Living kidney donation is the treatment of choice for patients with end-stage kidney disease, yet the long-term psychosocial and socioeconomic consequences for donors remain incompletely characterized, particularly in Eastern European cohorts. This study aimed to assess the long-term psychosocial and socioeconomic impact of living kidney donation in a single-center Romanian cohort and to compare donor-reported outcomes by kidney function at last follow-up. We conducted a retrospective cross-sectional assessment of living kidney donors who underwent nephrectomy at a single Romanian transplant center between January 2015 and December 2019. Of an initial cohort of 142 living kidney donors, six had died during follow-up; the remaining 136 donors were evaluated at a mean follow-up of 100.97 ± 17.89 months. Adverse outcomes were stratified by kidney function at last follow-up (eGFR < 45 vs ≥ 45 mL/min/1.73 m2). Overall, living kidney donors reported no regret (0%), no family disruption (0%), no financial burden (0%), and no occupational change (0%), along with low rates of depression (5.1%), anxiety (5.9%), and fear of kidney failure (2.2%). However, 10.3% reported they would not repeat donation if given the choice, and this unwillingness was markedly higher among donors who had reached eGFR < 45 mL/min/1.73 m2 at last follow-up (33.3% vs 6.8%, P = 0.003). Long-term psychosocial outcomes after living kidney donation are overall favorable, but long-term reduced kidney function was associated with donor reluctance to repeat donation, underscoring the importance of rigorous donor selection and careful monitoring of kidney function.
