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What’s It Like to Donate a Kidney?

There are two options to stay alive when a person has end stage renal disease (ESRD): dialysis or a kidney transplant. If a person with this last stage of chronic kidney disease (CKD) qualifies for and decides on a transplant he or she can go on a waiting list to receive a kidney from a deceased donor, or ask friends and family if they are willing to donate a kidney.

There’s a lot to think about when making this important decision of becoming a living donor. So, what’s it like to donate a kidney?

Qualifications for becoming a living kidney donor

The first requirement is good health. You must have normal kidney function and anatomy. Potential kidney donors will have a comprehensive physical examination. A psychological evaluation will be required to insure the potential donor’s mental health. Here is a list of what you may need to do if you want to donate a kidney:

  • Complete physical exam: From head to toe, a physical exam is performed to find any abnormal physical signs or symptoms.
  • Immunological tests: These determine blood type and tissue type.
  • Laboratory tests: Electrolyte balance, unsuspected glucose intolerance, pancreatitis, venereal disease – these are all conditions that need to be screened before a kidney donation can be approved. The transplant team will also test for liver abnormalities, heart function using an EKG (electrocardiogram) test, and past or present viral disease.
  • Chest X-ray: Shows images of your lungs, heart, ribs, bones of your spine and blood vessels, and can reveal conditions such as fluid in the lungs, emphysema, an enlarged heart, cancer and many health issues.
  • Medical history assessment: The kidney transplant team thoroughly examines the potential donor’s health and family history.
  • Kidney function tests: A urine sample is taken to screen for kidney disease and urinary tract infections (UTI), measure protein amount in urine and determine the glomerular filtration rate (GFR) – a measurement of kidney function.
  • Intravenous pyelography test: Dye is injected into a vein in the arm. The dye reaches the kidneys via the bloodstream where it is taken up and passed into the urine. X-rays are taken to identify the structure of the kidney, ureters and the bladder.
  • Helical CT scan of the kidneys: Produces images of the internal structure of the kidneys. It also can detect cysts, tumors and other abnormalities.
  • Renal arteriogram: This is the final X-ray that shows the vasculature of each kidney, the number of blood vessels to and from each kidney and any evidence of vascular disease. It requires an observation period of 6-8 hours after the exam and may involve hospitalization.
  • Psychological evaluation: This evaluation includes an impartial, private forum for a potential donor to discuss important information about the donation process and assess the donor’s motivation for wanting to donate a kidney. The health care team will also act as an advocate to either proceed with donating or declining to do so.
  • Gynecological exam and mammography: For potential female kidney donors.
  • Financial consultation: Like any significant medical procedure, cost and insurance coverage need to be considered. In many cases the kidney recipient’s insurance or Medicare will pay for testing and surgery. However, the donor may incur additional expenses. It’s important to discuss the details with the hospital’s transplant coordinator, your job’s human resource department and possibly an insurance attorney.

Test results will be evaluated by the kidney transplant team. The team is composed of nephrologists, surgeons, nurses, social workers and financial counselors who will determine if the potential kidney donor is a good match.

Your emotions when you donate a kidney

Kidney donors may have a wide range of emotions, including joy, relief, anxiety or a sense of loss throughout the process. Even if you are elated at the thought of giving the gift of life, as a potential kidney donor you should have a support system throughout the process. Family, friends, spiritual guidance, organized support groups and mental health counseling can be helpful.

Kidney donor surgery

If you are matched with a kidney recipient, surgery is usually scheduled in 4-8 weeks. You will undergo a nephrectomy, or kidney removal surgery. The transplant team will explain the procedure in detail when the surgery date is set.

How is a nephrectomy done?

There are two methods to remove a kidney: an open nephrectomy and a laparoscopic nephrectomy.

In an open nephrectomy, an incision approximately 12 inches long is made in the abdomen. Sometimes the surgeon must remove a rib. The ureter (the tube that carries urine from the kidney to the bladder) is cut between the bladder and the kidney, and blood vessels are cut and clamped before the kidney is removed. The incision is closed with stitches or staples. The procedure can take up to three hours. Some benefits of open nephrectomy include:

  • Allowing surgeons to place sterile ice directly on the kidney to prevent damage during surgery
  • Donors experience less urinary leakage after surgery

Laparoscopic nephrectomy is minimally invasive. It uses a wand-like camera called a laparoscope to view the abdominal cavity. The kidney is then removed through a small incision. Laparoscopic surgery takes approximately two hours. Its advantages are:

  • Shorter recovery time
  • Shorter hospital stay
  • Smaller incisions
  • Fewer post-operative complications

Recovery after the nephrectomy

A kidney donor is required to stay in the hospital for 2-7 days, depending on the type of nephrectomy performed and donor’s rate of recovery. Your health care team will carefully monitor your kidney function, blood pressure, electrolytes and fluid balance during your stay.  

It is common to experience discomfort and numbness caused by severed nerves near the incision area. Pain relievers will be available for you throughout the recovery process. Deep breathing and coughing may cause discomfort because the incision is near the diaphragm, but breathing exercises can prevent pneumonia. Movement may be encouraged as soon as you’re able in order to reduce the risk of blood clots. 

Risks and complications of kidney donor transplant surgery

Kidney transplant teams do everything they can to minimize risks to donors with the intensive pre-testing and screening we’ve described. But every surgery has risks. Possible complications of kidney transplantation include: 

  • Pain
  • Pneumonia
  • Infection
  • Damage to kidney
  • Blood clots
  • Collapsed lung
  • Bleeding (hemorrhage) requiring blood transfusion
  • Rare allergic reactions to anesthesia
  • Death

Leaving the hospital after a nephrectomy

You may feel tenderness, itching and some pain as the incision heals. Every kidney donor recovers at a different rate. It’s important to consult with a doctor to determine an appropriate activity level during recovery. Heavy lifting is not recommended for six weeks following the surgery.  

The Mayo Clinic recommends a follow-up evaluation 6-9 months after the surgery. A nephrologist will check kidney function through blood work and a urine sample.

Life after donating a kidney

Most kidney donors live long, healthy lives. It is important for a donor to alert all their doctors and pharmacists about the donation, and to have regular appointments to monitor blood pressure and kidney function. As long as a donor exercises and maintains a healthy weight, there should be no need for dietary restrictions.

Your remaining kidney will eventually grow to compensate for the missing kidney. Having a single, larger kidney can make you more vulnerable to injury so many contact sports should be avoided. Talk with your doctor about which activities you can participate in safely.

In fact, according to a study announced by The Johns Hopkins University School of Medicine in March 2010, "researchers have found the procedure carries very little medical risk and that, in the long term, people who donate one of their kidneys are likely to live just as long as those who have two healthy ones."

Giving life to a person in need

Giving life by becoming a kidney donor can be very rewarding. You are providing a person the chance to live without the help of dialysis. When you consider donating a kidney, remember that you will go through a concentrated evaluation process by a kidney transplant team. They will check that you are physically and emotionally ready to donate; they want to be sure you will continue a healthy life and the recipient gets the best kidney for his or her body. If you are thinking about changing a person’s life by becoming a donor, it’s important to gather all the facts and establish a support network. To get support online, join myDaVita.com where you may find others in your same situation.

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