Kidney Donations and Pregnancy

By Shreya Sharma and Katarina Zorcic

Normal Kidney Function & Living Kidney Donations

The kidneys are responsible for regulating the blood by removing waste and controlling salt and fluid levels in the body. However, certain diseases can cause end-stage kidney disease when the kidneys are nearing the end of their functioning. The most common illnesses causing end-stage kidney disease are high blood pressure and diabetes (What is living, n.d.). 

Kidney failure requires treatment so that the individual can continue to remove waste from the blood successfully. Treatment can occur through dialysis – a machine that filters the blood – or through a kidney transplant. While a kidney can come from a deceased donor, a kidney from a living donor is the preferred option for a transplant candidate whenever possible. A potential living donor must undergo a checkup to ensure they are eligible to donate. The donation process itself requires surgery to remove one of the donor’s kidneys, and after this, the remaining kidney will have to compensate for the loss (What is living, n.d.). 

Living Kidney Donors

There is no evidence of changes in the donor’s life expectancy following living kidney donation, nor is there an increased risk of kidney failure following the surgery. A donor is completely capable of living a normal life with one kidney. The remaining kidney increases in size to compensate for the loss of the other kidney. Of course, it is essential to schedule primary care follow-up appointments following the donation to ensure there are no health issues. Physical activity is possible and encouraged after donation, although waiting for a complete recovery is essential. Additionally, many physicians advise against contact sports that could cause injury to the one remaining kidney. Emotionally, the response is quite varied amongst donors. Many people reflect positively on their experience as a donor because it allowed them to save a life. However, many people also report feeling anxious or sad about their decision, especially during recovery (What to expect, 2020). 

Impacts on a Donor’s Fertility after Donation

There is no research-based evidence suggesting that a donor’s fertility is negatively impacted by the process of donating a kidney. However, recovering from a kidney donation can be physically demanding, so it is advised to delay pregnancy until at least one year after donation. Likewise, recovering from childbirth and pregnancy is also strenuous, and it is best to wait about a year before donating (Kidney Donation, n.d.). If pregnancy occurs soon after donating a kidney, it is crucial to have kidney function monitored by a physician throughout the pregnancy. It may be wise to seek counselling before deciding to donate, primarily due to the complex physical and mental natures of both kidney donation and pregnancy (Kidney Health, 2019). 

Impacts of Kidney Donation on a Donor’s Pregnancy and Childbirth

Given sufficient recovery time and overall health and well-being, there should not be severe kidney-related complications throughout pregnancy and childbirth. There may, however, be some increased risk of pre-eclampsia, which is when the pregnant individual experiences high blood pressure alone or in combination with protein in their urine. As the baby grows and hormone levels change, the kidneys and ureter usually stretch but typically return to normal after birth. There is also no evidence of negative impacts on a developing baby being carried by an individual who has donated a kidney. Risks of premature birth or birth by cesarean section are not heightened by kidney donation (Living kidney donation, 2018). 

Fertility and Pregnancy for Transplant Recipients

Fertility typically returns soon after a transplant is received. Menstruation may take a few months or up to a year to become regulated again. It is advisable to wait to become pregnant for at least one year after receiving a kidney, even though an earlier pregnancy may be possible. It is vital to ensure there is stable, healthy kidney function and good health overall. Pregnant individuals typically do not experience kidney complications if examined regularly by their medical team (Bachmann et al., 2019). However, there is always an element of risk to any pregnancy, and transplant recipients should take extra care and remain closely monitored so that any issues can be treated immediately. Immunosuppressant levels can be affected throughout pregnancy due to changes in body weight and blood volume. Increased doses of one’s anti-rejection medications may be necessary to compensate for these changes. These medications can also have varying effects on the fetus, so it is necessary to discuss the merits and risks of the medicines with a healthcare team. For patients who may have had high levels of creatine or blood pressure issues before pregnancy, there may be an increased chance of complications with the transplant during pregnancy (International transplant, n.d.).

References

Bachmann, F., Budde, K., Gerland, M., Wiechers, C., Heyne, N., Nadalin, S., Brucker, S., & Bachmann, C. (2019, October 23). Pregnancy following kidney transplantation – impact on mother and graft function and focus on Childrens’ longitudinal development. BMC Pregnancy and Childbirth. Retrieved November 4, 2021, from https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2496-z. 

Kidney donation, pregnancy and fertility. NHS. (n.d.). Retrieved November 4, 2021, from https://www.organdonation.nhs.uk/become-a-living-donor/donating-your-kidney/kidney-donor-health-considerations/kidney-donation-pregnancy-and-fertility/. 

Kidney Health Strategic Clinical Network, Alberta Health Services. (2019, July 25). Living kidney donation. Effects on Life. Retrieved November 4, 2021, from https://myhealth.alberta.ca/KidneyTransplant/living-kidney-donation/effects-on-life. 

Living kidney donation, pregnancy and fertility. (2018). Retrieved November 4, 2021, from https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/15436/1819-418-liv-kidney-facts-pregnancy-olc291a.pdf. 

What is living kidney donation? What’s living kidney donation? (n.d.). Retrieved November 4, 2021, from https://www.blood.ca/en/organs-tissues/living-donation/what-is-living-kidney-donation. 

What to expect after Kidney Donation. National Kidney Foundation. (2020, April 16). Retrieved November 4, 2021, from https://www.kidney.org/transplantation/livingdonors/what-expect-after-donation. 

International Transplant Nurses Society. (n.d.). Palliative care in Transplant Medicine – Hartfordhospital.org. Pregnancy and Parenthood after Transplant. Retrieved November 4, 2021, from https://hartfordhospital.org/File%20Library/Services/Transplant%20Services/Symposium/2016-Palliative-Care-in-Transplant-Medicine.pdf.