Donor medicine: An emerging field in nephrology

Donor medicine is an emerging field in nephrology. Medical specialties develop from how organ systems organize, new technologies, or groups of diseases. Donor medicine stands at the intersection of medicine, surgery, public health, and the humanities, but unlike recipient medicine does not involve immunology. Living kidney donors (LKDs) start from a position of excellent health and normal predicted lifespan. Nephrologists have a special obligation to follow altruistic LKDs over the long-term, even though the safety of donation has been generally well established. This paper summarizes the physiological changes associated with LKD surgery, resulting from reduced nephron mass, glomerular hyperfiltration, and blood pressure elevation, to the health risks associated with LKD surgery including chronic kidney disease, proteinuria, hypertension, preeclampsia, adverse psychology, and financial burden. Successful kidney transplantation does not simply mean performing a large number of transplants or even achieving a high long-term recipient graft or patient survival rate. Successful kidney transplantation means that the LKD also performs well in a situation that nature never intended for them. Placing long-term donor health into better perspective will help to provide a framework for establishing donor medicine as a distinct medical specialty, which will in turn encourage LKD and increase organ donation rates.