It turns out that the answer, somewhat to my surprise, seems to be "no." (I had thought there would be some such risk.) See Mary D. Ellison et al., Living Kidney Donors in Need of Kidney Transplants: A Report from Organ Procur. & Transp. Net., 74 Transplantation 1349 (2002) (noting that the best current estimates of the risk of kidney donors’ eventually developing end-stage renal disease “approximate[] the . . . adjusted incident rate for end-stage renal disease in the general U.S. population”); Margaret J. Bia et al., Evaluation of Living Renal Donors, 60 Transplantation 322, 326 (1995) (same).
I stress "seems to," because even though we do have decades of data, the studies have some understandable limitations. But the studies do suggest that there is no such elevated risk, and in any event it appears that even if there is some elevated risk that the studies don't catch, it's unlikely to be very high.
I'll update my article draft accordingly, but since the issue had come up in my posts and the comments to those posts, I'd note it. Recall that transplant operations do involve a roughly 0.03% chance of relatively prompt donor death, and a 2% or less chance of serious complications.
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I'm not surprised this isn't the case. Organs like regular exercise. A neprhologist (and marathoner) told me that kidneys particularly like processing water, to the point that if your urine is not clear, you're not drinking enough.
(When I die there's a good likelihood it will be from kidney failure, due to the drugs that are keeping me sighted and bipedal despite diabetes.)
Likely people who donate kidneys do not have pre-existing kidney problems, hence their probability of getting end stage renal disease probably starts lower than that of the general population.
Still the point is that the increased risk is sufficiently small that it is comparable to the risks people take when joining professions or taking up skiing.
You state that "people who donate kidneys do not have pre-existing kidney problems, hence their probability of getting end stage renal disease probably starts lower than that of the general population.
The general population doesn't have pre-existing kidney problems, generally.
The proposition we're considering is: Given a person who has no known pre-existing condition and who has donated an organ, is he at a higher risk for ESRD than if he had not?
The answer, surprisingly, for reasons that David Chesler mentions above, is "most likely not."
Thus, if a live donor does have a small higher chance of ESRD, that is offset by the much increased chance that he will receive an organ from the waiting list.
Cite for this proposition, by the way is Goodwin, Michele. Black Markets: The Supply and Demand of Body Parts. Cambridge: Cambridge University Press, 2006. pp. 97-98.
About 1 in 9 of the general population contract kidney disease at some point in their life. Given that kidney donors experience kidney disease at roughly the same odds as the general population, such donors are at quite substantial risk, precisely because their risk does not differ markedly from that of the general population. Kidney disease generally progresses inexorably to end-stage renal disease. I am not familiar with data on the prevalence of ESRD in donors in contrast to that in the general population. But, if ESRD were not found to be more common in kidney donors than in the general population, I would presume that to be due to death prior to the onset of ESRD.
Whatever our personal opinions, I suppose that we agree that correctly interpreting health statistics is a non-trivial endeavor. So, making deductions based on health statistics is itself a risky activity. The bottom line is that I, as a kidney-disease patient, am extremely reluctant to accept a kidney from a live donor. The recent findings have not prompted me to change my opinion.
But my more general point is that UNOS takes steps to make sure that SHOULD a live donor face ESRD (for any reason), they will be more likely to recieve a transplant than otherwise.
I've been told by a surgeon that the cells of a donor's remaining kidney actually grow in size as the kidney takes up more filtering activity. Don't know how reliable that claim is in general.
As far as long term effects of kidney donation, at my age of 55 years, 42 years does seem a rather long time. No matter what we do or avoid, we will all die precisely once.
Contrary to Professays comment, I have not been debilitated in any way by my donation. The only consequence - one that is quite common among kidney donors - is that about 20 years after the donation I developed secondary hypertension which requires mild pharmaceutical treatment.
[*]She carries a higher risk of future debilitation if something infectious or traumatic or cancerous happens to the remaining kidney.
So Dan, if you could back in time, would you still do it?
Dan