Despite declarations from the media and many medical professionals, being a Living Donor is not as simple as donating a pint of blood. Even though most nephrectomies (kidney removals) are done laparscopically, it is still major surgery and the loss of a crucial organ.

While the medical community has utilizing living donors for over 50 years, they have not followed or studied them comprehensively. An assessment of existing living donor studies in 2006 reveals small sample sizes, selection bias and many other limitations and liabilities, stressing the need for a living donor registry. (56)

UNOS acknowledged in 2004 that they lose track of 40% of living donors only six-months post-surgery, and then another almost 40% by one-year (28).

Regardless of the number of transplants performed, or the center’s reputation, there are still deficiencies in the data. For one in every five kidney donors in 2006, there were no forms submitted. (61) Because donors are expected to pay for their one-year and two-year post-donation exams, the number of incomplete or non-existent forms will continue to rise.

The following is a quick check-list complications. For more detailed research study results and information, click the link.

Physical & some Psychosocial Risks:

Bleeding

Cardiac/Heart

Chylous Ascites

Chronic Pain

Death/Living Donor Mortality

Financial Hardship/Living Donor Expenses. Also see Disincentives.

Gastrointestinal

Hernia

Hypertension

Infection

Insurance, Health. See Disincentives.

Kidney Failure/Kidney Disease/CKD/ESRD/

Martial/Relationship Conflict

Nerve Damage

Obesity

Pancreatitis

Post-Op Complications

Pregnancy Post-donation

Proteinuria

Testicular Swelling/Sensitivity/Pain

See Psychological Recovery Page for info on:

Anxiety/Stress

Anger/Hostility

Depression (see also Self-Image/Self-esteem)

Self-Image/Self-esteem

Post-Traumatic Stress Disorder (PTSD)

**There is evidence that 'young' donors (under 35) are at greater risk of developing nephrolithiasis, hypertension and Type II diabetes. (72)**

If you have any articles or links not on the References page, please contact info@livingdonor101.com

See Quick Facts, Myths and Psychological Recovery for more...

ANGER/HOSTILITY:

Of donors faced with adverse recipient outcomes, 13% felt the procedure had been a waste and 5% felt guilty (4) and of those whose recipient died, only 50% felt that their experience had been worth it (6). When assessed for hostility, donor scores at one and six months after donation were higher than pre-donation and control group scores (9).

6% and 24% felt that they had given up something for nothing in return.(2,3)

BLEEDING REQUIRING TRANSFUSION:

Bleeding requiring transfusion in 3.4% of living donors.(52)

Significant perioperative bleeding occurred in 1.6% of 1022 living donors. There were seven cases of renal artery laceration. Increased risk for a combined endpoint of intraoperative incidents, major complications and significant bleeding were seen in relation to laparoscopic surgery (88)

Cardiac/Heart:

Even mild degrees of kidney insufficiency and albuminuria have been associated with increased risks for cardiovascular disease. (85, 95)

CHYLOUS ASCITES: (aka Lymphatic Ascites) A rare disorder involving obstruction of the drainage of the abdominal lymph glands which results in abdominal accumulation of milky white fluid.

We found no previous description of chylous ascites after living donor nephrectomy, either open or closed. Chylous ascites needs to be considered as a potential complication of LDN owing to skeletonizing of the adjacent lymphatics of the renal artery and vein.

The accumulation of intraperitoneal lymph likely resulted in increased extravascular and interstitial oncotic pressure, thereby exacerbating the accumulation of ascites.(44,28)

CHRONIC PAIN

Some living donors experience chronic pain around the scar or incision site.  In one study, the surgical scar caused chronic pain for 2% of living donors (4).

One woman's story.

9% of living donors in one study reported bodily pain that interfered with their normal work 'quite a bit of the time' (5).

