Table 1.

Summary of the risks of living kidney donation

Nature of risk	Summary of current evidence	References
Perioperative risk	Perioperative risk relatively low: major complications around 2.5%; overall risk between 7 and 17%, mainly bleeding and infection. Increased risk conferred by black ethnicity, obesity, haematological disorders, psychiatric conditions and robotic nephrectomy.	[4, 5]
Mortality	Short-term (90 day) mortality risk: 3.1 in 10,000. Long-term mortality equivalent to control populations; one study reports higher mortality after very long-term (25-year) follow-up.	[5, 6, 9–12]
End-stage kidney disease	Overall prevalence low, but 3–5 times higher than in well-matched controls. Increased risk conferred by younger age, black ethnicity, male gender, lower GFR, smoking history and the presence of hypertension, albuminuria, obesity or diabetes.	[11, 13, 14]
Hypertension and cardiovascular risk	Some studies report a 2–4-fold increased risk of hypertension. Increased risk conferred by black ethnicity. No significantly increased risk of cardiovascular events.	[9, 18–22]
Gout	Slightly increased risk of gout post-donation but similar to the general population. Increased risk conferred by male gender and black ethnicity.	[24–26]
Metabolic bone disease	Observed differences in PTH, vitamin D3 and FGF-23 but no difference in pathological events.	[9, 22, 24, 29]
Psychological outcomes	Reduced HRQoL in the first 3 months, which improves by 12 months after donation. Reduced HRQoL associated with obesity, history of psychiatric difficulty and non-white race. Education, older age and first-degree relation to the recipient are protective factors.	[30–35]
Kidney stone	Donors with no metabolic abnormality and small kidney stones may safely donate.	[36–41]
Obesity	Slightly increased risk of infection and operative time. Increased incidence of hypertension and diabetes. Possible longer-term increased risk of ESKD and mortality.	[45–55]
Black race	Higher relative risk of hypertension, CKD and ESKD. Increased risk of gout. Increased perioperative risk.	[13, 56, 57, 59]
Pregnancy	2.4-fold higher risk of gestational hypertension and pre-eclampsia. No adverse effect on foetal or maternal outcomes.	[61–63]
Older donors	No significant difference in mortality, cardiovascular events or fall in GFR for older donors.	[13, 64–66]

PTH parathyroid hormone, FGF-23 fibroblast growth factor-23, HRQoL health-related quality of life, CKD chronic kidney disease, ESKD end-stage kidney disease, GFR glomerular filtration rate