*Purpose: Living donor kidney transplantation provides a critical source of high quality grafts for patients with end stage renal disease. Detailed understanding of specific sources of anxiety for donors, means by which they seek reassurance, and rates of realized negative outcomes will help to inform clinicians’ pre-donation evaluation and care of potential kidney donors.

*Methods: Living kidney donors at a single center received a questionnaire one-month prior to their scheduled surgery and 6-months after donation. Short Form Health Survey-36 (SF-36) and the Hospital Anxiety and Depression Scale (HADS) were utilized to measure global mood, quality of life, and overall health. Targeted items and invited respondent comments were employed to assess specific pre-donation concerns and calming methods, while the post-donation questions assessed actual adversities attributed to the donation process.

*Results: Complete, paired questionnaires from 157 donors included 114 women (73%), mean age of 47 years, and 97% Caucasian. Most respondents had some college (81%), were married (75%), and employed (82%). HADS analysis revealed significantly decreased anxiety after donation (3.8 versus 2.9, 28% reduction, p=0.001). While 22% of donors had high levels of anxiety prior to donation (HADS >7), this rate decreased to 9% after donation. Very low pre-donation depression scores were sustained post-donation (1.1 versus 0.9, p=0.32). Post-donation SF-36 scores showed significantly lower physical functional status, more bodily pain, less vitality, and a lower mental health scores than pre-donation. Pre-donation concerns included failure of the kidney transplant and pain associated with surgery. Post-donation, 20% of patients experienced more pain than expected and 22% experienced low energy. All reported good graft function/graft survival. Mean time to full recovery was 2.5 months. Techniques by which most prospective donors sought to reduce their anxiety included consulting with others (transplant team members, other donors, spouse, family, and their intended recipient), prayer, provided education material, and independent internet research. Relatively fewer prospective donors sought input from their personal physician or spiritual/religious leader. Endorsement of themselves as religious or spiritual did not affect pre- or post-donation anxiety or depression scores.

*Conclusions: These data provide critical insight into the pre- and post-donation experience for a large number of living kidney donors.

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