A 2009 German study of 58 living kidney donors, 34% suffered from chronic postoperative pain 22 months (range 9-57 months) after nephrectomy, and in 55% of these cases the pain interfered with daily life activities. (89)

Persistent pain was reported by 44.1% of 86 living kidney donors 3 years post-donation (91)

DEATH OR MORTALITY:

During the November 2008 ACOT meeting, Mr. Graham, Executive Director of UNOS, noted that one death was reported from donation-related causes within 6 weeks of donation, out of 19,000 donations performed from 2005-2007. (61)

Out of 9875 donation surgeries carried out between January 1, 1999 and July 1, 2001, there were three donor deaths and one donor that remained in a vegetative state. Unfortunately, this one-time survey missed 27% of the US transplant programs.(29)

A 20-37 year follow-up of 464 living kidney donors at the U. of Minnesota found 84 dead, 3 of kidney failure. (30)

As of 2003, with over 15,000 live kidney donors in Iran, the peri-operative mortality rate of live kidney donation was 3 in 15,000 (0.02%).(39)

With more than 20 years of follow-up, 85% of over 400 kidney donors were alive,
whereas the expected survival rate was 66%. (40,41)

More than a dozen liver donors have died world-wide after donation from complications resulting from the surgery. (55)

A 1-12 year follow-up conducted at the Cleveland Clinic (1983-1995) revealed 2 out of 274 had died (4).

DEPRESSION (see also, Low Self-Esteem)

In one study, 11% of living donors reported depression and 2% reported disappointment related to the surgery/donation.(5)

DIABETES

A disease of the pancreas, Diabetes is the biggest 'kidney killer' in the U.S.   Obesity and age increase the risk of acquiring diabetes.

1% of 274 living donors at one center had diabetes at follow-up (4)

FINANCIAL CONSEQUENCES/LIVING DONOR EXPENSES:

Exact quantification of the number of potential donors ultimately dissuaded from proceeding by financial concerns is not available, although a recent survey indicates it may be as high as 40%.(36)

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According to a review published in the July 2006 issue of Nephrology Dialysis Transplantation:

Overall costs averaged $837 per donor, ranging from $0 to $28,906.

Costs for travel and accommodation were experienced by 99% and 88% of donors, respectively, in 1 US study.

Three studies (from Canada, the United States, and the United Kingdom) reported that 14% to 30% of donors lost income due to being a living donor.

One study from Germany and 1 from Australia found that 3% of donors resigned or were fired from their jobs as a result of physical limitations following surgery.

A US study found that compared with non-donors, donors were 37% less likely to have long-term growth in household income.

Caregiver costs were incurred by 9% to 44% of donors.

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70% of 61 Living Donors have expressed socioeconomic concerns before making the decision to donate. (33)

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29% worried about financial ramifications of time missed from work, 10% about childcare, 2% about job security and another 2% about future health insurance coverage. Prospective donors who did not ultimately donate reported similar concerns. (34)

Estimates of out of pocket expenses associated with donation range from $550 to $20 000.(35)

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Donors rely on employer-provided vacation time and sick leave to recuperate, but the average donor required 12 days of unpaid leave before returning to work. (28)

There was no difference in recuperation time between open and laparoscopic nephrectomy as reported by donors.(28)

Almost all donors claim costs for transportation and lodging, paid for personally. Donors traveling from outside of the state to the transplant center accounted for 32% of the population. Many donors also realized costs from childcare, related to their surgery and recuperation.(28)

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23% living donors reported negative financial consequences. However, moderate financial problems (such as lost work time, medical bills not covered by insurance or other personal expenses) were experienced by 19% and severe problems by 4% of the donors, and 9% reported that being a kidney donor had a negative impact on the ability to obtain health, life or disability insurance.(4)

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Furthermore, 8% were concerned about medical costs and 14% were worried about loss of income.(10)

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The strongest correlates of donor dissatisfaction included perceived damage to finances (4).

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19% of living donors had moderate financial problems, while 4% reported severe financial consequences. Severe problems consisted of loss of work, loss of income, and mounting bills they were unable to pay. (5)

Questions to ask, or ways to minimize these financial risks can be found here.

GASTROINTESTINAL:

Readmission rate was higher for LN (1.6%) versus open (0.6%) donors (P 0.001), almost entirely as a result of an increase in gastrointestinal complications in LN/laparscopic donors. (29)

Drugs to treat gastrointestinal disorders, primarily reflux oesophagitis and dyspepsia, accounted for another 6.73% (only one-year post-donation).(28)

Although mostly minor, bowel complications occurred in our laparscopic series with an incidence of 1.3% compared with a reported incidence of 0% with open surgery. (51)

HERNIA:

Knoepp et al.(45) reported an unusual complication after LDN, that of retroperitoneal
hernia of the small bowel at the nephrectomy site.

