The hidden emotional costs of giving life: preserving donors' mental health and quality of life after living kidney donation.

Kidney living donation remains the best treatment available for kidney failure. Most living donors report positive personal outcomes, such as enhanced life satisfaction and personal growth. However, mental health challenges have also been documented. The study by Tahir, Aftab and Nabi (J Nephrol https://doi.org/10.1007/s40620-025-02217-5 , 2025) call the attention to a small subset of living donors who may experience significant depression symptoms and occasionally suicidal ideation after donation, particularly when the recipient dies or suffers severe graft failure with a return to dialysis. As observed in the previous studies, only donors whose recipients experienced negative outcomes reported mood alterations or life dissatisfaction (Menjivar et al., Transpl Int 31(12):1332-1344, 2018). These rare post-donation risk scenarios justify a careful mental evaluation to identify psychological vulnerabilities or a history of difficulties in managing and coping with stressful situations. These adverse outcomes appear more likely in donors with pre-donation physical and/or psychological vulnerabilities, in those with a complicated surgical recovery after donation, and in cases where recipients experience poor physical or psychological outcomes. Moreover, cases of graft failure or recipient death might significantly increase donor's likelihood of depression and anxiety, Despite the generally low incidence of psychosocial problems after donation, there have been calls for a more structured and routine follow-up assessment to further mitigate risks and ensure equitable mental health safety for all kidney donors.