Practice Clinical update

Living kidney donation

BMJ 2016; 354 doi: https://doi.org/10.1136/bmj.i4746 (Published 14 September 2016) Cite this as: BMJ 2016;354:i4746
  1. Pippa Bailey, clinical lecturer in renal medicine1 2,
  2. Anusha Edwards, consultant transplant and endocrine surgeon2,
  3. Aisling E Courtney, consultant nephrologist3
  1. 1School of Clinical Sciences, University of Bristol, Bristol BS2 8DZ, UK
  2. 2Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
  3. 3Belfast City Hospital, Belfast Health and Social Care Trust, Belfast BT9 7AB, UK
  1. Correspondence to: P Bailey pippa.bailey{at}bristol.ac.uk

What you need to know

  • Living donor kidney transplantation is the best treatment for most people with renal failure

  • There is no upper age limit and few absolute contraindications to living kidney donation

  • A living kidney donor does not always need to be the same blood group as the intended recipient

  • Most donors have no long term ill effects from living with a single kidney

  • Ensure living kidney donors have annual follow-up including blood pressure assessment, urine analysis for protein, and estimation of renal function

Globally each year more than 30 000 people become living kidney donors.1 In the UK there have been more than 1000 living kidney donations every year since 2009.2 There are two types of kidney donation, living and deceased. Living donor kidney transplantation offers the best treatment in terms of life expectancy and quality of life 2 3 4 5 6 7 8 9 for most people with kidney failure (see box 1), the prevalence of which is steadily rising. Living kidney donation is constantly evolving, with new ways of maximising recipient opportunities and increasing information regarding long term outcomes associated with donation. This review presents an overview of current practice covering who can donate, to whom, and the possible impact of donation on the donor’s health.

Box 1: Advantages of living donor over deceased donor kidney transplants

  • Living donor kidney transplants reduce the number of individuals on waiting lists for deceased donor transplants and offer the possibility of a transplant to more patients, who would otherwise be dialysis dependent10

  • Living donor kidney transplants typically last longer, and recipient survival is greater2 3 4 6 7 11

  • Living donor transplants are associated with shorter hospital stays, minimising disruption to recipients’ lives

  • Planned desensitisation of recipients can occur more easily to allow immunologically incompatible transplants

  • The elective nature of the surgery permits transplantation in patients who would be unsuitable for …

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