Perioperative complications and wound healing issues were reported by 23.07% of the donors, including two hernia (28).

One living donor's experience.

HIGH BLOOD PRESSURE/HYPERTENSION

According to 'Annals of Internal Medicine' 2006, volume 145, issue 3, page 185, a examination of 48 studies from 28 countries revealed that living kidney donors will see an average increase of 5-mm in blood pressure within five to ten years after donation over that anticipated by aging alone.

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A study published in Hypertension in 2006 studied Pulse Wave Velocity, a measure of aortic stiffness, a marker of cardiovascular risk independent of age, atherosclerosis, blood pressure, drug treatment, and presence of native kidneys in kidney transplant patients. The researchers found significantly higher PWW in kidney donors as compared to non-donors at follow-up. 

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An examination of 1400 living kidney donors between 1976 and 2002 revealed no greater incidence of hypertension, high creatine levels, diabetes, or heart-related ailments than in the general population in Egypt, although the researcher urged 'transplant centers to develop a registry or other system for the long-term follow-up of kidney function after living donation'.

4.8% of living donors reported they were treated for hypertension at  either 3, 6, 9 months or 1yr post-donation.(28) One year post-donation, 6.73% of living donors were on anti-hypertensives.(28)

31-year review of 370 Living Donors found 15% incidence of hypertension.(14)

Of 167 living kidney donors from 1983-1995 at The Cleveland Clinic as of 1997, 9 (5%) had hypertension.(4)

Thirty donors (38.4 %) were investigated. Of these, 25 of had normal blood pressure and 5 were hypertensive, needing antihypertensive treatment. The average age was higher in the hypertensive group (60.2/53.25 years). The time interval since transplantation was longer in the hypertensive group than in the normal one. (1)

INFECTION, WOUND:

Wound infection developed in 3.7% of donors.(88)

KIDNEY DISEASE/CKD/ESRD:

As of May 2008, 177 former donor candidates had been waitlisted since 1993 (although data was not complete on all donors, particularly those from longer ago). 63% were male, 42% were White, and 45% were African American. The mean age of those on the list was 47 years, compared to previous donors, who had a mean age of 51. SRTR found that the time from making a donation to being listed was about 18-20 years. (60)

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Analyses of the OPTN data by Cherikh et al. revealed that 148 previous living kidney donors were on the kidney waiting list between January 1, 1996, and March 31, 2007. Most of the donors who were later listed for a kidney had donated between the ages of 18 and 34 and to a full sibling. Of special concern was their finding that the median time from donation to listing was 21 years for white donors and 16 years for black donors (86)

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A presentation at the American Transplant Congress in 2009 revealed 88 living kidney donors now on dialysis. [note: not all people with ESRD on the waiting list are undergoing dialysis]

Of these 47 (53%) were male; 46 (52%) were White, 34 (39%) Black, 7 (8%) Hispanic, and 1(1%) other. Also, 23 were also identified on the OPTN kidney waiting list (WL) during 1/1/96-7/31/08. Of these 23, 15 (65%) were male, 8 (35%) were White, 14 (61%) Black, and 1 (4%) Hispanic.(59)

[In the OPTN database, 58% of total Living Donors are female and 42% male, 71% are White and 13% Black. ]

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Of living kidney donors between 1988-2006, 126 individuals entered the waiting list. 5- were African-American. For both African-Americans and whites, males and those who donated before age 35 made up a larger proportion of the donors on the waiting list than would be expected by proportion of overall donors.(71)

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UNOS review of the cadaver transplant waitlist between 1990 and 2000 they reported that 56 previous living kidney donors have been added to the kidney waitlist for transplant.

UNOS admits that their report of 56 previous donors now listed to receive kidney transplants is an underestimate of donors who develop renal failure.(27)

One patient died after transplantation; two candidates died while waiting on the list.(27)

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Kido et al. in 2009 released the first study examining why some LKDs develop ESRD. In their case studies, ESRD developed irrespective of pre-donation renal function or absence of risk factors such as proteinuria, hypertension, obesity or diabetes. In most cases, renal function stabilized for a long period (13.1 years) before declining after an initiating event. (67)

--More study results--

While it is known that some American donors eventually develop CKD themselves, long-term medical risk associated with donor nephrectomy cannot be accurately assessed in this country due to the patchwork access to health care afforded donors at this time.(27)

Of 167 living kidney donors from 1983-1995 at The Cleveland Clinic as of 1997, 4 donors (2%) had kidney disease(4).

