Kidney Donation

Overview

Kidney donation is when a healthy person gives one of their two kidneys to someone whose kidneys have stopped working well enough to keep them alive. Most people are born with two kidneys, but one healthy kidney is enough to do the job. The kidney can come from a living person (living donation) or from someone who has died and chose to be an organ donor (deceased donation). A kidney transplant is a planned operation, and it is one of the most common types of organ transplant in the world.

Kidney transplants are done in hospitals all over the world, and tens of thousands happen every year. Living kidney donation is less common than deceased donation, but it has been done safely for many decades and is well studied. Far more people need a kidney than there are kidneys available, so every donor makes a real difference.

Anyone can think about donating, but living donors are usually healthy adults. In the UK, you generally need to be over 18, and many centres set an upper age limit or assess older donors case by case. People who receive a kidney can be almost any age, from young children to older adults. Some people donate to a relative or friend, some donate to a stranger they will never meet (altruistic donation), and some take part in paired or pooled donation schemes, where donors and recipients are matched across several pairs.

Symptoms

Common symptoms

• Kidney donation is not an illness, so it does not have 'symptoms' in the usual sense. What people notice is recovery from the operation.
• Tiredness and low energy for a few weeks after surgery.
• Soreness, aching or numbness around the small cuts or the scar, which usually eases over time.
• Some bloating or discomfort in the belly, and needing to pass wind before going home.
• Changes in how often you pass urine in the first days, which usually settles.
• Feeling emotional or tearful — this is common and often eases with rest and support.

Symptoms in children

• Children are very rarely living kidney donors. Donation by a child is not standard practice in most countries.
• Children are much more often the people who receive a kidney. If your child needs a transplant, the children's kidney team will explain each step to you and your child in age-appropriate words.
• Children and young people who receive a kidney may feel tired, have swelling, or need to miss school around the time of surgery.

Symptoms in older adults

• Many older adults donate safely, but the checks before donation are more detailed.
• Recovery may take a little longer, and tiredness can last longer than in younger donors.
• The team will pay close attention to blood pressure, heart health, kidney function and any other long-term conditions.
• Some centres advise against donation if there is a higher chance of kidney problems later in life.

Causes

Main causes

• Kidney donation is a choice, not a disease, so there is no 'cause' in the medical sense.
• People choose to donate for many reasons: to help a relative or friend, after someone they love needed a transplant, for religious or ethical reasons, or simply to help a stranger.
• On the other side, the reason someone needs a kidney is usually kidney failure. Common causes include diabetes, high blood pressure, inflammation of the kidneys (glomerulonephritis), inherited conditions such as polycystic kidney disease, and damage from certain infections or medicines.
• Sometimes the cause of kidney failure is never found.

Risk factors

• Things that can make donation less suitable: high blood pressure that is not well controlled, diabetes, or a lower-than-normal kidney function.
• Being very overweight, smoking, or having heart or blood vessel disease.
• Having only one kidney already, or a family history of serious kidney disease.
• Some infections, such as HIV or hepatitis, may affect whether donation is possible — this is assessed case by case.
• Age: very young adults may be asked to wait, and older donors are assessed more closely.
• Taking certain medicines long term, or having had cancer in the past.

When to see a doctor

See a doctor urgently if:

• You are thinking about donating and have a long-term health condition, such as high blood pressure, diabetes or heart disease.
• You have a family history of kidney disease and want to know what it means for you.
• After surgery: fever, wound redness or discharge, pain when passing urine, or a leg that is swollen and painful.
• You donated recently and feel something is not right — it is always fine to call the transplant team.

Book a routine appointment if:

• You would like to explore living kidney donation, even if you are not sure yet.
• You want to know whether your health, medicines or family history would affect your chances of donating.
• You are a donor and your planned follow-up check is due.
• You feel low, anxious or unsettled about donation, before or after surgery.
• You want to talk about organ donation after death, or register your decision.

Diagnosis

There is nothing to 'diagnose' — instead, there is an assessment to check whether donation is safe for you and likely to work for the person receiving the kidney. This happens in stages, over weeks or months. You can stop at any stage, and you can also be told that donation is not advisable for you. The team will explain why, and this is a medical decision, not a judgement about you.

Tests that may be done

• Blood tests, including a check of how well your kidneys are filtering (often called eGFR).
• Urine tests to look for protein or blood, which can be early signs of kidney strain.
• Blood pressure checks, sometimes over 24 hours.
• Blood and tissue typing, and crossmatching, to see whether your kidney is compatible with the person who would receive it.
• Scans such as an ultrasound or CT scan to look at the shape and size of your kidneys and blood vessels.
• A heart check (such as an ECG) and sometimes a chest X-ray or lung test.
• Screening for infections and, depending on your age, routine cancer screening.
• A talk with a doctor who is not part of the transplant team, to make sure you have all the facts without pressure.
• A conversation about your mental health and your reasons for donating.

What to expect at your appointment

The assessment usually means several clinic visits and a number of tests. Some people find it slow, but the careful pace is there to protect you. You will be given time to ask questions and to talk things over with family or friends if you wish. If donation goes ahead, you will have a chance to meet the surgical team and talk through the operation, the recovery and the follow-up before you sign anything.

