Kidney Donation Surgery: What Happens

Medically Reviewed by Zilpah Sheikh, MD on October 31, 2023
Written by Tammy Worth
9 min read

During kidney donation surgery, a donor's healthy kidney is transplanted into a person with kidney failure. The new kidney takes the place of that person's two other kidneys to filter the body's waste. Getting a kidney donation allows someone whose kidneys have failed to avoid being on dialysis for the rest of their lives.

Are transplants always successful?

The success rate of kidney transplants is very high. With a kidney from a living donor, the success rate is 97% after 1 year and 86% after 5 years. If the new kidney comes from a donor who has died, the success rates are slightly lower—96% and 79%, respectively.

How long does a donated kidney last?

Life expectancy after kidney donation surgery is between 8 and 20 years, depending on the recipient's health and the type of kidney they got. The new kidney is likely to last longer if the recipient is in good health before the procedure. Research has shown that having a transplant before starting dialysis can also raise your chances of living longer with the new kidney. This is likely because of the toll dialysiscan take on the body. It can cause long-lasting inflammation, raise the risk of infections, and damage your veins and arteries. People who are young when they have a transplant may need more than one during their lives.

Make a decision

Before you donate your kidney, you need to understand the procedure and know the risks and benefits. You may want to talk with your friends and family about your decision. To get information on the process, talk to an advocate, which every living donor transplant center must make available to potential donors.

If you're considering donating your kidney, there are a few requirements. You must:

  • Be at least 18 years old, with no upper age limit; people older than 70 years can donate kidneys
  • Have two healthy kidneys
  • Be in good health without a history of certain conditions, including high blood pressure, diabetes, and cancer
  • Not have risk factors for heart disease
  • Show you're a willing donor who is not being compensated for your kidney
  • Be prepared to take a physical and psychological evaluation

Find a transplant center

There are several ways to find information on a transplant center for your kidney donation. You can talk with your doctor or the recipient's doctor or see if your insurance plan has a list of preferred physicians. (But you won't use your insurance for the process because the costs are paid for by Medicare or the recipient's insurance.) You can find transplant centers near you on the Organ Procurement and Transplantation Network's website.

Here are some important questions to ask:

  • How many procedures do they perform annually?
  • What are the survival rates for donors and recipients?
  • Do they keep up with the newest technology and transplant practices?
  • Do they have free services like support groups and travel assistance?
  • Do they take part in different types of donation programs like paired organ donation?

Once you've collected information from different centers, you can compare their data with national statistics from the Scientific Registry of Transplant Recipients.

Most kidney donation surgeries are what doctors call minimally invasive, requiring a few small cuts. That makes recovery faster and less painful than it would be with open surgery, which requires a large cut. Most kidney donation operations take 3-4 hours.

Open nephrectomy

Before your surgeon starts, they'll give you a general anesthetic. You won't be conscious or feel any pain during the procedure.

During an open procedure, the surgeon makes a long, diagonal cut from just below your ribs on your back to a little below your belly button in the front. That gives them easy access to the organ and structures around it but leaves you with a 5- to 7-inch-long scar. You'll probably stay in the hospital 3-4 days afterward.

Laparoscopy

Most doctors use this minimally invasive approach. The surgeon makes three small cuts in your belly and uses cameras and small instruments to remove the kidney. You'll probably be in the hospital for 2-3 days. With this type of surgery, you usually have a quicker recovery, a shorter stay in the hospital, and less risk of complications afterward. But not everyone is eligible for laparoscopic surgery. If you've had prior surgery in that area or your anatomy isn't suitable, you'll be told during the testing process. Sometimes, the type of surgery gets changed from laparoscopic to open during the operation.

After the procedure, you'll be moved from the operating room to a recovery room so hospital staff can watch you and keep you comfortable. When you wake up from the anesthesia, you'll notice a catheter in your bladder (so you won't need to go to the bathroom by yourself) and at least one IV line for fluids and medication. You may also need to wear compression stockings and take blood thinners so you don't get dangerous blood clots.

Once you're totally awake, you can start to sip water. If you don't feel sick to your stomach, you can move on to clear fluids before you start to eat normally again. This transition back to regular food usually takes about 1-2 days. You'll also have to wait 2 or 3 days before your catheter and IVs are removed.

How much will it hurt?

Everyone is different, but some people do have pain after the surgery. It will get easier each day, and you can take various types of pain relievers. Shortly after surgery, as your anesthesia wears off, you'll get pain medication through an IV into a vein. You might also have a patient-controlled analgesia device that sends the drug at the touch of a button. Once you start to eat normally, you'll rely on pain meds taken by mouth. You may also have some bloating and constipation for a few days after surgery. This is usually caused by anesthesia.

Most kidney donors recover in the hospital for 2-5 days before heading home. You'll probably still have some discomfort for the next week or 2, but you'll get a prescription for pain medication to keep you comfortable. As your cuts heal, they may feel itchy and tender, and you might end up with a scar.

