Living donor nephrectomy
Keyhole surgery in which a healthy person gives one kidney so it can be transplanted into someone with kidney failure.
Also called kidney donation, donate a kidney, living kidney donor, donor nephrectomy, laparoscopic donor nephrectomy, robotic donor nephrectomy, hand-assisted donor nephrectomy, give my kidney
- Where
- Transplant center operating room
- Anesthesia
- General anesthesia (you are fully asleep)
- Time in the room
- About 2 to 4 hours
- Hospital stay
- Usually 1 to 3 nights
- Back to normal
- About 4 to 6 weeks
- Back to work
- Desk work in 2 to 4 weeks; physical work in about 6 to 8 weeks
Overview
In a living donor nephrectomy, a healthy person, the donor, has one kidney removed so it can be transplanted into someone whose kidneys have failed, the recipient. A kidney from a living donor usually starts working right away and lasts longer than one from a deceased donor, and it can spare the recipient years of waiting on dialysis.
The operation is done through small keyhole cuts, using laparoscopic instruments, sometimes with a hand placed inside through a small cut to help (hand-assisted), or with a surgical robot. The left kidney is usually chosen because its vein is longer, which makes the transplant easier. The guiding rule is that the donor keeps the better kidney.
Your safety comes first. Before you are approved, you go through a careful evaluation of your health, kidney function, and reasons for donating. In the United States, every donor has an independent living donor advocate whose only job is to protect your interests. You can change your mind at any time, for any reason, and the transplant team will keep that decision private.
Risks are low but not zero. The chance of dying from the operation is about 3 in 10,000. Over a lifetime, donors have a slightly higher chance of kidney failure than similar healthy people who did not donate, though the risk stays low for most donors. Your remaining kidney grows and takes on much of the work.
The parts of your body involved
You have two kidneys high in the back of your belly, under the lower ribs. Each one receives blood from a renal artery and drains it through a renal vein, and urine flows from each kidney down a ureter to the bladder. Each kidney is wrapped in fat. On the left side, the kidney's vein is longer because it crosses in front of the aorta to reach the vena cava, which gives the transplant surgeon more length to work with. The left kidney vein also collects blood from the adrenal gland and the gonadal vein (which drains the testicle or ovary), which are carefully divided during donation.
- Kidney
Usually the left one, chosen so you keep the better kidney.
- Renal artery and vein
Divided as long as safely possible so the transplant surgeon can connect them.
- Ureter
Taken with its blood supply so it heals well in the recipient.
- Adrenal gland
A small hormone gland on top of the kidney. It is left in place.
- Remaining kidney
Grows slightly and increases its work after donation.
Why it’s done
People donate to help someone they love, or a stranger, live longer and better without dialysis. The decision is entirely yours.
- A better outcome for the recipient
Living-donor kidneys tend to start working right away and last longer than deceased-donor kidneys.
- A shorter wait
The recipient may avoid years on dialysis, or avoid dialysis entirely.
- Planned timing
Surgery is scheduled when both of you are at your healthiest.
- Helping more than one person
Through paired exchange or nondirected donation, one donor can start a chain of several transplants.
Other options
- Deciding not to donate
Choosing not to donate is always a valid choice. The transplant team will not share your reasons with the recipient.
- Paired kidney exchange
If your blood type or tissue does not match your intended recipient, you can donate to another recipient whose own donor gives to yours.
- Nondirected donation
Giving to a stranger on the waiting list, which can start a chain of transplants.
- Deceased-donor transplant for the recipient
The recipient can wait on the national list for a kidney from someone who has died, which often takes several years.
- Dialysis for the recipient
The recipient can continue or start dialysis while waiting.
Getting ready
Tick items off as you go. Your checklist is saved on this device only.
Months before: evaluation
Weeks before
The day before
The morning of surgery
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Going to sleep and lying on your side
You fall fully asleep and a breathing tube is placed. You are turned onto your side with the donor kidney up, and the table is bent slightly at the waist. A catheter is placed in your bladder. The anesthesia team gives generous fluids to keep the kidney well filled with blood.
The surgeon sits at a console a few steps from you and moves every instrument with hand controls and foot pedals. The robot cannot move on its own or make decisions.
A camera on one arm gives the surgeon a bright, three-dimensional picture magnified about ten times, which helps them see small nerves and vessels.
The instruments are about the width of a pencil and bend like a wrist inside your body, so the surgeon can stitch and dissect through small openings.
