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Updated: Jan 3, 2026
Single Port Donor Nephrectomy
Published on: March 12, 2011
Living Donor Nephrectomy: Is It as Safe as It Can Be? Analysis of Living Donor Deaths in the United States
Douglas Scott Keith1, Joe Brown2, Kenneth Andreoni3
1From the Sacred Heart Kidney Transplant Program, Sacred Heart Hospital, Pensacola.
Insights
The 90-day death rate from living donor nephrectomy is low, but this study suggests up to two-thirds of these deaths may be preventable. Implementing enhanced safety strategies could further reduce donor risk.
Area of Science:
- Nephrology
- Transplant Surgery
- Public Health
Background:
- The 90-day mortality rate following living donor nephrectomy is approximately 3 in 10,000 donations.
- While the overall risk is low, the potential for preventing these deaths warrants investigation.
Purpose of the Study:
- To analyze the incidence of death after living donor nephrectomy.
- To determine the proportion of these deaths that are potentially preventable.
Main Methods:
- Analysis of 139,186 living donor nephrectomies from the Scientific Registry of Transplant Recipients (1987-present).
- Deaths were categorized within 7, 30, 90, and 365 days post-donation.
- Preventable deaths were defined based on specific criteria, excluding unrelated events and certain causes within 90 days.
Main Results:
- The overall death rates at 7, 30, 90, and 365 days were 1.15, 1.87, 2.73, and 6.18 per 10,000 donations, respectively.
- From 2000 onwards, 19 out of 30 deaths (63%) were deemed potentially preventable.
- Laparoscopic donation showed a non-statistically significant higher death rate compared to open nephrectomy.
Conclusions:
- Up to two-thirds of deaths following living donor nephrectomy may be preventable.
- The transplant community should explore additional safety measures, including simulation training for rare complications, to minimize donor risk.
Introduction:
The reported 90-day rate of death from living donor nephrectomy is 3 in 10,000 donations. Although this risk is low, the important question is how many deaths are preventable?
Methods:
To study this question, all living donor nephrectomy cases, 139,186 procedures, recorded in the Scientific Registry of Transplant Recipients database since its inception in 1987 were analyzed to determine the death rate and the number of deaths that were potentially preventable. Preventable deaths were defined as any death in the first 7 days except due to clearly unrelated events or death from hemorrhage, pulmonary embolism, infection, cardiovascular cause, or suicide in the first 90 days.
Results:
The numbers of deaths at 7, 30, 90, and 365 days after donation were 16, 26, 38, and 86, which translated into 1.15, 1.87, 2.73, and 6.18 deaths per 10,000 donations, respectively. From 2000 onward, when coding was available for cause of death, 19 of the 30 deaths were deemed potentially preventable. The nonrisk-adjusted rate of death with laparoscopic donation was higher than open nephrectomy, but this difference did not reach statistical significance. Conversion from laparoscopic to open nephrectomy occurs in approximately 1 in 100 surgeries, and this rate has remained fairly steady since 2005.
Conclusions:
This analysis suggests that up to two thirds of deaths are potentially preventable. The transplant community should consider additional safety strategies such as simulation training of rare complications to lower donor risk.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management