Full recovery takes time. You should expect to lay low for at least a month after surgery. You may need 6-8 weeks to fully heal. During this time, you shouldn't lift anything heavier than about 10 pounds. You might not be able to drive or operate machinery if you're taking pain meds that make you drowsy.

If you notice blood in your pee or unusual swelling (especially in your legs and ankles), see your doctor right away. Those may be signs your remaining kidney isn't working right.

Whether you have laparoscopic or open surgery, kidney donation is a major procedure. Before making your decision, talk with your transplant team about the potential risks and how they could affect you after surgery. These can include:

  • Infections: If the surgery site becomes infected or you have a urinary tract infection, you'll be treated with antibiotics.
  • Pneumonia: This is always a risk after surgery. Your health care team will work with you on deep breathing and coughing to reduce the risk.
  • Blood clots: Moving around as soon as possible after surgery will reduce the chances of blood clots.
  • Collapsed lung: Because the lungs are near the kidneys, the space around a lung may be nicked during surgery. This could cause it to collapse, which doctors treat by inserting a tube in the chest.
  • Anesthesia allergy: If you have an allergic reaction to anesthesia during surgery, your doctor will fix the problem immediately.
  • Kidney damage: The donated kidney could be damaged.
  • Death: With any surgery, there's a chance that complications or other issues could lead to death.

Does a kidney donation affect your lifespan?

Donating a kidney shouldn't affect how long you live. One study compared donors with similar people who didn't donate a kidney. They found the donors lived about 6 months to 1 year less. The main health issue among donors was chronic kidney disease, which didn't happen until a couple of decades after their donation.

Long-term kidney donation risks

Kidney donation involves few major health risks. But some studies show that donors may have a higher risk of high blood pressure and high levels of protein in their pee. This condition, known as proteinuria, can cause symptoms like:

  • Swelling in the face, stomach, legs, and feet
  • Fatigue
  • Raised need to pee
  • Loss of appetite
  • Muscle cramping

Some other, rare, risks include pain, a hernia, nerve damage, or a blockage in the intestines.

What if you ever need a kidney transplant?

During your health screening before surgery, your transplant team can tell you if you're at a higher risk of getting kidney disease later in life. If you are, discuss the risks with your doctor.

If you do need a transplant, you'll have priority for a kidney from a deceased donor through the United Network for Organ Sharing, which manages the U.S. organ transplantation system. If you donated through a center that takes part in the National Kidney Registry, you'll have priority for a live donor kidney.

What to do if you are concerned

Any major surgery, including kidney donation, can be scary. Your transplant team and advocate can discuss questions and concerns with you and your family. All discussions and health information you share with them are confidential.

Most kidney donors get back to their normal healthy lives with one kidney. The remaining kidney you have will grow larger to make up for the one that was removed. Talk to your doctor, though, about ways your life may change after kidney donation surgery.

Your doctor may recommend you avoid contact sports like:

  • Football
  • Soccer
  • Basketball
  • Wrestling
  • Hockey
  • Boxing or martial arts

If you do choose to participate in a sport with lots of physical contact, talk to your doctor about how to protect your kidney. They may recommend wearing a padded vest or belt under your clothing.

If you've donated a kidney, stay in touch with your doctor to ensure you stay healthy. See your doctor for an annual checkup, during which they'll check your urine and blood pressure and do a blood test to track your kidney's function.

Along with your physical health, it's also important to care for your mental well-being. Between health testing before surgery and going through a major operation, you may not have time to process your emotions until afterward. Though the vast majority of donors have a good experience, some do have depression, anxiety, and family challenges after surgery. You may also worry about your own health and that of the kidney recipient.

If you're concerned about anything or are having negative thoughts or feelings, you can reach out to:

  • The social worker at the transplant hospital
  • A counselor or therapist
  • Your transplant team during follow-up visits
  • Other living donors who have likely had similar feelings

Does a kidney donation affect your insurance?

Donating a kidney shouldn't affect your health insurance coverage. It's illegal for health insurers to deny coverage or charge higher premiums based on preexisting conditions. If you have any issues with coverage after surgery, ask your transplant center for help.

Can you get pregnant after a kidney donation?

Yes, you can. Donors should wait for at least 6 months after surgery to become pregnant. If you have donated a kidney, you will usually have no complications during pregnancy. But you may have a higher risk of conditions like gestational diabetes, high blood pressure, protein in your pee, and preeclampsia (a combination of high blood pressure; high protein in the urine; and swelling in your hands, legs, and feet).

If you plan to become pregnant, talk with your transplant team and your OB/GYN so they can address any issues or concerns. Make sure to stay on top of all the recommended prenatal care to increase your chances of a healthy delivery.

Though kidney donation is a complex process, most donors are glad they've done it afterward. But it's a major decision you shouldn't take lightly. Before choosing to donate, take the time to talk with family and friends. Check out resources available online. And speak with your doctor and local transplant center about any concerns you may have.