A bedside assistant and a scrub nurse stay at the table, and the anesthesia team watches your breathing and blood pressure throughout. Most U.S. hospitals use the da Vinci system made by Intuitive.
After the operation
In the hospital
- Waking up
You wake with an IV, a bladder catheter, and squeezing sleeves on your legs.
- Pain control
Acetaminophen and other non-opioid medicines, with opioids if needed. Ibuprofen-type medicines are avoided to protect your remaining kidney.
- Walking and eating
You walk the same evening or next morning and start eating as your bowels wake up.
- Kidney function test
Your creatinine rises after donation. This is expected and reflects having one kidney.
- Catheter out and going home
The catheter usually comes out on day 1. Most donors go home in 1 to 3 days.
At home
- Pain
Soreness at the cuts, especially the larger one, and shoulder-tip pain from the gas for the first days. Use acetaminophen on a schedule.
- Protect your kidney
Avoid ibuprofen, naproxen and similar pain pills long term unless your doctor approves. Tell every doctor that you have one kidney.
- Tiredness
Fatigue is very common for several weeks, sometimes longer than the pain. Plan rest.
- Incisions
Shower after 24 to 48 hours; avoid baths and swimming for about 2 to 4 weeks.
- Fluids and diet
Drink enough to keep your urine pale. Eat a balanced diet with moderate salt and protein.
- Bowels
Use a stool softener while taking opioid pain medicine.
- Lifting and activity
Walk every day. Avoid lifting more than about 10 to 15 pounds (5 to 7 kilograms) for about 6 weeks.
- Driving
Not while taking opioid pain medicine. Most donors drive again in 1 to 2 weeks.
- Sex and work
Sex when comfortable. Desk work in 2 to 4 weeks; physical work in about 6 to 8 weeks.
Recovery timeline
- Day of surgeryDonation
You wake in recovery and walk that evening or the next morning.
- Days 1 to 3Home
The catheter comes out and most donors go home.
- Weeks 1 to 2Rest
Soreness and tiredness, slowly improving.
- Weeks 2 to 4Back to light routine
Many donors drive and return to desk work.
- About 6 weeksBack to most activities
Lifting limits are lifted for most people.
- 6 monthsFirst formal follow-up
Blood pressure, weight, kidney function and urine protein are checked.
- 1 and 2 yearsRequired follow-up
U.S. transplant centers collect follow-up at 6 months, 1 year and 2 years after donation.
- Every year afterLifelong checkups
A yearly visit with your own doctor for blood pressure, kidney function and urine protein.
What it feels like
Donors often describe the experience as one of the most meaningful things they have done. They also say the tiredness lasted longer than expected and that the emotional side, worrying about the recipient, can be intense.
Deciding
A mix of wanting to help and fear, sometimes with quiet pressure from family.
What helpsTalk openly with your independent donor advocate. You can say no or change your mind at any time, privately.
The day of surgery
Nerves for yourself and for your recipient in the next room.
What helpsAsk the team how and when you will hear about the recipient's surgery.
Waking up
Soreness, grogginess and shoulder pain from the gas. Many donors are surprised by how sore the larger cut feels.
What helpsAsk for pain medicine early, walk often, and hug a pillow when coughing.
The first weeks
Fatigue, and sometimes a dip in mood once the attention shifts to the recipient.
What helpsPlan help at home, rest, and talk with the social worker if you feel low. This is common.
Seeing the recipient do well
Joy and pride for many donors.
What helpsAllow yourself to feel it.
If the recipient has problems
Guilt or grief can follow if the kidney does not work as hoped, though this is uncommon.
What helpsYour gift was still a gift. Donor support groups and the transplant social worker can help.
How well it works
For the donor, success means a safe recovery and a healthy life with one kidney. For the recipient, it usually means a kidney that works right away.
- Your kidney function
After donation, your kidney function usually settles at about two thirds or more of what it was, because the remaining kidney grows and works harder.
- Blood pressure
Donors have a somewhat higher chance of developing high blood pressure over time. Yearly checks catch it early.
- Urine protein
Checked yearly as an early sign of kidney strain.
- Future pregnancy
Pregnancy is possible after donation, with a somewhat higher chance of high blood pressure in pregnancy. Tell your obstetrician you are a donor.
- Priority if you ever need a kidney
In the United States, prior living donors receive priority on the waiting list if they ever need a transplant.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Expected for several weeks.