In a long-term follow-up study of 464 living kidney donors, 84 were dead. Of those, 3 had kidney failure. Of the still living donors, 3 had abnormal kidney function and 2 had undergone transplantation themselves. (30)

Out of 400 living kidney donors, three developed renal disease, and one was on dialysis treatment.(41)

One year post-donation, one patient developed kidney stones.(28)

Renal/kidney stones appeared in 6.9% of 86 living kidney donors at 3-years post-donation (91)

LIVING DONOR REGISTRY or THE NEED FOR LONG-TERM COMPREHENSIVE DATA:

"I would not encourage people to be a living donor," said Joyce Somsak, a spokeswoman for the division of the federal government that oversees organ transplants, the Health Resources and Services Administration (HRSA).

"There aren't a lot of long-term studies on living donation and what the impact is, what's the impact on people's health," she said.

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According to OPTN/UNOS in 2004, only 60% of the 6-month follow-up forms are returned.(28)

At the November 2008 ACOT meeting, Dr. Cooper from OPTN reported that "For one in every five kidney donors in 2006, there were no forms submitted. For liver, there was more follow up and less loss of data". (61)

Dr. Cooper felt that centers do not report the donors with complications. Complication rates have not changed much over time, but the data may not reflect what is occurring. The centers may not know about complications or may minimize them. Living donors tend to be uncomfortable going back if they have a complication, which skewed the numbers. He felt that donors might be more honest if their responses did not go to the centers. (61)

Mr. Graham, Executive Director of UNOS, commented that the living donor data collected to date does not answer all of the questions on long-term complications, pre-donation issues, peri-operative conditions, and financial complications. (61)

By 6 months, complications data are 17% incomplete; by 12 months, data are more than 50% incomplete. About one-third of kidney donors were reported as lost to follow-up during the first year post-transplant. (61)

By 6 months, complications data were less than 10% incomplete; by 12 months, data were less than 20% incomplete. A small fraction of liver donors were reported as lost to follow-up during the first year post-transplant.(61)

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The short- and long-term health and social impacts of donor nephrectomy remain relatively undefined, owing in part to the paucity of long-term follow-up studies, the most comprehensive of which are from Western Europe.(14,30,37) (From American Journal of Transplantation 2006; 6: 2548–2555.)

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While it is known that some American donors eventually develop CKD themselves, long-term medical risk associated with donor nephrectomy cannot be accurately assessed in this country due to the patchwork access to health care afforded donors at this time.(27)

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The Amsterdam Forum on Care of the Live Donor:

Third, under current policy in the United States, donor interests remain unprotected relative to current Western standards: risk cannot be quantitated (particularly among ethnic minorities) and LDs are not adequately shielded from financial and health consequences associated with nephrectomy.(38)

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A study reviewed The International Liver Transplantation Society 13th Annual International Congress (2007) found 78% of prospective donors possessing one or more physical or psychosocial risk factors, and post-operative complications were seen in 63% of liver donors.

The Society agreed that "One of the key problems with examining living donor morbidity and mortality is the under-documentation or lack of direct reporting of complications by the transplant centers, leading to a dearth of hard data on which to base transplant decisions and to an to inability to provide potential donors with true informed consent."

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Spurious conclusions may have resulted from small study samples and low response rates. Non-responders may have differed from responders, as highlighted in a study where some with adverse outcomes did not participate.

The majority of studies were conducted retrospectively and donors contacted many years after donation may have a biased recall. Having already gone through the experience, donors may find it difficult to express negative feelings (7,26,4). Few studies collected data anonymously and donors may have been less likely to report adversity if studies were conducted by members of the transplant team.

