Does Donating a Kidney Increase Susceptibility to Serious Kidney Disease That Would Itself Require a Transplant?

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.

David Chesler (mail) (www):
I guess the supposed mechanism, if that were the case, is that the remaining kidney is getting over-worked.

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.)
11.27.2006 4:01pm
logicnazi (mail) (www):
Uhh your evidence doesn't really establish what you want to prove.

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.
11.27.2006 5:05pm
Sean M:
I'm not sure I understand your criticism, logicnazi.

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."
11.27.2006 6:17pm
Sean M:
I should also note that prior live donors, should they develop End Stage Renal Disease, are given more "points" in the United Network for Organ Sharing allocation system for organs.

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.
11.27.2006 6:20pm
wbisme (mail):
Despite this recent finding, there remains a basis for presumption of increased risk to kidney donors. I suppose that the increased risk is offset by somewhat more attentive health care that more than compensates for the increased risk. Kidney disease is generally a rather slowly progressing disease and is often not promptly detected in the general population, about 1 in 12 of whom have kidney disease but are unaware of their illness.

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.
11.27.2006 6:42pm
wbisme (mail):
Sean, I can confirm that donors get points, as you describe. But, it's not cleat whether the points adequately compensate for any risks incurred by the donors. I concede that it is also possible that the points more than compensate for such risks.
11.27.2006 6:44pm
Sean M:
I probably overstated my case when I wrote that it "more than compensates." Obviously, major surgery and life with immunosuppressants is not fun.

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.
11.27.2006 6:58pm
srp (mail):
It turns out that almost all kidney disease affects both kidneys at once, which is why donors are, for the most part, not in significantly higher danger when they get kidney disease than those with two kidneys. The two exceptions to this rule are a) trauma to a kidney and b) kidney cancer, both of which may affect only one organ and so give an advantage to a non-donor. The data seem to be saying that these incremental risks, while real, are very very small and so do not pop out of the statistical noise.

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.
11.27.2006 7:25pm
kidneydoc (mail):
As webisme has rightly pointed out, the risk of developing kidney failure needing dialysis/transplant [ESRD] for donors is the same as the general population. The donors are much healthier than the general population- eg, they are usually younger, they don't have diabetes, hypertension or any cardiovascular disease; a significant proportion of the general population does have a combination of any or all of the three mentioned risk factors. Hence, the donors should have a lower incidence of developing ESRD than the general population, when in fact, they have a similar incidence, which is clearly higher. For reasons, a good start is the study by Boudville et al in Annals Int Med Aug 2006, where they report a 5 mm Hg higher BP in donors at 5-10 years. Also remember that our experience with donors is not long- Dr Murray performed the first such Transplant in 1964 at Boston, and systematic study of donor follow ups is much shorter than that, so real long term effects of kidney donation are not known (atleast not longer, and in reality much shorter than 42 years).
11.27.2006 7:35pm
Dave Hardy (mail) (www):
I was about to ask whether it was probably that most forms of kidney failure take out both at the same time (so that losing one does not increase risk), but I see SRP has addressed that.

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.
11.27.2006 9:03pm
professays (mail):
Donating a kidney is tantamount to crippling oneself, making oneself an invalid without any exagerations. It ensues a string of devastating consequences for human organism and spoils the rest of donor's life.
11.28.2006 7:44am
Eugene Volokh (www):
ProfEssays: Interesting; here we had a post that cited to medical studies, and comments that seemed to have some pretty meaty details. Your comment is intriguing, but I'm afraid longer on conclusion than on the evidence. Might I ask you to, in the spirit of the rest of the thread, point us to some data supporting your assertion? I should say that all the medical studies I've read seem to support the contrary view, but I certainly want to know whether they are mistaken.
11.28.2006 8:56am
Dan Cole (mail):
As kidney donor myself - I donated it to my mother 24 years ago - I can tell you that kidney donors should have lower risk than the general population because of pre-donation testing that is required to ensure that they are low risk for developing kidney disease in the future.

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.
11.28.2006 9:16am
David Chesler (mail) (www):
Seconding Dan Cole, a good friend lost a kidney to an infection some twenty years ago (before I knew her, so I don't know all the details -- but she's got only one kidney and nobody's got the other one she was born with) and she is not presently[*] debilitated. She regularly travels long distances by air. (I'm not as ancient as Dave Hardy, but as I and my circle of friends enter our mid-forties, none of our healths is as good as when we were young. This friend is doing better than most of us -- her nulliparity helps.)

[*]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?
11.28.2006 10:40am
Dan Cole (mail):
Absolutely, I would do it again. It has greatly improved my mother's quality of life for the past quarter century, and it has impacted mine hardly at all.

11.30.2006 4:15pm