During the kidney donor operation, you will be put under general anesthesia, which means that you will be given medications to put you to sleep, block pain and paralyze your body. You will also be placed on a machine to help you breath. The anesthesiologist will discuss with you in more detail about the anesthesia prior to your surgery.
Once you are asleep, a breathing tube, intravenous lines and a urinary catheter will be placed in your body. To keep you from vomiting, you may have a tube placed through your nose into your stomach to drain the contents of your stomach.
The kidney donation surgery involves removing a healthy kidney from your body and placing it into a recipient’s body where it can perform all the functions that a failing kidney cannot. Your kidney will be removed using one of two methods: laparoscopic nephrectomy or open nephrectomy.
This is a minimally invasive procedure in which a special camera called a laparoscope is used to produce an inside view of
the abdominal cavity to remove a kidney. Laparoscopic kidney removal is considered minimally invasive because it minimizes
abdominal incisions required to remove the kidney.
This can be done using three to four small skin incisions to perform the surgery, and then remove the kidney from a low
incision in the pelvis or through a new approach by placing one incision in the navel area. During the procedure, carbon
dioxide gas is passed through one of the incisions into the abdominal cavity to lift the abdominal wall away from the organs
below, creating more operating spaces to perform the surgery. The surgeon will use laparoscopic instruments to separate the
kidney. Once your kidney is separated, your surgeon will remove it through a non-muscle cutting incision in the lower abdomen
area or the navel area (six to seven centimeters).
- Hand Assisted Laparoscopic Nephrectomy
One approach to laparoscopic donor nephrectomy is where the surgeon uses the small incision needed to remove the kidney
during the surgical procedure. Generally, a seven centimeter incision is made over the navel in addition to two small incisions
for laparoscopic operative ports.
A laparoscopic camera and laparoscopic instruments are placed into the ports. Each of these incisions avoid dividing any
muscle. Laparoscopic instruments are used to remove the kidney after the abdomen is inflated with carbon dioxide gas. Once
the kidney is divided, it can rapidly be removed through the navel port, so the recipient surgical team can begin preparation for
Most people are eligible for laparoscopic nephrectomy, but for some donors it may be best to remove the kidney through a traditional “open” procedure. During open surgery, the surgeon makes a nine to eleven centimeter incision on your side to remove the donor kidney. Sometimes the lower rib is removed.
Your surgeon will complete a preoperative evaluation and discuss your options of laparoscopic nephrectomy vs open nephrectomy and which is the most appropriate for you. Note that a small percentage of laparoscopic procedures must be converted to open procedures.
Once your kidney is removed, another surgical team will immediately prepare the kidney for transplantation into the recipient
while your surgeon completes your procedure. In most cases, your donated kidney will begin performing the work of the recipient’s failed kidneys soon after transplant.
Care and Recovery
After your surgery, you will be taken to a specialized Post-Anesthesia Care Unit (PACU) until you have recovered from the anesthesia and there are no signs of immediate or early complications.
After your stay in the PACU, you will be transferred to the surgical inpatient unit where you will be closely monitored until
you are discharged. Immediately after the surgery, some pain, gas and discomfort is normal. The nursing team will carefully
monitor this and administer medication to control the pain. Most kidney donors see a sharp decrease in pain two to three days
after surgery. Getting out of bed and starting to walk will greatly help.
You may need to remain in the hospital longer than expected depending on how quickly you recover, or as determined by your doctor.
After you leave the hospital, you will still be recovering. For the first few weeks, you will have some limits on your daily activities. If you have any complications after the surgery, your recovery time may be longer. During the recovery period,the kidney donor team will follow your progress very closely including a post-surgical clinic visit, usually 2-6 weeks after the kidney donation. If you have any signs of infection or any other complication from kidney donation, you may have to bereadmitted to the hospital or return for additional clinic visits.
Long-Term Follow Up After Donation
You will require long-term follow-up after the kidney donation procedure. It is requested that all living donors commit to having the post-donation follow-up coordinated by the living donor team. If you are unable to return to CCAD for this follow-up, arrangements can be made with your Primary Care Provider (PCP) to ensure that CCAD receives the necessary information.
Follow-up care will consist of clinic visits, blood work, urine samples and vital signs. Your name and clinical information will also be placed in a CCAD database registry for tracking and follow-up purposes.
Any infections disease or malignancy pertinent to acute recipient care discovered during the donor’s first two years of postoperative follow-up care will be disclosed to the donor and will be disclosed to the recipient’s transplant team at CCAD.
Post Donation Kidney Function
- On average, donors will have a 25-35% permanent loss of total kidney function at donation.
- Baseline risk of End Stage Kidney Disease (ESRD) does not exceed that of members of the general population with same demographic profile.
- Donor risks must be interpreted in light of the known epidemiology of both Chronic Kidney Disease (CKD) and End Stage Kidney Disease (ESRD). When CKD or ESRD occur, CKD generally develops in mid-life (40-50 years old) and ESRD generally develops after age 60. The medical evaluation of a young potential donor cannot predict lifetime risk of CKD or ESRD.