It is noteworthy that the few studies that did assess donors prospectively were more likely to report post-donation depression, poorer quality of life scores and psychological
functioning. However, such assessments were often made shortly after surgery and whether such findings are persistent remains unclear. (17)

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Management of complications is poorly described in the literature. Moreoever, there is a lack of regulation and uniformity in reporting of complications related to living donation as well as an absence of a national or international registry for tracking donor outcomes. (53)

There should be a national data registry of donors to measure accurately the immediate impact and the long-term impact on donor health.(54)

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According to a single-center study from 2000-2007, 12% of living donors not having seen an MD since postoperative follow-up; 7% not having had a blood pressure checked; 29% had not had a urinalysis and 20% reported not having had any blood tests.  Records obtained from PCPs of patients confirmed that of this cohort, 39% had not had a urinalysis and 14% had not had a creatinine measured.

CONCLUSION: At this time the follow-up of living kidney donors at our institution as orchestrated by patients and their primary care providers does not meet recently established international standards. This finding suggests a need for a transplant center-driven clinic or more dedicated outreach. (58)

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Out of 167 donors from 1983-1995 at one transplant center, 23 were unlocatable. (4)

 

LOW SELF ESTEEM

Donors reported that they did not feel any better about themselves after donation.(1)

6% and 24% felt that they had given up something for nothing in return. (2,3)

MARITAL CONFLICT

13% believed donation caused conflict with the spouse. 1 donor ascribed donation as the reason for their divorce.(4)

NERVE DAMAGE

One of the risks of any hand-assisted laparscopic surgery is the possibility of cutting or damaging nerves. Some living donors have reported permanent numbness, pain, and paralysis of the back and lower extremities.

OBESITY IN LIVING DONORS:

A retrospective examination of 553 obese kidney donors found the laproscopic nephrectomy 'generally safe in selected donors', but encouraged more in-depth and long-term research. Another recent study still leaves many unanswered questions regarding the long-term consequences of and increased risks of OBESITY in LIVING DONORS, including hypertension and kidney disease.

2009 Norwegian study found an increased risk of wound infection in living donors with a body mass index over 25 (88).

PANCREATITIS:

Perioperative complications and wound healing issues were reported by 23.07% of the donors, including two cases of pancreatitis.(28)

POST-OP COMPLICATIONS:

(83)

Norwegian study from 1997-2008 of 1022 living donors found total of 30 major (2.9%) and 184 (18%) minor complications.(88)

A 2004 World Transplant Consortium admitted that some physicians will not report a medical issue as a consequence of living donorship out of fear of retribution for the donor from their insurance company.

Study of 86 living kidney donors revealed a total complication rate of 54.6%. (91) Serious complications occurred in five cases (5.8%). (91)

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A study reviewed The International Liver Transplantation Society 13th Annual International Congress (2007) found 78% of prospective donors possessing one or more physical or psychosocial risk factors, and post-operative complications were seen in 63% of liver donors.

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An October 2007 report in the  American Journal of Transplantation discusses post-operative complications for living liver donors, and the difficulty of obtaining data due to a 'lack of standardized system for classifying complications and... a bias against reporting' them.

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A study presented at the World Transplant Congress in 2006, the largest  North American study to date (391 people from 9 hospitals between 1998-2003, followed for six months), found that 62% of living liver donors suffer no complications, 2% had life-threatening, last disabilities and 1 died 21 days after surgery.

Some of the most c0mmon problems were leaks of bile fluid, hernias and infections.

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Complications that donors report during the first year post-donation are higher than previous reports. Rates reported by the transplant programs may greatly underestimate the actual complication rates. Retrospective surveys rely on the responder's memory of complications and their desire to be forthright. Additionally, many donors come from outside of the state to donate, therefore the transplant program may not be aware of the donor complications.

Perioperative complications and wound healing issues were reported by 23.07% of the donors.

Serious complications were reported by 7.7% of the donors in this registry. There was no difference between the type of donation procedure (open vs. laparscopic) and the complications reported.

7.7% reported they were treated for genitourinary problems.

One patient complained of urinary urgency, and another patient developed epididymitis post-transplant.

