50320 Donor nephrectomy (including cold preservation); open, from living donor

Name of the Procedure:

Donor Nephrectomy (including cold preservation); open, from living donor

Summary

In an open donor nephrectomy, a kidney is surgically removed from a living donor to be transplanted into a recipient who needs a kidney due to renal failure. The procedure involves open surgery and specialized preservation techniques to keep the kidney viable for transplantation.

Purpose

Medical Condition: End-stage renal disease or severe kidney failure in the recipient. Goals: To obtain a healthy, functioning kidney from a living donor to transplant into a recipient, restoring kidney function and improving the recipient's quality of life.

Indications

• Recipient with chronic kidney disease or end-stage renal disease.
• Living donor in good health and compatible with the recipient.
• Evaluation showing donor’s suitability for nephrectomy without compromising their health.

Preparation

• Fasting: No food or drink after midnight before the surgery.
• Medication Adjustments: Certain medications may need to be stopped beforehand; the healthcare team will provide specific instructions.
• Preoperative Tests: Blood tests, imaging studies (e.g., CT scan), EKG, and kidney function tests to assess both donor and recipient.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: An incision is made in the donor’s abdomen to access the kidney.
3. Dissection: The surgeon carefully dissects around the kidney, preserving blood vessels and the ureter.
4. Cold Preservation: The kidney is flushed with a cold preservation solution to reduce metabolic activity and maintain viability.
5. Removal: The kidney is removed and placed in a sterile container with cold preservation solution.
6. Closure: The incision is closed with sutures or staples.

Duration

The surgery typically takes between 3 to 4 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeon: Performs the nephrectomy.
• Anesthesiologist: Administers anesthesia and monitors patient.
• Surgical Nurses: Assist with the operation.
• Scrub Technicians: Maintain the sterile field and assist as needed.

Risks and Complications

• Common Risks: Pain, infection, bleeding, reaction to anesthesia, and blood clots.
• Rare Complications: Organ damage, hernia, and long-term kidney function issues for the donor.
• Management: Postoperative monitoring and medications to manage pain and prevent infection.

Benefits

• Provides a life-saving kidney to a recipient, significantly improving their quality of life and life expectancy.
• Donors typically resume normal activities with one functioning kidney post-recovery.

Recovery

• Post-procedure care: Pain management, monitoring for complications, and gradual increase in activity.
• Recovery Time: Typically 4 to 6 weeks before returning to normal activities.
• Restrictions: Avoid heavy lifting and strenuous activities during recovery.
• Follow-up: Follow-up appointments to monitor donor’s health and recovery.

Alternatives

• Dialysis: A less invasive option but requires ongoing treatment.
• Deceased Donor Transplant: Availability may be limited; longer wait times.
• Pros and Cons: Living donor transplants often have better outcomes and longer graft survival compared to deceased donor transplants. Dialysis is less invasive but does not offer the same quality of life improvements as a transplant.

Patient Experience

• During Procedure: The patient will be under general anesthesia, ensuring no pain or awareness during surgery.
• After Procedure: Pain and discomfort managed with medications; instructions provided for wound care and activity limitations to aid recovery.