Researchers discovered Wednesday that people who choose to donate a kidney had an even lower chance of death from the operation than doctors previously assumed.
The study followed 30 years of living kidney donation and discovered that by 2022, fewer than one in every 10,000 donors died within three months of surgery. Transplant centers have used outdated data, suggesting a risk of three fatalities per 10,000 living donors, to caution donors about potentially fatal surgical complications.
“The last decade has become a lot more safe in the operating room for living donors,” said Dr. Dorry Segev, an NYU Langone Health transplant specialist. He co-authored the study, which appeared in the journal JAMA.
Segev cited newer surgical procedures as the primary reason, advocating for guideline modifications to reflect such safety advances and perhaps raise interest in living donation.
He frequently finds that transplant recipients are more concerned about potential risks to their donors than prospective donors themselves.
“For them, this is even more reassuring to allow their friends or family to donate on their behalf,” Segev told the audience.
Every year, thousands of people die while waiting for organ transplants. Living donors can donate one of their two kidneys or a portion of their liver, which is the only organ that regenerates.
With approximately 90,000 people on the waiting list in the United States for a kidney transplant, finding a living donor not only shortens the years-long wait, but those organs also tend to live longer than those from deceased donors.
However, living donors provided only 6,290 of the nation’s more than 27,000 kidney transplants last year, the highest number since before the outbreak. Safety is not the only obstacle to living donation. Many patients are hesitant to ask, therefore awareness is important. While the recipient’s insurance covers medical expenditures, some donors may incur expenses such as travel or lost earnings while recovering.
The NYU team examined US records of over 164,000 surviving kidney transplants from 1993 to 2022 and discovered 36 post-surgical fatalities. The most vulnerable were male donors and those with a history of high blood pressure.
Only five of the deaths have happened after 2013. During that time, U.S. transplant facilities transitioned to less invasive kidney removal and adopted a better method of stopping renal artery bleeding, Segev explained.
Dr. Amit Tevar of the University of Pittsburgh Medical Center, who was not involved in the study, said, “Over time, it’s a safe operation that’s become even safer,” which is crucial for potential donors to know.
However, there are long-term dangers to consider, such as the longevity of a donor’s remaining kidney.
The likelihood of a donor developing kidney failure later in life is also low and depends on variables such as obesity, high blood pressure, smoking, and a family history of renal disease. Doctors use risk calculators to evaluate the chance of a possible donor experiencing problems later in life, and transplant centers may have slightly varying qualifying standards.
“There’s no such thing as a moderate- or high-risk donor — either you’re perfect or you’re not,” is how Tevar describes the decision to accept or reject a possible donor.
Doctors once believed that young adults were the perfect living donors. However, Segev believes there is a trend toward more older living donors because it is easier to forecast that they will not outlive their remaining kidney.
If a living donor later develops kidney failure, they are given precedence for a transplant, he stated.