Kidney transplantation · For the donor
If I give my brother a kidney, what happens to me?
This is the question that stops most transplants — and it deserves numbers, not reassurance. Here are the real figures, including what 135 of our own donors told us years afterwards.
The short answer
- The risk of death from donor surgery is 1 in 3,000. Stated plainly, because you are entitled to the number.
- The remaining kidney grows into the job — by three months it delivers about 75% of what two kidneys did.
- Over 10–20 years, donors show no difference in blood pressure or protein in the urine compared with their own non-donor siblings.
- In a 20-year study, 85% of donors were alive versus 66% of the general population — donors did better, because they get checked regularly.
- Of our own 135 donors, 94.8% said they would do it again.
The centre's first duty is to the donor
This needs saying before any numbers. From the moment a potential living donor comes forward, the most important person for the transplant centre is the donor — not the patient.
The patient is already ill. The donor is healthy, and the aim is to end up with two healthy people in one family, not two patients.
After all tests, the final decision is taken by a council — nephrologist, surgeon, transplant coordinator, radiologist, psychologist. No single physician can approve a donor alone.
And the team can stop the transplant at any point if they judge the risk to the donor too high — including on the operating table.
The surgical risk
As with any operation, nobody can promise a 100% safe surgery. The honest figures:
| Risk | Rate | Comparison |
|---|---|---|
| Death | 1 in 3,000 | — |
| Wound infection | 5% | Same as any abdominal surgery — appendix, gallbladder |
| Urinary tract infection | 4% | |
| Pain at the surgical site after 1 year | 4%, and mild | — |
Recovery: there is pain for a few days. Discharge is usually on the third day after surgery. By two months the donor can do everything they did before, including heavy lifting.
What happens to the remaining kidney
The kidney that stays behind does not simply carry on at half capacity. It adapts.
- By the end of three months, the remaining kidney provides on average 75% of the pre-donation filtration rate — not 50%.
- Long-term creatinine clearance settles around 10–20% lower than before.
- In one prospective study, measured kidney function in donors was still improving 36 months after donation, while the control group showed the normal age-related decline.
Landmark studies followed donors for 10 to 20 years and compared them with their own non-donor siblings — the same genetics, the same family history.
There was no difference in protein in the urine, and no difference in blood pressure.
It is also worth remembering that some people are born with a single kidney and live an entirely healthy life.
Do donors die earlier?
No. Three large retrospective studies found no increase in mortality risk among donors.
One 20-year follow-up went further. At the end of the period, 85% of donors were alive, against a survival rate of 66% in the general population — a 19% better outcome in the donor group.
The likely reason is not that donating is protective in itself. It is that donors are screened thoroughly before surgery and then followed at regular intervals for the rest of their lives. Most people never get that.
What our own donors said
Statistics from elsewhere are useful. But we wanted to know what happened to our patients' families — so we interviewed 135 living kidney donors, 76 women and 59 men, about their lives after donation.
Average age was 39.7 years, ranging from 18 to 64. Who they gave to:
| Donated to | Share |
|---|---|
| Their child | 46% |
| Their sibling | 32% |
| Their mother or father | 5.9% |
| Other relatives (spouse, cousin) | 5.2% |
What they reported afterwards
- 72% had no health problems at all. The remaining 28% reported various issues — 9.6% high blood pressure, 3% pain or swelling at the surgical site, 3% digestive complaints. These occur at the same rate in people who never donated.
- Average hospital stay: 6.7 days.
- 28% of donors who smoked gave up after donating, and began paying closer attention to their health generally.
- Half of the donors who were single before donating were married afterwards.
- No donor who wanted children was unable to have them.
- Being a donor had no effect on relationships with spouses or friends in 70% of cases — and where it did have an effect within the family, it was positive.
- 85% remained in close contact with the person who received their kidney.
94.8% of donors said they would donate again — for a relative if needed, or for anyone after their death.
These are people answering years later, with the surgery, the recovery and the long follow-up behind them.
Was everyone a willing donor?
Almost, and it is worth being honest about the rest. 92% said they became donors entirely voluntarily. The other 8% agreed because of a family decision, or because they were the only medically eligible person in the family.
This is exactly why the process includes a signed statement that the donor is acting voluntarily and without pressure, and why a psychologist sits on the council. If you are being pushed, the transplant team is the right place to say so — and they will listen.
What the recipient gains
The donor's risk has to be set against what it buys. For the person receiving the kidney:
- Life expectancy is extended by an average of three times.
- 80% return to the work they did before. Young recipients can work, marry and have children — men and women alike.
- Death rate in the first year is 1–3%, against 14–17% for patients who remain on dialysis.
- If the transplanted kidney eventually fails, the patient can return to dialysis or receive a second transplant. After dialysis alone, there is no second option.
A family member on haemodialysis three times a week, or peritoneal exchange four times a day, does not carry that alone. Hospital visits, tests, medication, nights spent watching a fever — the whole household lives it, and it gets heavier over time.
The donor is not only giving an organ. They are giving the family its ordinary life back.
Prof. Dr. Murat Tuncer
Nephrologist and transplant physician. The 135-donor follow-up study described here was conducted at his centre. Author of Kidney Transplantation — With Questions and Answers (Istanbul, 2020).
Thinking about donating? Ask before you decide
Send us your own test results — not the patient's. We will tell you honestly whether you would be a suitable donor, including when the answer is no.
Medical disclaimer. This article is general information adapted from a published book. It is not personal medical advice, it does not establish a doctor–patient relationship, and it cannot replace assessment by the physician treating you. Donor suitability is decided by a multidisciplinary council after detailed testing. Always consult a transplant centre before making decisions about donation.
References
- Ibrahim HN, Foley R, Tan L, et al. Long-term consequences of kidney donation. N Engl J Med 2009;360:459–69.
- Fehrman-Ekholm I, Elinder CG, Stenbeck M, Tydén G, Groth CG. Kidney donors live longer. Transplantation 1997;64:976–8.
- Segev DL, Muzaale AD, Caffo BS, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA 2010;303:959–66.
- Knoll G, Cockfield S, Blydt-Hansen T, et al. Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation. CMAJ 2005;173(10).
