Do not sell a kidney on the assumption that one is spare; 86% of surveyed sellers reported worse health
Among carefully screened kidney donors with medical follow-up, the estimated 15-year risk of end-stage kidney disease was about 31 per 10,000, versus 4 per 10,000 among similarly healthy nondonors. Kidney sellers do not have the same screening and follow-up. Six years after selling, 86% in one survey reported worse health and three-quarters were still in debt.
What it takes
Free. Understand the consequences before considering the money.
What you may gain
A US study compared 96,217 living kidney donors with 20,024 matched healthy nondonors from NHANES III. Estimated 15-year end-stage renal disease (ESRD) risk was 30.8 per 10,000 donors (95% CI 24.3–38.5) versus 3.9 per 10,000 healthy nondonors (95% CI 0.8–8.9), P<0.001. ESRD requires dialysis or transplantation to sustain life. Estimated lifetime risk per 10,000 was 90 for donors, 326 for the unscreened general population and 14 for healthy nondonors. A Norwegian study compared 1,901 donors, median follow-up 15.1 years, with 32,621 donation-eligible controls, median follow-up 24.9 years. Donors had higher all-cause mortality (HR 1.30, 95% CI 1.11–1.52), cardiovascular mortality (HR 1.40, 1.03–1.91) and ESRD (HR 11.38, 4.37–29.6). Overall ESRD incidence in those donors was 302 per million. In another US cohort of 3,698 donors, 11 developed ESRD: 180 cases per million person-years, compared with 268 in the contemporary general population. Of these donors, 255 returned for assessment an average of 12.2±9.2 years after donation. Glomerular filtration rate (GFR) was ≥60 ml/min/1.73 m² in 85.5%; the source describes 60 as the clinical lower limit of normal. Hypertension affected 32.1% and proteinuria—protein leaking into urine—12.7%. A survey of 305 kidney sellers in Chennai, India, conducted on average 6 years after sale, found that 96% sold to repay debt and received an average US$1,070. Average family income fell by one-third after nephrectomy (P<0.001), the number below the poverty line increased, and three-quarters remained in debt. Health was reportedly worse in 86%, and 79% would not recommend selling a kidney.
Context & considerations
The studies differ in comparison groups. Ibrahim compared donors with the general population and found similar survival and ESRD risk. Muzaale and Mjøen compared donors with equally healthy, donation-eligible people and found higher risks. The disagreement concerns whom to compare against. All three agree absolute risk is small: 30.8 per 10,000 over 15 years. The point is not that regulated donation is extremely dangerous, but that the remaining kidney carries a burden, reflected in hypertension and proteinuria, and that these studies involved screened donors with follow-up and access to hospital care. Black-market sellers lack those protections; the Indian survey describes a different outcome. The original studies report self-rated health, proteinuria, hypertension and ESRD, not proportions left bedridden; no such figures are invented here. See China's donation relationship requirements, fines and criminal penalties, and, for people already needing dialysis, taking prescribed medicine and registering for cross-province outpatient chronic-disease reimbursement.
Research & references
Muzaale AD, Massie AB, Wang MC, Montgomery RA, McBride MA, Wainright JL, Segev DL (2014). Risk of end-stage renal disease following live kidney donation. JAMA, 311(6), 579-586. https://doi.org/10.1001/jama.2013.285141 ; Mjøen G, Hallan S, Hartmann A, et al. (2014). Long-term risks for kidney donors. Kidney International, 86(1), 162-167. https://doi.org/10.1038/ki.2013.460 ; Ibrahim HN, Foley R, Tan L, et al. (2009). Long-term consequences of kidney donation. New England Journal of Medicine, 360(5), 459-469. https://doi.org/10.1056/NEJMoa0804883 ; Goyal M, Mehta RL, Schneiderman LJ, Sehgal AR (2002). Economic and health consequences of selling a kidney in India. JAMA, 288(13), 1589-1593. https://doi.org/10.1001/jama.288.13.1589