By David Wolthuis
Dutch patients with end-stage renal disease who are on the waiting list for a donor kidney may experience the best of human kindness when an altruistic donor decides to give them theirs.
However this altruistic act is illegitimate in a number of countries. For instance, people in Germany cannot altruistically donate their kidney. One of the reasons for this is to protect the future donor from unforeseen risks that kidney donation may bring. Although it is true that one is able to live with one kidney, it does bring certain risks. In a recently published paper in New England Journal of Medicine (NEJM), scientists show that among 52,998 living kidney donors, the risk to develop end-stage renal disease is 3,5 to 5,3 times higher than in the general population, making these donors more likely to become in need of a donor kidney themselves. This exact risk is based on several demographic and clinical factors, including smoking, race and sex. With these and additional variables, the authors also developed a new tool to assess the risk (increase) of developing end-stage renal disease in prospective kidney donors before donation takes place.
With all the risks that kidney donation brings, one can only be amazed by the kindness of living donors. It does however raise the question if these donors should not receive more than mere gratitude for donating their kidney.
Grams et al., N Engl J Med 2016;374:411-21