Living donor kidney transplants: personal reflections.

Short- and long-term living kidney donor morbidity and mortality are discussed herein. The analysis includes over 3000 living donor kidney transplants from 1963 through 2002 at a single institution. The category of living donors includes living related donors, such as fathers, mothers, siblings, offspring, and other genetically related donors, as well as living unrelated donors, such as spouses, friends, or altruistic strangers. Graft and patient survival rates with living related and unrelated living donors are compared to rates with cadaveric donors. Donor risks are discussed, including short-term surgical risks as well as long-term risks of impaired renal function, possible hypertension, and psychological risks. Finally, early and late donor mortality statistics are presented. In addition, the benefits to potential donors are reviewed. Donors are carefully screened before donation. During this screening process, a significant number of donors have been found to have abnormal renal function--some had undisclosed hypertension and others had unknown cardiovascular disease. In addition, six malignancies were found, eventually resulting in curative resection. A secondary benefit to donors was reported in a study from Norway and Sweden, which showed that donors had improved long-term survival versus the general population. Our own long-term studies involving follow-up of 20 to 30 years after kidney donation have shown no significant difference in donor renal function, blood pressure, and incidence of proteinuria, as compared with their nondonor siblings. We also found donors to be perfectly normal in all other categories; several had even undergone normal pregnancies after donation. Most donors reported a high quality of life, with a boost in self-esteem and an increased sense of well-being: 96% felt it was a positive experience. In conclusion, living kidney donation has a very low mortality rate. Long-term follow-up shows minimal impact after donation. Donor quality of life is reported as excellent.