The likelihood of dying for individuals who donate a kidney for transplant—previously considered low a decade ago—has significantly decreased by over 50%, according to a recent study.
The likelihood of dying for individuals who donate a kidney for transplant—previously considered low a decade ago—has significantly decreased by over 50%, according to a recent study.
Annually, around 6,000 Americans step forward to donate a kidney, as reported by the Organ Procurement and Transplantation Network. Before the procedure, donors are made aware of possible risks, including the risk of death. From studies conducted between 1995 and 2009, experts estimated that approximately three out of every 10,000 donors could die within three months post-surgery. However, the new researchers claim that improvements in surgical methods, selection of donors, and aftercare have outmoded that prediction.
Examining 30 years’ worth of medical records from 164,593 kidney donors nationwide, a team led by NYU Langone Health researchers discovered that by 2022, fewer than one death occurred for every 10,000 donations. This resulted in just 36 deaths over a three-decade span.
“While we have always recognized kidney donation as a safe process, our findings indicate that donor fatalities are extremely rare, making the procedure safer than it has ever been,” stated study lead author Allan Massie, PhD. Massie directs the Center for Surgical and Transplant Applied Research (C-STAR) Quantitative Core at NYU Grossman School of Medicine, where he also teaches in the Surgery and Population Health departments.
The study revealed that, although the overall risk of death remained low, male donors and those with a history of high blood pressure had a higher likelihood of dying within 90 days following the procedure compared to other donors. However, factors like age, race, and ethnicity did not impact mortality rates.
Massie pointed out that surgical techniques have evolved significantly since the 1990s. The traditional open donor nephrectomy, which involves a large 6- to 8-inch incision, has mostly been replaced by laparoscopic nephrectomy. This method is less invasive, utilizing a smaller incision and a camera inserted through a thin tube to guide the surgery.
Published online on August 28 in the Journal of the American Medical Association (JAMA), this report is the first of its kind since 2009 to investigate mortality trends among living kidney donors, providing an updated perspective on organ donation at a time when laparoscopic techniques are the norm, according to the authors.
The research team collected data from the Scientific Registry of Transplant Recipients, managed by the U.S. Department of Health and Human Services. They obtained death records through the Organ Procurement and Transplantation Network, the sole organization authorized by the U.S. Congress to oversee the nation’s transplantation network.
They assessed mortality rates within 90 days of donation, dividing data into three time periods: 1993–2002, 2003–2012, and 2013–2022. They compared outcomes across these periods while accounting for various demographic and health factors, including sex, body mass index (BMI), and the type of surgery performed.
The findings indicated that approximately half of the deaths occurred within the week following donation, mainly due to surgical blood loss. Additionally, mortality rates remained consistent from 1993 to 2012, with 13 deaths recorded before 2003 and another 18 from 2003 to 2012. In contrast, since 2013, only five donors have died within 90 days of their operation.
According to study co-author Dorry Segev, MD, PhD, the current guidelines informing potential kidney donors about risks need updating to reflect nearly a decade’s worth of safety advancements. Segev serves as a professor and vice chair in the Surgery department at NYU Grossman School of Medicine and directs C-STAR.
“As both a kidney donor and researcher in this field, it’s encouraging to see the advancements we’ve achieved,” added study co-author Macey Levan, JD, PhD, an associate professor at NYU Grossman School of Medicine, who has also chaired the C-STAR Qualitative Core. Levan serves as vice president of patient and donor affairs for the Organ Procurement and Transplantation Network and donated a kidney to her cousin in 2009.
The study received financial support from National Institutes of Health grants R01DK132395 and K24AI144954.
Segev has acted as a consultant for pharmaceutical companies including AstraZeneca, CareDx, Moderna Therapeutics, Novavax, and Regeneron and has received speaker fees from various health organizations. Co-author Levan has received personal fees from PatientsLikeMe and Takeda. None of these organizations participated in this study, and all relationships were managed according to NYU Langone Health’s policies.
Alongside Massie, Segev, and Levan, Jennifer Motter, MHS, from NYU Langone also contributed to the study. Jon Snyder, PhD, from the Hennepin Healthcare Research Institute in Minneapolis, Minnesota, was another co-investigator in the research.
