What is the incidence of death in living kidney donors?

Incidence of Death in Living Kidney Donors

The mortality rate for living kidney donors is extremely low at approximately 0.02% (3.1 per 10,000 donors) in the perioperative period, with no increased long-term mortality risk compared to matched healthy non-donors. 1

Perioperative Mortality

Living kidney donation is considered a relatively safe procedure with very low mortality rates:

• Surgical mortality is 3.1 per 10,000 donors (0.02%) within 90 days of donation 1
• This mortality rate has remained stable over a 15-year period despite changes in surgical practices and donor selection criteria 1
• A 1997 study reported zero mortality in their series, with a national estimate of 0.03% at that time 2

Risk Factors for Perioperative Mortality

Several factors are associated with higher perioperative mortality risk:

• Gender: Men have higher surgical mortality (5.1 vs 1.7 per 10,000 donors) compared to women 1
• Race: Black donors have higher surgical mortality (7.6 per 10,000) compared to white (2.6 per 10,000) and Hispanic donors (2.0 per 10,000) 1
• Hypertension: Donors with hypertension have significantly higher surgical mortality (36.7 vs 1.3 per 10,000 donors) 1

Perioperative Complications

Beyond mortality, perioperative complications are also relatively uncommon:

• Overall complication rate of approximately 8.2%, with only 0.2% considered major complications 2
• Complications are associated with:
  • Male sex
  • Body weight ≥100 kg
  • Inadvertent entry into the pleura during surgery 2
• Reoperation rates vary by surgical approach:
  • 0.4% for open nephrectomy
  • 1.0% for hand-assisted laparoscopic nephrectomy
  • 0.9% for non-hand-assisted laparoscopic nephrectomy 3
• Readmission rates are higher for laparoscopic approaches (1.6%) compared to open nephrectomy (0.6%), primarily due to gastrointestinal complications 3

Long-Term Mortality

The long-term mortality risk for living kidney donors is not increased compared to the general population:

• After a median follow-up of 6.3 years, mortality rates for donors were not significantly higher than for age- and comorbidity-matched healthy non-donors 1
• Some studies even suggest better long-term survival among donors - one study showed 85% of donors were alive after 20 years of follow-up, compared to an expected survival rate of 66% in the general population 4
• This survival advantage is likely due to the rigorous screening process that selects only healthy individuals for donation 4

End-Stage Renal Disease Risk

While not directly related to mortality, it's worth noting:

• ESRD rates in donors are slightly higher than in the general population (0.1% to 1.1%) 5
• Black donors have a higher risk of developing ESRD compared to other racial groups 5

Practical Implications

The extremely low mortality rate associated with living kidney donation supports its continued use as a valuable source of organs for transplantation. However, proper donor evaluation remains essential to minimize risks:

• Mandatory evaluation includes ABO compatibility, HLA typing, and cross-matching 6
• Thorough cardiovascular risk assessment is critical, particularly for donors with risk factors 6
• Special attention should be paid to higher-risk groups (men, Black donors, those with hypertension) 1

The excellent safety profile of living kidney donation, both in the perioperative period and long-term, provides reassurance to potential donors and transplant teams. However, continued vigilance through comprehensive donor registries and long-term follow-up remains important, particularly for donors from higher-risk demographic groups.