The Strange Price Some Men Pay After Donating a Kidney? Swollen Balls

Donating a spare kidney is one of the most precious gifts of life a person can give. But the act may come with more tradeoffs than commonly advertised for men. Research out today finds that many men who donate a kidney will later need surgery to fix their swollen scrotums.

Scientists examined the medical records of living male kidney donors in Ontario, Canada. About one in every eight male donors will eventually require surgery to treat a buildup of fluid in their scrotums, they found. The researchers say the findings shouldn’t discourage men from becoming living kidney donors, but they do highlight the need for greater awareness of this potential complication.

“Past and future male donors should be informed about the risk and advised on symptoms to monitor after donation,†they wrote in their paper, published Monday in the Annals of Internal Medicine.

Scrotal swelling

Our bodies carry two kidneys, though we only need one to function normally. That means kidneys are one of the few body parts that we can safely donate while alive (we can also donate parts of other organs, such as the liver or lungs).

Studies have consistently found that the average kidney donor lives as long as they normally would have and likely with few, if any, long-term health effects. But any surgical procedure, including kidney donation, can come with its potential risks, both in the short- and long-term.

Kidneys are typically removed from the donor via a laparoscopic nephrectomy, which makes small incisions in the abdomen. This procedure is generally safer and takes less time to recover from than open surgery. Doctors have noticed, however, that some male donors post-surgery will develop a fluid-filled sac in their scrotum—a condition known as a scrotal hydrocele. This buildup of fluid surrounds the testicle and appears on the same side as where the procedure was performed.

Sometimes, this condition will resolve on its own, especially when it happens in very young children. But in adult men, it’s more likely to persist and can cause noticeable swelling, discomfort, and pain. In more serious cases, people will need surgery to drain or remove the hydrocele.

Though this complication is known to happen in men who donate their kidney, the researchers say theirs is one of the first studies to examine how often men will need surgery to treat it over the long term.

The team analyzed linked healthcare data from residents living in Ontario, Canada (the country provides universal healthcare, making it easier for researchers to study population health outcomes). They identified and tracked nearly 900 men who donated a living kidney between April 2002 and March 2023. They specifically compared the men’s odds of receiving scrotal surgery to non-donor men matched in age and other factors.

All in all, about 8% of men received scrotal surgery following kidney donation during the study period, compared to 0.2% of non-donors. Most of these surgeries (over 90%) were performed to remove a hydrocele. The incidence of surgery also gradually rose over time.

Based on this data, the researchers estimated that about 14% of men who donate a kidney—one in every eight—will need scrotal surgery over a 20-year span, compared to one in every 143 non-donors. They further estimated that about 30% of male donors will eventually receive an ultrasound of their scrotum.

Should men still donate their kidney?

The findings don’t contradict past studies establishing the long-term safety of living kidney donation. And the researchers certainly aren’t calling for men to stop donating their kidneys while alive, noting that most male donors will never need this surgery. “Continuing to encourage living kidney donation is vital, as the practice benefits donors, recipients, families, and society,†they wrote.

But roughly half of living kidney donors are men, and even if having a swollen scrotum isn’t a life-threatening problem, it can still be a plenty stressful one. So while this risk may be small, it’s a real issue that transplant doctors and others should try to mitigate.

“Our findings merit action from the transplant community to safeguard the practice,†the researchers said.

These actions can include informing prospective and past male donors about the risk; ensuring that donors are not forced to pay the costs of scrotal surgery if they happen to need it; and studying whether it’s possible to safely change how kidneys are retrieved from male donors to lower their chances of developing the condition.