People with Health Complications Can Still Be Kidney Donors. Here’s How.

A Keck Medicine of USC transplant expert explains how coordinated care before, during and after surgery can protect kidney donors from risks and complications.

Kidney donation surgery has come a long way over the years, making it safer than ever before. Minimally invasive laparoscopic procedures, for instance, are now available that allow most donors to go home a day or two after surgery. That said, there are still some health conditions and comorbidities that can make donating a kidney more complicated.

“Health conditions like diabetes, heart disease and autoimmune disorders can all put extra stress on the body during surgery,” says Thin Thin Maw, MD, a transplant nephrologist with the USC Living-Donor Kidney Transplant Program, part of the USC Kidney Transplant Program, the USC Transplant Institute and Keck Medicine of USC. “No matter a patient’s medical history, our top priority is ensuring that the donor is healthy enough to have a safe surgery and enjoy a strong, long-term recovery.”

In the face of complicating factors, kidney donation is still possible, especially if an integrated team of multidisciplinary transplant specialists works together to make sure a living donor is well-prepared for surgery and recovery.

Health conditions that may impact kidney donation

Certain health conditions can weaken critical functions in a donor’s body, making surgery or recovery more difficult, even with laparoscopic surgery. Dr. Maw says that while not all conditions render a person ineligible to donate a kidney, it is important that any of these conditions be evaluated and well-controlled (if not cured) before, during and after surgery.

Cardiovascular disease

Surgery places extra stress on the heart due to changes in blood pressure, fluid shifts, blood loss, the effects of anesthesia and increased oxygen needs.

When a potential living kidney donor has high blood pressure or coronary artery disease, these conditions must be well-managed and under control long before the surgery. More serious conditions, like heart failure or cardiomyopathy, will render a person ineligible to be a donor, for their own safety and to ensure the donated kidney would function optimally for the patient who would receive it.

Cancers

“When someone has a history of cancer, we have to make certain they’re in remission before we’ll subject their bodies to surgery,” Dr. Maw says.

Even then, the effects of cancer can last after the disease has been cleared from the body. Cancer and past cancer treatments, such as chemotherapy and radiation, can weaken the body and cause ongoing inflammation, which slows healing. All of this must be carefully considered when evaluating someone as a potential donor.

Autoimmune disorders

Autoimmune-related inflammation in any part of the body — whether from rheumatoid arthritis, sarcoidosis or lupus — can lead to increased pain and fatigue, or delayed recovery after surgery. Medications used to manage these disorders can also create problems for kidney donations. For example, steroids can slow down healing after surgery, and medicines that weaken the immune system can increase the risk of infection.

“Unfortunately, lupus in particular is very hard on the kidneys, and in some cases, it can lead to kidney failure,” Dr. Maw says. “For this reason, we don’t accept people who have lupus as living kidney donors.”

Diabetes

Diabetes is the leading cause of kidney disease and kidney failure. Because of this, Dr. Maw says, people who have diabetes are usually not good candidates to donate a kidney since they may need kidney support themselves at some point in the future. However, people who have prediabetes may still be able to donate a kidney if they improve their health by better controlling things like blood sugar and cholesterol.

Weight Issues

One health condition that often comes up is being overweight, but Dr. Maw says that people with a high BMI shouldn’t necessarily count themselves out as kidney donors.

“If you’re very muscular, and your BMI is 32, that indicates a very different state of health from someone who carries extra weight around the abdomen, which is more likely linked to metabolic issues or heart disease risk,” Dr. Maw says.

If a prospective donor does have abdominal obesity with metabolic issues, Keck Medicine offers the assistance of its Donate Well program, which helps living kidney and liver donors build healthier lifestyle habits that will help them lose the excess weight and keep it off. Improving overall health can lower the risk of surgery-related complications and support better long-term health.

Working with patients’ health challenges

Living donors with health conditions that could complicate kidney donation surgery need to be careful, but they still have options, Dr. Maw says.

Getting care at an integrated health system like Keck Medicine can be extremely beneficial, because it ensures that a multitude of experts — nephrologists, cardiologists, endocrinologists and/or rheumatologists — can collaborate to make sure any and all treatment plans for a kidney donor are working in harmony with each other, before, during and after surgery.

“With a comprehensive, team-based approach, as well as minimizing pre-donation risks and receiving long-term coordinated care, most kidney donors can go on to live healthy, normal lives,” Dr. Maw says.

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