Living kidney donation
======================

* Ann Bugeja
* Edward G. Clark

## 1 Benefits of kidney transplantation from living donors are improved compared with dialysis

Kidney transplantation from living donors has improved survival rates, better quality of life and lower costs for health care for eligible patients with end-stage kidney disease than dialysis.1,2 Kidney transplants from living donors also last about 25% longer (typically 20–25 years) and are associated with better overall survival than transplants from deceased donors.1

## 2 Living kidney donors remain at low risk of end-stage kidney disease3

Potential donors undergo extensive evaluation to assess surgical and long-term risks (Appendix 1, [www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.170304/-/DC1](http://www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.170304/-/DC1)). The risk of death is 3 in 10 000 donor nephrectomies.2 Perioperative complications, such as infection or bleeding, occur in fewer than 10% of these procedures.2 After 15 years, end-stage kidney disease is diagnosed in about 0.3% of donors.3 Life insurance premiums are unlikely to be affected.4

## 3 About 400 Canadians become living kidney donors annually1

Most living kidney donors know their recipient but are not necessarily related or share the same blood group. Fewer than 3% of living kidney donors are anonymous and do not have an intended recipient.1 For all potential living kidney donors, assessment of eligibility is started after they have contacted a living kidney donor transplant program (Box 1). There are over 3000 Canadians with end-stage kidney disease on the transplant waiting list.1

Box 1: 
### **Supplementary resources for people interested in living kidney donation**

General information from the Kidney Foundation of Canada/La Fondation canadienne du rein regarding kidney transplantation, including living kidney donation, is available at:

*   English: [https://www.kidney.ca/organ-donation](https://www.kidney.ca/organ-donation)

*   Français: [https://www.kidney.ca/dons-dorganes](https://www.kidney.ca/dons-dorganes)

Contact information for all living donor kidney transplantation programs in Canada is available at:

*   English: [https://blood.ca/en/organs-tissues/becoming-live-kidney-donor](https://blood.ca/en/organs-tissues/becoming-live-kidney-donor)

*   Français: [https://blood.ca/fr/organes-tissus/donner-rein-son-vivant](https://blood.ca/fr/organes-tissus/donner-rein-son-vivant)

This site also provides information regarding the Canadian Blood Services/La Société canadienne du sang Kidney Paired Donation Program for immunologically incompatible living kidney donors and their intended recipients.

## 4 Preeclampsia and gestational hypertension are more likely to develop in living kidney donors5

The absolute increased risk of preeclampsia and gestational hypertension, compared with nondonors, was 3% in an Ontario study that included 85 living kidney donors (131 postdonation pregnancies) who were followed for up to 20 years.5 No significant differences were found for other important maternal and fetal outcomes. Women can be reassured that risks to pregnancies after kidney donation are minimal.

## 5 Annual follow-up is recommended after kidney donation2

Living kidney donors may have an increased risk of hypertension and proteinuria after donation.2 For early identification of these modifiable risk factors for progressive loss of kidney function, annual monitoring of blood pressure, serum creatinine level and urine albumin:creatinine ratio is suggested after donation.2

## Footnotes

*   **Competing interests:** None declared.

*   This article has been peer reviewed.

## References

1.  Organ donation and transplantation in Canada — system progress report 2006–2015. Ottawa: Canadian Blood Services; 2016. Available: [https://professionaleducation.blood.ca/en/organs-tissues](https://professionaleducation.blood.ca/en/organs-tissues) (accessed 2017 Mar. 16).
    
    

2.  Bailey P, Edwards A, Courtney AE. Living kidney donation. BMJ 2016;354:i4746.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6MzoiYm1qIjtzOjU6InJlc2lkIjtzOjE3OiIzNTQvc2VwMTRfOS9pNDc0NiI7czo0OiJhdG9tIjtzOjIzOiIvY21hai8xODkvMzIvRTEwNDEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9) 

3.  Mjoen G, Hallan S, Hartmann A, et al. Long-term risks for kidney donors. Kidney Int 2014;86:162–7.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1038/ki.2013.460&link_type=DOI) 
    
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4.  Yang RC, Young A, Nevis IF, et al. Life insurance for living kidney donors: a Canadian undercover investigation. Am J Transplant 2009;9:1585–90.
    
    [CrossRef](http://www.cmaj.ca/lookup/external-ref?access_num=10.1111/j.1600-6143.2009.02679.x&link_type=DOI) 
    
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5.  Garg AX, McArthur E, Lentine KL; Donor Nephrectomy Outcomes Research (DONOR) Network. Gestational hypertension and preeclampsia in living kidney donors. N Engl J Med 2015;372:1469–70.