements are generally expanded upon at individual transplant programs, resulting in center-specific protocols that are based on local experience and may be tailored for individual donor characteristics.

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Literature review current through: Dec 2017. | This topic last updated: Jan 20, 2017.
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