Fades in 1 to 3 days.
From anesthesia and pain medicine.
May last months.
Less common
Usually treated with antibiotics.
A bulge at the larger cut, sometimes months later.
Uncommon.
Somewhat more likely than in similar people who did not donate.
Gestational high blood pressure or preeclampsia is more common after donation, in about 11 in 100 pregnancies compared with about 5 in 100 in similar non-donors.
Rare
The spleen, bowel or large blood vessels can rarely be injured.
Rarely needed for bleeding or difficult anatomy.
A clot in a leg vein that can travel to the lungs.
Slightly more likely than in similar healthy people who did not donate, but the lifetime risk remains low for most donors.
Very rare.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- Feeling faint, a racing heart, or severe or worsening belly or side pain
- Much less urine than usual, or no urine for 8 hours
- Pain, swelling or redness in one calf, or chest pain or trouble breathing (call 911)
- Vomiting that will not stop, a swollen belly, or no bowel movement for more than 3 days
- Redness spreading from a cut, pus, or a cut that opens
Questions to ask your surgeon
- Which kidney would you take, and why?
- Will you use a laparoscopic, hand-assisted or robotic approach?
- How many donor surgeries does this center do each year?
- What is my personal long-term risk of kidney disease after donating?
- Who is my independent donor advocate?
- What costs will I have to pay, and what help is available?
- How long will I be off work?
- What follow-up will I need, and who pays for it?
- How will donating affect a future pregnancy?
- What happens if I change my mind?
- What happens if my recipient's surgery is delayed or canceled?
Words you may hear
- Pneumoperitoneum
- The gas-filled belly that makes keyhole surgery possible. Carbon dioxide is pumped in through a thin needle or the first port until the belly wall lifts like a tent (usually at a pressure of 12 to 15 mmHg), giving the camera and instruments room to work. The gas is let out at the end, and the little that remains is absorbed and breathed out over a day or two; it can cause shoulder-tip ache in the meantime.
- Living donor nephrectomy
- Surgery to remove a kidney from a healthy person for transplant.
- Donor
- The person giving the kidney.
- Recipient
- The person receiving the kidney.
- Hand-assisted laparoscopy
- Keyhole surgery in which the surgeon places one hand inside through a small sealed cut to help.
- Independent living donor advocate
- A team member who focuses only on the donor's interests and rights.
- Paired kidney exchange
- A program that swaps donors between incompatible pairs so each recipient gets a compatible kidney.
- Nondirected donor
- A person who donates to a stranger on the waiting list.
- Crossmatch
- A blood test that checks whether the recipient's body would attack the donor's kidney.
- Creatinine and eGFR
- Blood test numbers that show kidney function.
- Preeclampsia
- High blood pressure with signs of organ strain during pregnancy.
Common questions
Can I live a normal life with one kidney?
Yes. Most donors live normal, active lives. Your remaining kidney grows and does much of the work of two. Yearly checks of blood pressure, kidney function and urine protein are recommended.
Why the left kidney?
Its vein is longer, which makes the transplant easier. But if your left kidney is the better one, or has more complex blood vessels, the surgeon will take the right one so you keep the better kidney.
Will I have to pay?
The recipient's insurance usually covers your evaluation, surgery and hospital stay. Travel, lodging and lost wages may not be covered. Ask the center's financial counselor about assistance programs.
Can I still have children?
Yes. Many donors have healthy pregnancies after donation. There is a somewhat higher chance of high blood pressure in pregnancy, so tell your obstetrician you are a donor.
Can I still play sports?
Most donors return to their usual sports. Talk with your doctor about contact sports where a blow to the remaining kidney is likely.
What if my recipient's body rejects my kidney?
Rejection is usually treatable with medicines. If the kidney is lost, it does not mean you did anything wrong. Your gift still gave the recipient a chance.
Sources this page draws on
- KDIGO (Kidney Disease: Improving Global Outcomes), Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors (2017)
- Organ Procurement and Transplantation Network (OPTN), Living Donation policies
- JAMA, Perioperative mortality and long-term survival following live kidney donation (Segev et al.) (2010)
- JAMA, Risk of end-stage renal disease following live kidney donation (Muzaale et al.) (2014)
- New England Journal of Medicine, Gestational hypertension and preeclampsia in living kidney donors (Garg et al.) (2015)
- National Kidney Foundation, Living Donation
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.