What to Expect Before, During and After Donating a Kidney

The kidneys are two bean-shaped organs that are primarily responsible for filtering the blood and removing waste from the body. Located on each side of the spine, just below the ribcage, the kidneys also help produce red blood cells, play an important role in controlling blood pressure and help regulate substances such as water, electrolytes and minerals to maintain balance in the body for proper cell function. Even though people have two kidneys, they can live normal lives with just one kidney. This is one of the reasons why the kidney is the most commonly transplanted organ from living donors. In 2023, there were more than 6,000 living donors in the United States who donated a kidney for transplant. It is considered a safe procedure with a low risk of complications and has a high rate of success for the organ recipient. 

“Donating a kidney is an amazing gift from one person to another and can transform both the donor’s and recipient’s lives,” said Ty Dunn, MD, MS, transplant surgeon, surgical director of the Froedtert & the Medical College of Wisconsin kidney and pancreas transplant programs and MCW faculty member. “It weighs heavily on us to make the living donor’s experience as perfect as possible because unlike other surgeries, the goal of this operation isn’t to make them healthier or get them better. They are giving someone else the gift of life.”

Becoming a Living Kidney Donor 

Living kidney donors must be at least 18 years old and in good overall health. The odds of being approved as a living kidney donor are about 1 in 4. 

Certain medical conditions or circumstances that can disqualify a person from becoming a living donor are:

• Uncontrolled hypertension (high blood pressure)
• Diabetes
• Active cancer
• Evidence of coercion or illegal financial exchange
• Mental incapacity
• Any condition determined by the evaluating medical staff that makes the donor unsuitable to donate

The first step to considering kidney donation is the evaluation. The evaluation process is how the transplant team gets to know the potential donor and their medical and surgical history, as well as exchange information about donation from the perspective of a kidney specialist (nephrologist), donor surgeon, social worker and dietitian. Other team members involved in the evaluation include a pharmacist and an independent living donor advocate. Diagnostic testing for the evaluation includes blood and urine tests and other tests such as a chest X-ray, EKG and a CT scan to evaluate the kidneys. Living donor evaluation is completed during a full day of appointments in the clinic. All of the tests are paid for by the potential recipient’s insurance. 

“The evaluation ensures the donor can safely donate and continue a healthy life for their foreseeable future,” Dr. Dunn said. “Our team is highly experienced in working through complicated decisions about donation and provides individualized counseling. We take each person’s unique situation under consideration, balance the risks with the benefits and give people the ability to make informed decisions.”

Nearly one third of living kidney donors do not match their intended recipient, but participating in kidney exchange programs makes it possible to achieve a living donor kidney transplant. This provides the best long-term outcomes for the recipient and significantly decreases the recipient’s wait for a deceased donor transplant. 

Preparing for Living Kidney Donor Surgery 

Once a living donor is medically approved, the timeline to surgery can vary widely based on the recipient’s situation. Sometimes, even if the donor is compatible with their recipient, it can be more convenient to donate through the National Kidney Registry’s paired exchange. This allows the donor to schedule their surgery at a time that is convenient for them. It is also leverages an opportunity for better matching and gives priority for a living kidney donor when their recipient is ready for transplant. 

The National Kidney Registry offers certain programs that ease financial disincentives for living kidney donors, including reimbursement for out-of-pocket expenses such as travel, lodging, dependent care and lost wages. For altruistic kidney donors (people who have no current named recipient), the family voucher program allows the donor to name up to five individuals; if any of those individuals ever need a kidney, they would receive prioritization for a living donor kidney. No donor that has donated through the National Kidney Registry has ever required a transplant themselves, but in the unlikely event the living donor would need their own kidney transplant at some point in their life, the exchange program also gives them top priority.  

In Wisconsin, living organ donors are eligible for a state tax deduction for unreimbursed expenses associated with donation of up to $10,000. Organ donation is additionally covered under the Family and Medical Leave Act (FMLA).

Living Kidney Donor Surgery

The surgical procedure to remove the healthy kidney from the living donor is called a donor nephrectomy. The procedure is covered by the recipient’s insurance. The transplant team at Froedtert Hospital is highly experienced in complex living donation cases and offers a minimally invasive approach to donation of the left or right kidney, including kidneys with multiple vessels or other complex features. Nephrectomies are done laparoscopically or robotically, using instruments and a camera that go through small incisions. This has the benefit of a quicker recovery and minimal scarring. The kidney extraction incision is about 3 inches in length and is placed on the lower abdomen, above the pubic hair or on the lower left or right side of the abdomen, depending on which kidney is being donated. Robotic technology allows for extreme precision and may be associated with less pain. 

The kidney donation is usually scheduled 4-6 weeks in advance. The week prior, the living donor comes to the hospital for a preoperative examination. The morning of the surgery, the donor fasts — no food or drink (other than water) 8 hours before surgery. The procedure typically lasts 2-3 hours, after which the donor will spend the night in the hospital. While they are hospitalized, the care team ensures donors meet all important post-operative milestones, which means their pain is well controlled, that there is no sign of bleeding, and they are able to drink, urinate and walk without difficulty. Patients are usually discharged one day after surgery and continue recovering at home. Some pain and discomfort is normal at first, but pain medication can usually be stopped after a few days. 

Most kidney donors do not experience complications after the procedure. The Kidney Transplant Program at Froedtert Hospital offers consistent excellence in outcomes that align with or exceed national benchmarks. 

“Complications can happen, but 95% of the time, the donor nephrectomy and recovery goes exactly as planned,” Dr. Dunn said. 

People with desk jobs can usually return to work in 3 weeks, but people who do heavy labor work may be off of work for up to 3 months. For the first 6 weeks after donation, people should not lift more than 10 pounds.  

“The incisions are small, but it is a major surgery on the inside,” Dr. Dunn said. “Donors are healthy people, so they are not used to feeling fatigued or unwell. It is important to be kind to yourself and take the time to heal for proper recovery.”

Donors are seen in the clinic about 3 weeks post-donation. They get lab follow-up at the 6-month mark, as well as at the 1 and 2-year marks to document their post-donation kidney health. These visits are covered by the transplant recipients insurance.

Life After Donating a Kidney

After donating a kidney, the body adapts and functions well with one kidney. The remaining kidney adjusts to take on extra blood flow so that once the healing is done, donors have not half, but about 70% of the kidney function they started with. Studies have shown that life expectancy for living kidney donors is about the same as or higher than non-donors. This is because the evaluation process for living donors selects people who have above-average health.
“The most important piece of advice we give our living donors is to continue to maintain their healthy living habits,” said Beje Thomas, MD, transplant nephrologist, medical director of the Froedtert & MCW adult kidney and pancreas transplant programs and MCW faculty member. “Continuing to exercise and eating a healthy diet are the best ways to prevent excess weight gain. Being overweight or obese can put people at risk for diabetes and high blood pressure, which are known risk factors for kidney disease.” 

Living donors should also:

• Be established with a primary care provider
• Keep up with all routine health screenings
• Avoid certain activities that could cause trauma to the remaining kidney, such as extreme contact sports like rugby or boxing
• Avoid smoking, excessive amounts of alcohol and illicit drugs
• Always disclose that they are a kidney donor when being prescribed medication and follow dosing instructions carefully 
• Consult with their primary care doctor before taking over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs), which can affect kidney function

“Our team is highly experienced in performing living donor surgeries and has done a large number of these procedures,” Dr. Thomas said. “We are always available as a resource to our living donors. They have the freedom to check in with us as needed, and we will provide robust support and personalized attention.”