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The incidence of end-stage renal disease (ESRD) has increased steadily over the last several decades. As a result, the number of patients who require renal replacement therapy for ESRD has also increased; the majority of these patients receive renal replacement therapy in the form of dialysis. Alternatively, a growing number also receive renal replacement therapy in the form of transplantation. As the dialysis population increases, so does the number of patients waiting for a transplant. Although our demand continues to increase, the organ supply has not changed appreciably over the last decades. The shortage of viable standard cadaveric organs has forced the need to innovate and improve the utilization of every possible donor organ to include use of new ex-vivo perfusion technologies,1 expansion of the use of increased risk donors to using known human immunodeficiency virus (HIV) and hepatitis C–positive organs.2,3 Despite these innovations, there remains a significant disparity between the organ supply and demand. This disparity affects our renal population the most, because more patients are surviving to go onto dialysis, and as a result the percentage of patients who are eligible for a transplant also continues to increase. This huge disparity between organ supply and demand limits our ability to transplant every eligible patient. However, in terms of kidney disease, we do have a viable option in live donation. Although it has been demonstrated that live donation is safe with an acceptable risk profile in well-selected patients, and though major complications are rare events, complications do occur.

The donation of living donor organs, however, poses a difficult dichotomous solution to our organ shortage. We subject healthy donors to a potentially lethal procedure in order to improve the survival of another person. Understanding that living kidney donation is a supreme act of generosity and selflessness, transplant teams are compelled to carry out the procedure with little to no risk and negligible patient suffering, allowing donors to return to a fully active and working life. This edict requires we work toward a zero-event occurrence. Thus, we should consistently strive to avoid well-described hazards in live donors.


Living donor nephrectomy has been shown to be a safe procedure that does not cause long-term morbidity. Despite this, it is important to understand that the risk of mortality does exist, so we must be prepared and cautious at all times. The overall mortality from living donor nephrectomy ranges from 0.02–0.06%.4,5

  • One of the causes for conversion of a laparoscopic donor nephrectomy to an open nephrectomy, and even death, is bleeding from the renal artery. This may result from dislodgement of the hemoclip on the renal artery (currently in black box by the U.S. Food and Drug Administration (FDA) for donor nephrectomy), failure of the endoscopic vascular stapler, or multiple arteries not previously identified on preoperative imaging or during nephrectomy. Renal artery bleeding can lead ...

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