(This only ONE YEAR post-donation!)(28)

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5% reported that surgery was complicated by a problem that increased hospital stay or time away from normal life beyond their expectations.(4)

Surgery and recovery were more painful than expected for 34% of donors.(4)

Complications not requiring re-operation were reported for 19 (0.3%) open, 22 (1.0%) hand-assisted LN, and 24 (0.8%) non-hand-assisted LN cases (P .02). Readmission rate was higher for LN (1.6%) versus open (0.6%) donors (P 0.001) (29)

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Complications [of laparscopic surgery] included hemorrhage and blood transfusions, vascular injuries, incisional hernia, bowel obstruction, and pneumonia. No statistically significant differences in donor mortality or complication rates were found comparing laparoscopic approach to the open procedure. (46)

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The complication rate was 14%, the rate of open conversion was 2%, and 3% of the patients required transfusions. Complication rates of laparoscopic and open are similar.

Complication rates of laparoscopic and open are similar.
Complications included:
Bleeding requiring transfusion
Stapler malfunction
Epigastric artery injury
Bowel injury
Pneumonia
Incisional hernia
Wound infection
Prolonged ileus.(47)

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Conversion rates 6-13%. The most important reason for conversion is bleeding. Reoperation is 1-5% for hemorrhage, small bowel obstruction, internal hernia, splenic injury, retrieval of foreign body and wound neuroma.

Present new life-threatening complications that are usually NOT seen in the open approach. The complications unique to laparoscopy include those related to creation of pneumoperitoneum, patient positioning, and surgical intervention.(48)

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Post-op complications observed in 19%. No deaths.

Laparoscopic renal surgery is associated with unique challenges and complications as compared to open. 5.6% had major complications: bleeding requiring conversion, splenic injury requiring conversion, pneumothorax, PE, bleeding ulcer, acute renal failure. Minor: pneumonia, urinary retention, ileus, chest pain, dyspnea, wound infection, anemia, port hernia.(49)

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Early postoperative complications reached a mean of 9% and included chronic wound pain, hemorrhage, ileus, urinary retention, pneumonia, atelectasis, wound infection and urinary infection. Late complications included incisional hernia and lap neuroma, SBO, nerve entrapment, and chylous ascites. Conversion rates from 0-13% due to bleeding or vessel injury, inadequate exposure and obesity, stapler malfunction and loss of pneumoperitoneum. (50)

Perioperative morbidity in lap was 14%, wound complications 6.8% (51)

Donor complications following lap-total complication rate was 16.5%. (52)

The overall rate of intraoperative complications was 2.8%. The overall rate of postoperative complications was 3.4% and included urinary retention, wound infection, temporary lateral thigh numbness, chylous ascites, and nerve entrapment. Thirty of 500 patients in our LDN series experienced an intraoperative or procedure-related complication (6.0%). (53)

Major intraoperative complications was 6.8% and major postoperative complications in 17.1%. Major complications presented a significant risk to the donor. Included vascular injuries (renal artery, renal vein, aorta, common iliac artery, vena cava and mesenteric veins) and bowel injuries. Minor complications redressed laparoscopically and were not thought to present a significant risk—included splenic laceration, liver laceration, pneumothorax, diaphragm injury, stapler misfiring, controlled injury to vein or arteries, cardiac arrhythmias, and urethral strictures. Major postoperative complications included atrial fibrillation, small bowel obstruction requiring return to the OR, sepsis, respiratory distress, pneumonia, retroperitoneal hematomas, and a splenic laceration requiring reoperation. The major complication is bowel function. May take 7-10 days to return to normal. A major complication is internal hernia. (54)

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Complications can include a wide range of medical problems, from infections and bile leaks to pulmonary embolism and deep vein thrombosis. (55)

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Two national studies in the past year reported that more than one in three liver donors experience at least one medical complication, during surgery or in the months or more after. (55)

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A conference of more than 90 experts who met in Vancouver in May 2007 and reviewed data from around the world found that 35% of liver donors are likely to have complications, including pneumonia, renal failure and repeat surgery. The time frames for follow-up varied among the research examined, but most complications arise shortly after surgery. Data from a national study that reviewed a sample of liver donors from 1998 to 2003 found a similar complication rate of 38%, with a median follow-up time of six months. (55)

PREGNANCY POST-TRANSPLANT: 

Most organ transplant organizations will state that kidney donation has not been shown to affect the completion of a safe pregnancy and childbirth.  However, the issue has not been well researched.

Pregnancy is a time of net salt and water retention, with 50% increase in plasma volume
and glomerular filtration rate (GFR), associated with single nephron hyperfiltration. Animal studies have demonstrated that reduced nephron mass is related to an increase in blood pressure and protein excretion in late pregnancy. In addition, human studies report higher rates of HDP (hypertensive disorders of pregnancy) in women with preexisting kidney disease. After donor nephrectomy, the GFR of the remaining kidney increases by 40%, and its response to hormones such as angiotensin II is altered.(79)

November 2008, a study of over 2000 women revealed that a living donor poses no increased risk of developing hypertension or diabetes during a future pregnancy than non-donors. This is the largest study to date.

April 2009 study of 1085 living donor pregnancies at U. of Minnesota - fetal and maternal outcomes and pregnancy outcomes after kidney donation were similar to those reported in the general population, but inferior to pre-donation pregnancy outcomes. (in other words, outcomes were worse post-donation than pre-donation):

Post-donation (vs. pre-donation) pregnancies were associated with a lower likelihood of full-term deliveries (73.7% vs. 84.6%) and a higher likelihood of fetal loss (19.2% vs. 11.3%).

Post-donation pregnancies were also associated with a higher risk of gestational diabetes (2.7% vs. 0.7&), gestational hypertension (5.7% vs. 0.6%), proteinuria (4.3% vs. 1.1%) and preeclampsia
(5.5% vs. 0.8%). Women who had both pre- and post-donation pregnancies were also more
likely to have these adverse maternal outcomes in their post-donation pregnancies.(78)

Norwegian study in April 2009:

A normal pregnancy is characterized by an increase in renal blood flow and glomerular filtration rate (GFR). In previous donors, the nephrons of the remaining kidney are already hyperfiltering, which has raised concerns about future pregnancies in female donors. It may be particularly relevant since it is conceivable that increase of blood pressure and loss of kidney function in donors may predispose for hypertensive pregnancy disorders and other complications (77)

The researchers analyzed the women's pre- and post-donation pregnancies. 106 post-donation pregnancies in 69 kidney donors found a higher rate of gestational hypertension (2.8%) pregnancies after donation as opposed to 1.8% before donation, as well as a higher incidence of preeclampsia in post-donation pregnancies (5.7% in comparison to 2.6%). (77)

And here is a critical analysis of both Ibrahim & Reister (77,78)

Donor nephrectomy is not detrimental to the prenatal course or outcome of future pregnancies. It was recommended, however, to delay pregnancy until at least 2 months after nephrectomy to assess renal compensation prior to conception. (42, 43) [note: these studies have been criticized for their small sample sizes and self-reporting and retrospective natures.]

The pregnancy of a kidney donor will automatically be considered 'high risk'. This risk increases exponentially with the age of the birth mother. Also, it is recommended a donor wait at least six months post-surgery before getting pregnant.

PROTEINURIA: aka Albuminuria or Urine Albumin

Proteinuria is defined as excreting excess protein in urine. Most proteins are too big to be filtered through the kidneys but will leak when the filters (glomeruli) are damaged.

Excretion of even small amounts of albumin in the urine may portend serious future events, such as Chronic Kidney Disease and progressive renal dysfunction (95)  Read more here. 

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Kido's case studies found LKDs were more likely to develop persistent proteinuria than non-donors, and no pre-donation risk factors existed (67)

One year post-donation, perioperative complications and wound healing issues were reported by 23.07% of the donors, including one living donor with proteinuria. (28)

 TESTICULAR SWELLING/PAIN:

A study in the Journal of Endourology indicates that 9.6% of men suffer from Ipsilateral Orchialgia on average 5 days post-surgery.

This pain/swelling, sometimes up to grapefruit size, seems to occur mainly in the left testicle, and more commonly in men who have undergone vasectomies.  It can abate within a few weeks, but in at least one severe case, more than two years post-donation, "searing pain like an intentional kick" exists during specific movements or activities. Surgery is sometimes necessary to alleviate the symptoms. 

Some possible causes:

Infection

Testicular varicose vein

Hernia

Reduction/cut-off in the blood supply to the left testicle (which is already compromised during the vasectomy)

Hydrocele aka water on the testicle (symptoms reported up to 4+ years post-donation)

Detailed discussions here and here.

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