The recent piece “My sister and I each gave our brother a kidney — and faced health consequences decades later” presents an incomplete representation of living kidney donation. While we sympathize with the family’s experience, the fact is that there exist decades of clinical evidence showing that it is safe and low risk for an individual to donate their kidney. While undoubtedly there are exceptions to the rule as is always the case with medical procedures, we remain concerned that highlighting the rare exceptions, rather than the overwhelming safety and lifesaving outcomes of living kidney donation, endangers the tens of thousands of individuals on the kidney waitlist who are in desperate search for a living donor at this moment. Efforts to reduce the number of living kidney donors increase the already fraught state of our transplant system and increase the threat to the future of transplant care.

Every day, more than a dozen individuals die waiting for a kidney transplant. Because there will never be enough deceased donors to meet the demand from those with kidney failure, living donation is the only path where the supply can begin to match the need. Modern surgical advances, along with the current thorough pre-donation evaluation, have drastically reduced the risks; for example, recent studies have shown a mortality rate of less than 1 in 10,000 (which is better odds than the average worker driving to the office) and less than 1% will develop kidney failure. While the proven health risk of living kidney donation is minimal, logistic and financial barriers remain, and donors are too often forgotten soon after donation.  A better system would ensure donors do not have to shoulder too much alone and are more closely followed post-transplant.

As medical practitioners, advocates, and leaders, we must strive to build a more robust, efficient, and safe kidney transplant system. That means providing financial (cost reimbursement) and long-term clinical support, ensuring lifetime follow-up beyond the current mandate of two years, and removing the practical and economic barriers that discourage potential donors from stepping forward.— Andy Howard, chairman of Kidney Transplant Collaborative

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