Risks & Benefits

• Although a transplant recipient will always have to take medications to prevent the rejection of the kidney, most aspects of their lives can return to normal. The majority of recipients return to their normal activities of daily living and even full-time work.
• Long-term kidney transplant survival rates are very good for kidneys from living donors, often lasting 10 – 20 years.
• In general, the only way a patient with severe kidney disease can avoid a long period of time on dialysis is if they have a willing and suitable living donor. The average waiting time for a deceased kidney transplant in Ireland is two and a half years. A living kidney transplant can sometimes be organised in 4 to 6 months and may be planned prior to the person actually starting dialysis.

RISKS

• As with any surgical procedure, there are risks for transplant recipients. This includes the risk of death, which is less than two to three cases per thousand living transplant recipients.
• Poor blood supply to the kidney or severe rejection can cause failure and great disappointment to everyone. It is estimated, however, that 95% of living kidney transplants are still functioning at one year and many patients are fit and well twenty years after surgery.
• Relationship and emotional problems can arise within the family for the potential recipient as well as the donor. Potential recipients may feel under pressure from other family members – even the donor – to go ahead with the procedure. It is a topic that needs to be discussed, at length, with all members of the family. The recipient might feel a tremendous sense of guilt about the donor and this needs to be recognised and spoken about.

FOR THE DONORS

Benefits

• A potential donor is likely to have experienced some changes that needed to be made to their own lifestyle due to a family member’s illness (e.g., as a sibling these could include greater domestic responsibilities). A successful kidney transplant may mean the balance of roles/ responsibilities change in a positive way in a family, when a formerly ill person may be able to contribute more to family life.
• Spousal transplantation offers the potential for considerable improvement in quality of life for both parties; if the transplant is a success spouses and families are free of the burden of dialysis.
• The main benefit of donating a kidney is purely an emotional or psychological one. The sense of satisfaction, at giving a loved one a kidney, can sometimes be thoroughly rewarding for the donor.

Risks

• Only one in eight donors that come forward to be tested will be considered suitable as an actual donor. Donors who have gone through testing and found to be unsuitable may be left feeling helpless and disappointed.
• Any patient who has a general anaesthetic or a major operation runs a slight risk of problems, though the tests that are done before the operation try to ensure that this risk is made as small as possible.
• The removal of a kidney involves a rather more difficult and uncomfortable operation than the transplant operation. It involves a degree of post-operative pain and discomfort which can be partly controlled by painkillers. The potential donor should keep in mind that they are likely to feel less well than the recipient in the first few weeks after the operation.
• The tests involved in the process could reveal an abnormality or health problem that the donor was unaware of before volunteering as a potential living donor.
• After the operation, the donor may experience a sense of anti-climax and may be at a slightly higher risk of depression, particularly if he or she or the recipient has post-operative problems.
• An emotional difficulty for the donor may be the worry around how they will face their future with one kidney; the donor may worry that they do not have the ‘assurance’ of the second, in case of serious accidents or illness.
• The risk of the surgery not working out needs to be seriously considered. As we know, no matter how many tests are undertaken beforehand, there is still a risk that the transplanted kidney will fail and the recipient will have to return to dialysis.
• There is a possibility that, as a result of tissue type testing, we will discover that one of your parents or other potential donors is not in fact your blood relative. You need to think about how you could cope with this news before you embark on becoming a living kidney donor.

One of the most common emotional challenges a recipient may face is fear – particularly fear that the transplant will not work out. This can be especially difficult for recipients as they are aware that the donor has made a sacrifice on their behalf. By discussing these issues as openly as possible, difficult situations such as the transplant not working out can be handled in a sensitive and supportive way by all involved.

IN SUMMARY, THE MAIN RISKS OF THE SURGERY FOR DONORS ARE AS FOLLOWS:

1. The risk of death (estimated to be approximately 1 in 1600 – 3300 cases).
2. Negative reaction to anaesthetic or other drugs.
3. The general complications of major abdominal surgery:
   a) Venous blood clot
   b) Intra-abdominal bleeding and infection
   c) Wound complications
   d) Chest complications
   e) Urinary retention/urinary infection
   f) The possible need for blood transfusions
   g) Risk of adhesions and blockage of the bowel
4. The possibility of short and long-term wound pain.
5. The need for a recovery period of between 4-12 weeks. Potential donors should check their sick leave entitlement with their employers.
6. The possibility of increase in blood pressure and protein in the urine.
7. The possible emotional consequences of donation: the risk of the donor feeling pressure from family, feeling worried about the future with one kidney, or feeling upset after surgery.
8. The possible family and relationship consequences of donation: the risk that tensions can arise in families around the surgery or that the balance in a donorrecipient relationship can change after surgery (e.g., a recipient feeling like they “owe” something or are indebted to a donor).
9. The emotional and psychological impact on the donor of the recipient dying suddenly or the transplanted kidney failing.
10. The risk that surgery may impact on the current or future insurability of the donor. This has to be checked by the donor with their own insurance agency.