ABSTRACT
Many donors have no conception of what is involved. A number do not know the location of their kidneys and some do not even realise that a surgical operation is required to remove a kidney for transplantation. They must understand that admission to hospital, a general anaesthetic, a surgical wound, a stay in hospital of approximately one week, and a period of recuperation of one month or more before returning to work will be involved. The probability of some postoperative pain, or at least discomfort, albeit alleviated by analgesia should be explained. They must know that the possibility exists of a postoperative complication, such as wound or urinary tract infection (the latter following urethral catheterisation), pneumonia and venous thromboembolism. There is an approximately 5% possibility of one or more of these complications occurring. They must also know that very occasionally death has followed donor nephrectomy. The procedure is carried out on a fit individual by an experienced surgeon and anaesthetist, and is planned carefully. The risk of death is of the order 1 in 1,000 or less, and it may be appropriate to explain that the risk is less than that of emergency appendicectomy. Deaths have occurred from venous thromboembolism, in particular, in the postoperative period. It should be explained that the remaining kidney will hypertrophy (enlarge) and that eventual renal function will be near-normal or normal, and certainly satisfactory enough under usual circumstances to maintain normal health. The individual with a single kidney is, however, at some disadvantage, which should be explained. For example, if trauma to the remaining kidney, development of malignancy within it (normally treated by nephrectomy) or development of an obstructing stone were to ensue, the donor would be at a disadvantage compared with an individual with two kidneys. Follow-up of live donors for up to 15 years has to date providing reassuring results, although some series have shown an increased prevalence of high blood pressure and proteinuria in donors. Whether this results from glomerular hyperfiltration in the presence of a single kidney, or reflects the increased probability of renal disease in relatives of a patient who has developed renal failure, is unclear.
