The rising prevalence of end-stage renal disease and Germany's chronic organ shortage subsequently calls more people upon to consider living kidney donation. The benefits for living donor recipients and the relative low risk of physical complications for donors have been well documented. Less well understood, however, remain the risks of impaired quality of life, hypertension and symptoms of fatigue.

We performed a study on 356 living kidney donors undergoing nephrectomy at our transplant center between 1998 and 2013, and aimed to address the impact of donation on social determinants, mental, and physical health. Quality of life assessment was performed using the standardized short form 12 questionnaire (SF-12). In addition questions on social, financial, and job-related consequences, donation-related stress, and health changes were inlcuded.

The response rate was 90.2%. Using a standardized quality of life score, 51% of donors were in excellent health, while 34% reported of moderately, and 15% of severely compromised health. Severely compromised donors were more likely to be younger, unemployed (25%), or forced to change their job (16%; p<0.05). Chronic pain, hypertension, and symptoms of fatigue characterized donors with compromised quality of life. Donors with preexisting hypertension and positive family history were most likely to develop diabetes mellitus in long-term follow-up (p<0.001). Donors with symptoms of fatigue were more likely to be younger and having physically and mentally demanding jobs (p<0.05). Most donors would be willing to donate again (90%). However, siblings (16%) and donors under 45 years (15%) had more negative attitudes towards donation (p<0.05).

Our results indicate that living kidney donation has an impact on quality of life in long-term follow-up. We identified younger age and an unemployed social status as factors associated with strong impairment on quality of life characterized by the presence of chronic pain, hypertension or symptoms of fatigue. The proportion of donors not willing to donate again was higher in identified risk groups. For adequately informing potential donors, medical professionals must know incidences and impact of long-term complications on physical and mental health in different subgroups. Reliable donor education is the cornerstone to improve society recognition of living donation.

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