What is the current mortality rate for living kidney donors after organ donation?

Mortality and Survival Statistics for Living Kidney Donors

Living kidney donors have excellent long-term survival rates, with mortality during the initial hospitalization for donation being extremely rare (effectively 0% in most modern transplant centers), and long-term survival that may actually exceed that of the general population.

Perioperative Mortality

• The perioperative mortality rate for living kidney donors is approximately 0.03% 1
• Modern transplant centers track this as a quality indicator, with the percentage of living kidney donors who die during the initial hospitalization for donation being a key safety metric 2

Short-term Complications

Living kidney donation has a well-documented safety profile with:

• Overall complication rate of approximately 8.2%, with only 0.2% considered major complications 1
• Risk factors for complications include:
  • Male sex
  • Body weight ≥100 kg
  • Inadvertent entry into the pleura during surgery 1
• Most donors are discharged from the hospital in less than 5 days 1
• Factors associated with longer hospital stays:
  • Age 50 or older
  • Operative time of 4 hours or more 1

Long-term Survival

• After 20 years of follow-up, 85% of kidney donors were alive, compared to an expected survival rate of 66% in the general population 3
• This represents a 29% better survival rate among donors 3
• This improved survival is likely due to the rigorous screening process that ensures only healthy individuals are accepted for donation 3

Long-term Renal and Metabolic Outcomes

• Risk of end-stage renal disease (ESRD) is slightly increased but remains uncommon (<0.5% increase in incidence at 15 years) 4
• Donors may experience:
  • Mild renal function decline over time, similar to normal aging 3
  • Average glomerular filtration rate (GFR) in donors aged 75+ years is approximately 48 ml/min/1.73m² 3
  • Increased urine albumin to creatinine ratio over time 5
  • Higher risk of developing metabolic syndrome features 5
  • Potentially elevated risk of hypertension and proteinuria 6

Quality of Life After Donation

• Most donors report quality of life better than that of the general US population 1
• This positive quality of life persists for years after donation 1
• The vast majority find the experience rewarding and would donate again if possible 1
• Approximately 4% of donors report dissatisfaction and regret, primarily:
  • Donors who are not first-degree relatives
  • Donors whose recipient died within the first post-transplant year 1

Important Considerations and Caveats

1. Donor Selection: The excellent survival statistics reflect careful donor selection through comprehensive screening protocols 3

2. Long-term Follow-up: Establishing and maintaining donor registries is crucial for accurately tracking long-term outcomes 6

3. Ethical Concerns: Informed consent must incorporate all known risks, acknowledge uncertainty where it exists, and ensure donor risks are proportional to benefits 4

4. Financial Impact: Many donors experience financial expenses due to lost wages, sick days, and travel expenses 4

5. Special Populations: More research is needed on outcomes for donors from developing countries and those with pre-existing conditions such as obesity 4

The excellent survival statistics for kidney donors highlight the overall safety of living kidney donation when performed at experienced centers with proper donor selection and follow-up protocols.