Study underscores low risk to kidney donors as Toledo prepares for annual walk

Your chances of dying after donating a kidney is less than that of being struck by lightning during a lifetime, a University of Toledo doctor estimates.

“The risks to a living donor are minimal,” said Dr. Obi Ekwenna, a kidney transplant surgeon and urologist with the University of Toledo Medical Center. “We are very selective.”

His assertion is backed by a new NYU Langone Health study published in August. An analysis of 30 years of living kidney donation estimated that three of every 10,000 living kidney donors may die – of any cause – within three months of surgery. But safety improvements over the past decade meant that, by 2022, that risk dropped to fewer than one death per 10,000 donors.

“While we had understood that kidney donation is safe, our findings suggest that mortality among donors is rare, and the procedure is safer than before,” said Dr. Allan B. Massie, lead author of the Langone Health study and director of the Center for Surgical and Transplant Applied Research Quantitative Core at NYU Grossman School of Medicine.

“Before someone becomes a living donor, they have to qualify,” Dr. Ekwenna said.

Of the roughly 25,000 kidney transplants undergone each year in the United States, about one-third of the kidneys come from a living person. The remaining two-thirds of the donations are from deceased individuals. As of Aug. 29, there were 89,795 patients in the United States waiting for a kidney, according to the Organ Procurement & Transplantation Network.

The advent of laparoscopic and robot-assisted operations have promoted surgical techniques that are minimally invasive, according to Dr. Ekwenna. That results in less discomfort and quicker recovery times.

“The advent of minimally invasive surgery drastically improved the number of people who donate their kidneys,” Dr. Ekwenna said.

It does not mean that there is no risk. Any surgery poses some uncertainty: There is anesthetic to consider. A blood clot could form after the surgery, or a hernia might develop postoperative. None of these situations is likely – but possible. Donors are some of the most healthy individuals walking the earth. Otherwise, their donations would not be accepted.

Dr. Dorry Segev, a transplant surgeon at Landone Health who co-authored the NYU study, said he often finds transplant recipients more worried about potential risks to their donors than the would-be donors themselves.

“For them, this is even more reassuring to allow their friends or family to donate on their behalf,” Dr. Segev said.

Nevertheless, thousands of people die each year waiting for an organ transplant. It's possible for living donors to give one of their two kidneys or part of a liver, the only organ that regenerates.

Genetic advances also help to calculate the long-term health of a potential donor. What is the likelihood that the second kidney may be needed in the future?

“We have tools to assess kidney risk, including some genetic dispositions to kidney disease,” said Dr. Ekwenna of long-term calculations. “We may be looking at risks a potential donor should not take.”

Dr. Alvin Wee, a renal transplant surgery specialist with Cleveland Clinic, can recall a very healthy 21-year-old son who wanted to donate a kidney to his father. He was turned down because kidney disease ran through the family and he might one day need that kidney.

“The rule for donors is always to protect them,” Dr. Wee said. “The son was at risk in the future.”

There is some comfort in knowing that anyone who has donated a kidney, then later needs one, is made a priority on any waiting lists.

No matter what advances are made, there is always a deficit of kidneys available for transplant compared to demand, according to Dr. Wee.

“Year to year, our transplants increase but the number of people needing transplants grows faster,” he said.

While the National Kidney Foundation reports that 37 million adults are estimated to have chronic kidney disease, the Centers for Disease Control reports that nine out of 10 people don't know they have it because there are no identifiable symptoms until later stages. However, it is known that diabetes and high blood pressure are two leading causes of kidney disease. Both are seeing increased numbers globally.

In addition to improved surgical techniques, donors may also see increased legal protections.

Michigan is the 32nd state to pass legislation in support of donors. The Living Donor Protection Act, approved in 2023, prevents insurers from denying, limiting coverage, or charging higher premiums solely based on a person's status as a living donor. Ohio approved the act in 2022.

“Living donors are heroes in our eyes, and we're thrilled to have them protected in this way,” said Linda Smith-Wheelock, president and CEO of the National Kidney Foundation of Michigan.

Th2 2024 Toledo Kidney Walk takes place Sept. 15. It hopes to raise $46,000 to fund research and awareness of kidney disease.

The Associated Press contributed to this article.