Don't sell a kidney for money thinking “one less kidney is nothing”: the remaining one does the work of two, and 86% of people who sold a kidney said their health got worse afterward

Cost

Free. Just look at this bill first.

What you get

The U.S. compared 96,217 living kidney donors with 20,024 healthy non-donors with similar characteristics. The latter came from the National Health and Nutrition Examination Survey (NHANES III). Now look at the estimated risk of reaching kidney failure 15 years after donation. For donors it was 30.8 per 10,000 (95% CI 24.3–38.5, the plausible range). For healthy non-donors it was 3.9 per 10,000 (95% CI 0.8–8.9), P<0.001. Kidney failure is technically end-stage renal disease (ESRD), the point at which you need dialysis or a transplant to stay alive. The estimated lifetime risk of reaching ESRD: 90 per 10,000 for donors, 326 per 10,000 for the unscreened general population, and 14 per 10,000 for healthy non-donors. Norway also made a comparison. On one side were 1901 kidney donors with a median follow-up of 15.1 years. On the other were 32,621 controls who would have qualified to donate, with a median follow-up of 24.9 years. Donors had about 30% higher death from any cause (HR 1.30, 95% CI 1.11–1.52). Cardiovascular death was about 40% higher (HR 1.40, 1.03–1.91). Reaching ESRD was about 10 times higher (HR 11.38, 4.37–29.6). The overall ESRD incidence in this group of donors was 302 cases per million. Another U.S. group of 3698 kidney donors had 11 cases of ESRD, equal to 180 cases per million person-years, versus 268 in the general population over the same period. 255 of these people came back for a checkup an average of 12.2±9.2 years after donating. Of them, 85.5% had a kidney filtration rate (GFR) of 60 ml/min/1.73 m² or above; 60 is the clinical lower limit of normal. 32.1% had high blood pressure. 12.7% had proteinuria (protein leaking into the urine). In Chennai, India, 305 people who had sold a kidney were surveyed an average of 6 years after the sale: 96% sold to pay off debt, and received an average of 1070 U.S. dollars. After the nephrectomy, average household income fell by one-third (P<0.001), the number living below the poverty line rose, and three-quarters were still in debt at the time of the survey. 86% reported their health was worse than before the surgery, and 79% would not recommend that others sell a kidney.

Notes

Disputed: the Ibrahim study used ordinary people as the comparison and concluded that donors' survival, and their risk of reaching kidney failure (ESRD), were similar to those of ordinary people. Muzaale and Mjøen changed the comparison to people who were equally healthy and equally eligible to donate, and the risk then came out clearly higher. The disagreement is about who is used as the comparison, not about the donors. All three studies agree the absolute risk is not large (30.8 per 10,000 over 15 years, that is, 30.8 people out of 10,000). So the point is not that “donating a kidney is very dangerous”; the thing to look at is two other matters. The remaining kidney really is paying a price; the shares with high blood pressure and proteinuria are right there. And all of these figures come from people who were screened before surgery, were checked afterward, and could return to a hospital if something went wrong. A black-market kidney sale has none of those three, and the Indian follow-up shows a different outcome. The original studies give only self-reported worse health, proteinuria, high blood pressure and the rate of kidney failure; they have no figures such as “how many were bedridden,” and none is supplied here. For the legal restrictions on relatives in legal donation, and fines and criminal liability, see §9.22 (don't sell your own organs). For people who already need dialysis, see §16.1, §16.2 (take medicine as directed in full; register for chronic-disease outpatient care in another province) for direct settlement across provinces and long-term medication.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. 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
2. 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
3. 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
4. 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

Translated from the Chinese original. Original book, section 1, tip 35. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer