Don’t trade “losing one kidney is no big deal” for cash: the remaining kidney has to do the work of two, and 86% of kidney sellers later say their health got worse

No cost at all. It simply requires a clear look at the facts.

U.S. researchers compared 96,217 living kidney donors with 20,024 similarly healthy non‑donors drawn from the NHANES III survey. After 15 years, the estimated risk of developing end‑stage renal disease (ESRD) was 30.8 per 10,000 donors (95% CI 24.3–38.5) versus 3.9 per 10,000 non‑donors (95% CI 0.8–8.9; P<0.001). Over a lifetime, ESRD risk was 90 per 10,000 donors, 14 per 10,000 non‑donors, and 326 per 10,000 in the general population. A Norwegian study of 1,901 donors (median follow‑up 15.1 years) showed a 30% higher overall mortality (HR 1.30, 95% CI 1.11–1.52), a 40% higher cardiovascular mortality (HR 1.40, 95% CI 1.03–1.91), and roughly tenfold higher ESRD risk (HR 11.38, 95% CI 4.37–29.6). Among 3,698 U.S. donors, 11 developed ESRD — an incidence of 180 per million person‑years, compared with 268 per million in the general population. Of those re‑examined after an average of 12.2 years, 255 remained healthy, and 85.5% retained a glomerular filtration rate of at least 60 ml/min/1.73 m², the clinical lower limit of normal. Hypertension affected 32.1% and proteinuria 12.7%. In Chennai, India, 96% of 305 kidney sellers acted to pay debts; they received an average of $1,070. Six years post‑surgery, family income fell by one‑third (P<0.001), poverty rose, and three‑quarters remained indebted; 86% said health worsened, and 79% would not recommend kidney selling to others. The absolute numbers from these studies are 32,621 donors, 24.9 years of follow‑up, 302 ESRD cases, and 9.2 years of average follow‑up after surgery.

Muzaale AD, Massie AB, Wang MC, Montgomery RA, McBride MA, Wainright JL, Segev DL (2014). Risk of end-stage renal disease following live kidney donation. JAMA, 311(6), 579-586. https://doi.org/10.1001/jama.2013.285141；Mjøen G, Hallan S, Hartmann A, et al. (2014). Long-term risks for kidney donors. Kidney International, 86(1), 162-167. https://doi.org/10.1038/ki.2013.460；Ibrahim HN, Foley R, Tan L, et al. (2009). Long-term consequences of kidney donation. New England Journal of Medicine, 360(5), 459-469. https://doi.org/10.1056/NEJMoa0804883；Goyal M, Mehta RL, Schneiderman LJ, Sehgal AR (2002). Economic and health consequences of selling a kidney in India. JAMA, 288(13), 1589-1593. https://doi.org/10.1001/jama.288.13.1589

Controversy: Ibrahim's study uses ordinary people as the comparison group. Its conclusion is that the survival of kidney donors, as well as the risk of progressing to end-stage renal disease (ESRD), is similar to that of ordinary people. After Muzaale and Mjøen changed the comparison group to people who are "equally healthy and equally qualified to donate," the risk becomes significantly higher. The disagreement lies in whom to compare against, not in the donors themselves. All three studies agree that the absolute risk is not large (30.8 per 10,000 over 15 years, i.e., 30.8 people out of 10,000). Therefore, the focus is not on "kidney donation being dangerous," but rather on two other matters. The remaining kidney is indeed paying a price; the proportions of hypertension and proteinuria are right there. All these figures come from a population that underwent pre-operative screening, post-operative follow-up, and could return to the hospital if something went wrong. The black market kidney trade lacks all three of these. The follow-up from the Indian study provides a different outcome. The original studies only provide data on self-reported declining health, proteinuria, hypertension, and the incidence of ESRD; they do not include figures such as "how many people are bedridden," and I will not supplement that here. Family-relationship restrictions on legal donation, fines, and criminal liability can be found in Section 9, Item 22 (do not sell your own organs). For those already requiring dialysis, cross-province direct settlement and long-term medication can be found in Section 16, Items 1 and 2 (take medication in full as prescribed by a doctor, and file for out-of-area registration for chronic and special outpatient diseases).