Updated Data on Risk of Living Kidney Donation

Prospective living kidney donors researching the risks of living kidney donation are often confronted with the statistic that 3 in 10 000 living kidney donors are expected to die from surgical complications. The source of this number is the Segev et al paper ¹ that used data from 1994 to 2009 and found that 3.1 per 10 000 living kidney donors died within 90 days of their nephrectomy. As Segev et al noted, this period included the transition to laparoscopic nephrectomy; the authors suggested that the rise and then fall in donor deaths over this period might be driven by the adaptation to the new technique. However, more recent data from the United Network for Organ Sharing shows that the current risk of death from surgical complications is less than 3 in 10 000.

The authors obtained data from the United Network for Organ Sharing on donor deaths that occurred within 2 years of donation for transplantation years 2010-2022. These data categorized the number of living donor deaths within 2 years of donation by 3 general causes of death: medical (not cancer), accident/homicide, suicide, overdose, cancer, and unknown.

Data on the number of living kidney donors per year was obtained from the public website of the Organ Procurement and Transplantation Network (OPTN). As the window of death that can be attributed to the nephrectomy is 2 years, the deaths within 2022 might correspond to surgeries within 2022, 2021, or 2020. If the risk from surgery is generally falling, then the risk of death per year provided to prospective donors would be an overestimate of the risk of death as it would reflect generally riskier surgeries from previous years.

The death rate from living kidney donation since 2009 was roughly 1.8 deaths per 10 000 living donors, which was roughly 40% less than the risk from 1994 to 2009 provided by Segev et al ¹ The risk of death from 2010 to 2014 was 3.2 per 10 000, the risk of death from 2015 to 2019 was 1.0 per 10 000, and the risk of death from 2020 to 2022 was 1.1 per 10 000. Table 1 shows the number of living donors and living donor deaths that occurred within 2 years of donating (excluding cancer) summarized by the rate of deaths per year by 10 000 donors.

Table 1.

Living Donor Deaths per 10 000 Kidney Donors.

Year	No. of donors	No. of deaths	Risk of death
2010	6278	0	0
2011	5773	5	8.66
2012	5619	2	3.56
2013	5734	1	1.74
2014	5539	1	1.81
2015	5628	1	1.78
2016	5629	0	0
2017	5811	1	1.72
2018	6443	1	1.55
2019	6866	0	0
2020	5234	0	0
2021	5971	0	0
2022	5864	2	3.41
All years	76 389	14	1.83

Risk of death is the number of living donors that were reported as dying of a medical, non-cancer cause within 2 years of donating.

Therefore, since 2010 the risk of surgical death for current living kidney donors has fallen by 40% and is at most 1.83 deaths per 10 000. The number of deaths, the numerator, is based on all non-cancer medical deaths within 2 years of donation so the risk of death reported here may be an overestimate. Prospective donors should be informed of the most recent data concerning the risk of surgery.