- Donors may be at a higher risk for CKD and sustain damage to the remaining kidney. The development of CKD and subsequent progression to ESRD may be more rapid with only one kidney.
- Dialysis is required when reaching ESRD.
- Current practice is to prioritize prior living kidney donors who become kidney transplant candidates.
Benefits Associated with Living Donation
Kidney transplant surgery can be scheduled at a mutually agreed upon time rather than performed as an immediate operation.
A potential psychological benefit for the recipient is that the recipient may experience a positive feeling knowing that the gift came from a loved one, friend or a caring stranger. In addition, the donor may experience the satisfaction of knowing that he or she has contributed to the improved health of the recipient.
Potential Risks Advese outcomes & Complications of Donation
There are risks with all surgeries, especially surgeries that are done under general anesthesia. Many complications are minor and improve on their own. However, in some cases, the complications are serious enough that you might need another surgery or medical procedure. Some patients may require readmission to the hospital for medical care.
The following medical, surgical, psychosocial and financial risks are associated with living kidney donation. These risks may betransient (e.g. temporary or occasional) or permanent and include, but are not limited to the following:
Medical or Surgical Risks
- Discomfort or acute pain or chronic pain
- Gastrointestinal symptoms, including bloating, gas, constipation, nausea, slowing of the gastrointestinal activity
- Post-operative infections: urinary tract or wound. These may require antibiotics.
- Bleeding which could possibly require a transfusion of blood products. If you have bleeding during or after your surgery,you may need blood transfusions or blood products. These may contain bacteria and viruses that can cause infection.Although rare, these infections include, but are not limited to, the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV)
- Increase risk with the use of over the counter medications and supplements (avoid NSAIDS)
- Cardiac complications such as an irregular heartbeat or heart attack
- Pulmonary complications such as atelectasis (collapse of the air sacs in the lungs) or pneumonia
- Blood clots. Despite attempts to prevent them, blood clots may occasionally develop in the legs. These clots can breakfree and move through the heart, lungs, or brain which may cause seriousproblems with breathing, circulatory function,stroke or death. Blood clots are treated with blood-thinning drugs that may need to be taken for long time and/or othertherapeutic procedures
- Abnormal kidney function which may progress to the point of needing dialysis or a kidney transplant
- Nerve damage. This can happen from direct contract with the chest or abdomen, or from pressure or positioning of the arms, legs, or back during the surgery. Nerve damage can cause numbness,weakness, paralysis, and/or pain. In most cases, these symptoms are temporary, but in rare cases they can last for long periods of time or even become permanent
- Rhabdomyolysis. Muscle breakdown from positioning can cause pain, and the by-products can be toxic to the remaining kidney
- High blood pressure
- Protein in the urine
- Chylous Ascites: the accumulation of milky white fluid in the peritoneal cavity usually associated with abdominal distention. This may require re-operation
- Corneal Abrasions: eye scratches that cause pain and temporarily compromise vision
- Pregnancy-related complications post-donation, including high blood pressure, gestational diabetes, protein in the urine or preeclampsia
- Testicular Swelling/Sensitivity/Pain
- Adrenal gland, spleen, or pancreas injury resulting in adrenal insufficiency, splenectomy, or pancreatitis
- Bowel obstruction
- Donor death
There may also be risks associated with your personal medical conditions (i.e. high blood pressure, obesity) that may impact your future health.
- Problems with body image
- Post-surgery depression or anxiety
- Feelings of emotional distress or bereavement if the transplant recipient experiences any recurrent disease or in the event of the transplant recipient’s death
- Potential impact of donation on the kidney donor’s lifestyle
Potential Financial Risks
- Personal expenses of travel, housing, child care costs and lost wages related to live kidney donation might not be reimbursed
- Need for life-long follow-up at the donor’s expense
- Loss of employment or income
- Negative impact on the ability to obtain future employment
- Negative impact on the ability to obtain, maintain, or afford health, disability, and life insurance
- Future health problems experienced by living donors following donation may not be covered by the recipient’s insurance
Health and Life Insurance
After organ donation, health insurance companies might consider that you have a pre-existing condition, and might refuse payment for medical care, treatments or procedures. After the surgery, your health insurance and life insurance premiums may increase and remain higher. In the future, insurance companies might refuse to insure you.
Right to Opt-Out of the Donation Process
You do not have to participate as a living kidney donor.
If you decide to participate, you may change your mind at any time, including the day of your scheduled surgery. If you change your mind, simply notify any member of the Living Kidney Donor Team or Kidney Transplant Team. If you change your mind about participating, your decision and reasons are kept confidential.
Communication between the donor and the Transplant Center’s Living Donor office will remain confidential. Only information crucial to assuring the safe donation/transplantation of the organ will be shared with the corresponding teams.
Please note: You will be asked to sign a consent form acknowledging that you have received this document and stating that you agree to proceed with the evaluation process at your first appointment.