Treatment

The 'treatment' here is the donation operation itself, plus the care around it. Most living kidney donations are done with keyhole surgery (laparoscopic surgery), using a few small cuts rather than one large one. You will have a general anaesthetic, so you will be asleep. The operation usually takes a few hours. Most donors stay in hospital for around two to four days, and many are up and walking the next day. The kidney is usually transplanted into the recipient very soon after it is removed.

Self-care at home

• Take the pain relief your team offers, especially in the first week, so you can move and breathe comfortably.
• Walk a little and often each day, and build up slowly. Short walks help prevent blood clots.
• Follow the wound care advice you are given, and keep the area clean and dry as instructed.
• Drink plenty of fluids, and eat regular meals even if your appetite is small at first.
• Avoid heavy lifting, strenuous exercise and driving until your team says it is safe — often around four to six weeks.
• Ask for help with shopping, childcare, pets and housework for the first few weeks.
• Keep your follow-up appointments, including the long-term yearly checks.

Medical treatments

Your team will manage pain and help prevent infection and blood clots using medicines they choose for you — this may include pain relief, antibiotics and blood-thinning medicine, all prescribed and monitored by your doctors. Do not take any new medicine, including over-the-counter painkillers and herbal remedies, without checking with your transplant team first, because some common medicines can affect the kidneys. You will also have blood tests after surgery to check how your remaining kidney is coping. Long-term follow-up usually includes a yearly check of blood pressure, kidney function and general health.

When is surgery considered?

Donation is always planned surgery, never an emergency. It happens only after the full assessment is complete, you have given written consent, and a date suits you. If anything changes in your health or your life before then, tell the team — the operation can be paused or cancelled at any time, including on the day.

Living with this condition

Most donors are back to normal activities within four to six weeks, though tiredness can linger for a few months. After that, life usually carries on much as before. You will have a scar or small marks, and some people have numbness or a pulling feeling around them for a while. You can usually go back to work, sport and travel once your team is happy. Your remaining kidney takes over the work of two, and for most people it keeps working well for life.

Lifestyle tips

• Keep an eye on your blood pressure and have it checked at your yearly review.
• Stay active — regular movement supports heart and kidney health.
• Avoid smoking, as it raises the risk of kidney and heart problems.
• Keep to a healthy weight, and be careful with crash diets or extreme fasting.
• Tell any doctor, nurse, dentist or pharmacist that you have one kidney, and remind them before they prescribe anything.
• Be careful with anti-inflammatory painkillers and with supplements sold as 'kidney cleanses' — ask your pharmacist first.
• Drink enough fluid, particularly in hot weather or during illness.

Diet and exercise

You do not need a special diet after donation. A balanced way of eating — plenty of vegetables, fruit, beans, whole grains, and less heavily processed food and added salt — is good for your heart and kidneys. There is no need to drink excessive amounts of water; just drink when you are thirsty and a little more in hot weather or if you are unwell. Start with gentle walking after surgery and build up over weeks. Aim for something you enjoy and can keep up, and ask your team before returning to contact sports, heavy weights or long-distance training.

Mental health and emotional wellbeing

Donation can be a deeply positive experience, but it can also bring mixed feelings. Some donors feel anxious before surgery, or unexpectedly low afterwards. If the transplant does not work, or the person you donated to becomes unwell, you may feel grief, guilt or anger — all of these are understandable. Some people feel pressure from family to donate, or feel they cannot say no; support is available and you are allowed to change your mind. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away, or reach out to someone you trust and ask them to stay with you while you get help.

Prevention

You cannot 'prevent' kidney donation — it is a deliberate, planned choice, and one that many people feel glad they made. What you can do is protect the health of your remaining kidney for the long term by keeping blood pressure in a healthy range, not smoking, staying active and having your yearly checks. On the other side, many cases of kidney failure are linked to diabetes and high blood pressure, so good control of those conditions protects kidneys — for you and for people you care about.

Vaccines

Before surgery, your team will check that your routine vaccinations are up to date. Some vaccines are best given before an operation rather than straight after, so mention any jabs you are due when you are being assessed.

Screening programmes

Donors are offered long-term follow-up, usually a yearly check of blood pressure and kidney function. Keep these appointments even if you feel completely well, because early changes often cause no symptoms. If you have a family history of kidney disease, tell your doctor — they may suggest extra checks.

Complications

If left untreated

• For the person who needs a kidney: untreated kidney failure leads to a build-up of waste in the blood, tiredness, swelling, breathlessness and eventually life-threatening problems. Treatment such as dialysis keeps people alive, but a working transplant usually gives a better quality of life.
• For the donor: most people recover without problems. Rarely, there can be bleeding, infection, a hernia at the wound, a blood clot, or damage to nearby tissue.
• A small number of donors develop higher blood pressure or reduced kidney function later in life. This is why long-term follow-up matters.
• Very rarely, serious complications can be life-threatening. The care team watches closely for these and treats them quickly.

Long-term outlook

The great majority of kidney donors recover well and go back to their normal lives, and many say they would do it again. Living donor transplants often work for many years, and some last for decades. Risks to donors are real but small, and the careful testing before surgery is designed to keep them as low as possible. Whatever you decide, you deserve good information, time and support to make the choice that is right for you.

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