Live kidney donors report high satisfaction rates and minimal health problems

Researchers from Egypt, where live donations are currently the only legal option, carried out detailed evaluations of 339 patients who attended follow-up clinics between January 2002 and January 2007.

Based at a centre which performs about 100 live donor transplants a year, they included patients who had donated kidneys between 1976 and the end of 2001 in their research.

“Living donors remain the main option in developing countries where donations from dead donors have yet to establish roots, because of the lack of infrastructure or the implementation of legal criteria for brain death” explains lead author Dr Amgad E El-Agroudy from the Urology and Nephrology Center at Mansoura University.

“Even in developing countries, the increasing demand for kidneys has resulted in a rapid increase in the number of living donors being used. This had led to concerns about the risk involved in the procedure and its long-term consequences.”

All of the people who took part in the study underwent an extensive physical and psychosocial assessment, which included a full range of laboratory tests and detailed medical history. Any medical problems were then compared with health tables for the general population.

The researchers found that the live donors studied had good kidney function and tended to suffer a lower incidence of high blood pressure, diabetes and heart-related deaths than the general Egyptian population.

However, the authors point out that donors have to have good general health, at the time of the transplant, including normal blood pressure, to even be considered for the procedure and this could account for some of the results.

90 per cent of the donors who took part in the study said that they would make the same decision again if a family member or partner needed a kidney and would strongly encourage others to become donors.

47 donors went on to have 65 babies between them, including 25 who had their first baby after surgery

1,200 kidney transplants using live donors are carried out in Egypt every year, where the incidence of end-stage kidney disease is 200 people in every million.

In the current study, almost two-third of the donors (62 per cent) were women and the sample included people who had donated five to thirty years ago, with an average gap of 11 years between surgery and follow-up.

37 per cent had donated a kidney to their child, 47 per cent to a brother or sister and 16 per cent to a spouse or partner.

60 per cent were working at the time of the donation and 67 per cent had a moderate financial income. No-one reported losing their job as the result of the surgery and only one person said it has put them at a financial disadvantage.

“Our conclusion is that living kidney donation is a safe procedure with minimal long-term complications” says Dr El-Agroudy. “Overall kidney function is well maintained after one kidney has been removed and donor satisfaction is consistent.

“It is important to point out that the donors were all partners, spouses or relatives of the patients they donated their kidney to and that they all underwent comprehensive medical screening before they were accepted onto our transplant programme.

“We believe that making sure that living kidney donors receive long-term follow-ups is very important and we would urge all transplant centres to establish programmes like ours to monitor their ongoing progress.”

“The authors have quite rightly identified a significant increase in live kidney donations in countries that also accept organ donations from deceased donors” says BJU International’s Editor, Professor John Fitzpatrick from University College Dublin, Ireland.

“In the UK for example, NHS figures state that live kidney donations now account for one in four kidney transplants in the UK and 690 were carried out in 2006-7, a 50 per cent increase on 2003-4.

“The Journal was keen to publish this study from a country that relies exclusively on living kidney donors as the authors had the opportunity to follow up a large number of transplants carried out between five and 30 years ago.”