Washington – People who donate a kidney voluntarily face a lower risk of death from surgery than doctors had long thought, a team of researchers announced Wednesday.
For 30 years, the study tracked living kidney donations and found that by 2022, fewer than 1 in 10,000 donors had died within three months of surgery. Transplant centers have been using older data that cited a risk of 3 deaths per 10,000 living donors when counseling donors about life-threatening surgical complications.
“Over the past decade, the operating room has become much safer for living donors”says Dr. Dorry Segev, a transplant surgeon at New York University Langone Health and co-author of the study published in the journal JAMA.
This has been made possible largely by more modern surgical techniques, Segev said, calling for guidelines to be updated to reflect these safety improvements and perhaps increase interest in living donation.
Transplant recipients are often more concerned about potential risks to their donors than the potential donors themselves.
“It is even more reassuring for them to allow their friends or family to donate to them.”Segev said.
Thousands of people die each year waiting for an organ transplant. Living donors can donate one of their two kidneys or part of their liver, the only organ that regenerates.
With nearly 90,000 people on the waiting list for a kidney transplant in the United States, finding a living donor not only reduces the waiting period, but those organs often outlive those from deceased donors.
However, last year, only 6,290 of the more than 27,000 kidney transplants in USA came from living donors, the lowest number since before the pandemic. But safety is not the only obstacle to living donation. Awareness is also a factor, as many patients are reluctant to ask about this option and although the recipient’s health insurance covers the costs, some donors have to deal with expenses such as travel or loss of wages during the recovery period.
The NYU team analyzed U.S. records of more than 164,000 living kidney donations from 1993 to 2022 and found 36 post-surgical deaths. The donors at highest risk were men and those with a history of high blood pressure.
Only five of those deaths have occurred since 2013. That period coincided with U.S. transplant centers shifting to minimally invasive kidney removal and adopting a better way to stop bleeding from the renal artery, Segev said.
“It’s a safe operation that has become even safer over time,” something that’s important for potential donors to know, said Dr. Amit Tevar of the University of Pittsburgh Medical Center, who was not involved in the study.
But there are also long-term risks to consider, he stressed, including whether the donor’s remaining kidney is expected to last the rest of his or her life.
The risk of a donor later developing kidney failure is also small and depends on factors such as obesity, high blood pressure, smoking and a family history of kidney disease. Calculating risk helps doctors determine the likelihood that a potential donor will have problems later, and transplant centers may have slightly different eligibility criteria.
“There is no such thing as a moderate-risk or high-risk donor: either you are suitable or you are not,” Tevar said of the decision to accept or reject a potential donor.
Doctors used to think that young adults were ideal living donors. But Segev says older living donors are now preferred because it is easier to predict with certainty whether they will outlive their remaining kidney.
If a living donor later suffers from kidney failure, he or she will have priority for the transplant.