Bhasdon,Sherri & Donna summarized the current state of knowledge quite well. (From Sherri's note, I just learned that I am "our unofficial LDO physician." Hmm. What happened to informed consent? 
)
I want to expand two points in what they wrote.
First: Current knowledge about the medium and long term effects of living kidney donation is not adequate, but one issue is clear: living kidney donation raises blood pressure for most donors. The average rise in systolic, the first number in B/P, is six (6) points -- 6 mm Hg (mercury) -- above what it would be without having donated a kidney. That is the *average* increase. The rise in some donors will be more than 6, and in a few donors will be much more. Moreover, most people experience a rise in blood pressure as they got older; by the age of about 60, the majority have high blood pressure. Thus, adding an average of 6 points to what will likely be the rise in our blood pressure as each of us gets older means we will get high blood pressure at a somewhat younger age than we would if we had not donated a kidney.
Thus, living donors are likely to experience the adverse effects of high blood pressure at an age earlier than we would if we had not donated. Those adverse effects are: heart attacks; strokes; and kidney failure (leading to dialysis and being on the list to receive a kidney transplant). Although many kidney specialists focus on the chance of developing kidney failure years after donation (see the article quoted by Sherri), that event is actually rare. The most common severe, life-threatening, problems with high blood pressure are heart attack and strokes -- again, at an earlier age than otherwise.
Heart attacks and strokes due to high blood pressure are largely preventable, though. Controlling blood pressure has been proven to prevent early heart attacks and strokes, and thus can be life-saving.
Bottom line: donors should have our blood pressure checked at least yearly, and also adopt a low salt diet because that diet lowers blood pressure in many people. Moreover, with only one kidney, most likely it is better to start on a simple high blood pressure pill if a donor's blood pressure gets to be 130 or more systolic or 85 or more diastolic (the second number) -- because higher blood pressure also causes damage to the kidneys (or, in our case, to our one kidney) that in turn leads to even higher blood pressure, and so on in a vicious circle. "We should all be worried about our current and future health" means especially "Check our blood pressure yearly, and start treatment if/when it reaches 130 or more systolic or 85 or more diastolic."
This first point also means that, although what happens to GFR after donation is important, for most donors, the measurement more important for health is blood pressure.
Second, current knowledge does not answer your specific questions, Bhasdon; we simply do not know the significance or meaning to the health of living donors of the lower GFR resulting from living kidney donation. (This lack of knowledge was and is especially frustrating to me, a physician who is a living donor, who wants to tell patients -- and himself -- what a medical change means to health.)
Less than 10 years ago, the nephrologists divided "CKD" (= Chronic Kidney Disease) into 5 Stages. GFR (Glomerular Filtration Rate) depends mainly on the number of glomeruli (the microscopic units in kidneys that filter the blood); that number decreases by half with living kidney donation. Statistically, people with a GFR below 60 *AS A GROUP* have a higher chance of developing kidney failure, heart attacks, and strokes than their same-age peers.
But that "GROUP" consists of two subgroups: one subgroup is of people who truly are at increased risk due to disease; and the other subgroup is people are not at increased risk at all. In which subgroup are previously healthy people whose GFR drops close to or lower than 60 due only to their donation of 1/2 of their glomeruli to another person? No-one knows -- because the number of living donors is small and no-one has done real research to answer that question. (A large, several year, research project is being done as we speak; I am guessing it will be about 3 years before results will be in.) As Donna noted, insurance companies assume (but do not know) that GFR at or below 60 means statistically worse health for everyone with that GFR.
But tracking our own GFR is important, too, even with our limited knowledge. As Sherri noted, a small percent of donors go on to develop renal failure, and a small percent of them do so within 5 years -- and those latter people are disproportionally African American. I mean REALLY disproportionally. That finding, discovered at least 3 years ago, has not yet been explained. (WHAT IS THE CAUSE? Was the work-up and evaluation of those potential donors incomplete, such that they were accepted to be donors when a complete work-up and evaluation would have not accepted them? Or did they have risk factors not previously known to cause early kidney failure after living kidney donation? Or did they not receive appropriate F/U care after donation, that could have prevented their slide into renal failure and then dialysis? Or, ...?) What ever the cause(s), medicine should -- must -- discover them and correct them to avoid doing harm to more potential donors. As both a physician and a living donor, I am dismayed that we do not yet know the answer. To say it bluntly, that is neither fair to, nor good medical care for, potential donors, especially black potential donors.
Bottom line: we should track our GFR, even though we do not know its full significance. If it starts going down more than, say, 2 points per year for 3 years, see a nephrologist.
On a cheerier note, the recipient and her "new/used" kidney are getting along well together. Carolyn and I recently hosted a "2 year anniversary" dinner for her, her family, her husband's parents, another non-directed donor (who had donated in Nov 2009) and her recipient and friend, and some of the people at Swedish Medical Center's Organ Transplant Program in Seattle, including our surgeon (for the other non-directed donor and me) and his wife. I was thankful for the many virtual ("spiritual"?) gifts I received on the way to donation and since from each person there -- none of which I anticipated -- especially appropriate in this season of Thanksgiving, Hanukkah, and Christmas.
Bill - living kidney donor, non-directed - Nov 24, 2008
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