Donor Nephrectomy

WHAT IS DONOR NEPHRECTOMY?

A donor nephrectomy is a surgical procedure in which a healthy kidney is removed from a living donor, to be transplanted into a patient with kidney dysfunction. 

The kidneys play a major function in the body. Their main role is to filter and remove waste and toxic substances from your body and return vitamins, amino acids, glucose, hormones, and other vital substances into the bloodstream.

Donor nephrectomy is performed through either an open (traditional) or laparoscopic donor nephrectomy surgical approach. Laparoscopic donor nephrectomy is a surgical diagnostic procedure, used to examine the organs inside the abdomen. Laparoscopy is a low-risk, minimally invasive procedure that requires only small incisions, unlike open surgery which uses large incisions. 

Although lap donor nephrectomy takes a longer time, it records a lower casualty and recovery time than open surgery.

TYPES OF LIVING DONOR NEPHRECTOMY

• Direct Donation

Indirectly donating a kidney, the donor names a particular transplant recipient. This is the most common type of living donor organ transplant. Family members and friends use this type to transfer their healthy kidneys to their loved ones. If the donor and recipient are not compatible or a match (in blood types), paired-organ donation chain programs may be an option.

• Indirect/Good Samaritan Donation

Here, the doctor doesn’t name the recipient. The match is guided by medical needs and compatibility. Indirect or non-directed donation is also known as an altruistic donation.

• Paired-Organ Donation

When the direct donation doesn’t work out, then on the agreement, a cross-exchange between members of each pair group is deemed possible. This means groups [D₁R₁] and [D₂R₂] exchanging their organ. Thus, D₁ donates to R₂, and D₂ donates to R₁, resulting in a paired-organ donation of [D₁R₂] and [D₂R₁] pairings.

• Donation Chain Program

This is a kidney donor chain initiated by a Good Samaritan donor, who offers to donate a kidney on a philanthropic basis. Anyone who needs a transplant will take a compatible organ from that poll for him/her. A kidney donor chain creates opportunities for endless recipient-donor pairings.

BENEFITS OF DONOR NEPHRECTOMY

• Deceased donor kidneys can’t meet the demand for donor’s kidneys, and hence, a living donor offers attractive bail-out options.
• Fewer complications than open surgery.
• The long survival of the donor’s organ than the deceased’s.
• Provision of alternatives to waiting for a deceased donor’s organ to be available.
• Intervention option for kidney failure patients who could’ve depended on dialysis all their life.

RISKS

Especially on the part of the donor, the risks of donor nephrectomy are much. The risks of donor nephrectomy in general, include:

• Pains.
• Hernia.
• High blood pressure.
• Reaction to anesthesia.
• Bleeding and blood clotting.
• In rare cases, death may occur.
• Conversion to open nephrectomy.
• The risks of re-admission to a hospital.
• Elevated urine protein levels (proteinuria).
• Infections (pneumonia or wound infections).
• Wound complications that need re-operation.
• Mental health issues (anxiety, depression, etc).
• Slightly higher risk of kidney failure in the future.

The worldwide mortality rate for living kidney donors is 0.03%─0.06%. The risks associated with donor nephrectomy are enormous. 

The potential risks accompanying donor nephrectomy can be minimized if you will have extensive testing and evaluation to ensure you’re eligible to donate. 

You should also be exposed to detailed information on donor nephrectomy; seek advice from friends, family, social groups, and some previous kidney donors. 

Healthcare counselors are always at your disposal, to counsel you on the risks and benefits of donor nephrectomy before you make a personal decision.

DONOR NEPHRECTOMY STEPS & PREPARATION

A decision to donate your kidney is purely your own choice. A careful evaluation of the risks and benefits of the procedure is necessary. 

The following are the steps to prepare for kidney donation:

1. Take decision steps.
2. Making an informal decision.

Your decision shouldn’t be based on sympathy, but on a good understanding of risks and benefits. Potential risks may be deemed enormous.

• You shouldn’t feel pressured to donate (and you’re free to change your mind at any point).
• You should provide an advocate to protect your consent. The Centers for Medicare and Medicaid Services (CMMS) and the Organ Procurement and Transplantation Network (OPTN) stipulate that living-donor transplant centers provide an independent living-donor advocate to protect the informed consent process; either a social worker or counselor who can stand in for you, to protect your best interests throughout the donation process.
• You should meet the kidney donation criteria, such as:

1. Be 18 years old or above.
2. Have general good health.
3. Have two well-functioning kidneys.
4. Be willing to donate without persuasion.
5. No history of:

• Diabetes.
• Kidney disease.
• Certain cancers.
• High blood pressure.
• Major risk factors of heart disease.

 

• Completion of a thorough physical and psychological evaluation at the transplant center.

If you meet all requirements to be a living donor, you’ll be informed by the transplant center, on all aspects, and potential results of organ donation, and they’ll receive your informed consent to the procedure.

• Choose a transplant center.

You are free to choose any transplant center of your choice, or from your insurance company’s list of preferred providers. You may seek the assistance of your doctor as well, or that of your recipient’s doctor, to recommend a good transplant center for your donor nephrectomy. 

While you consider a transplant center, be guided by the following vital information:

1. Additional services provided by the center, such as:
2. Support groups.
3. Travel arrangement.
4. Referrals to other resources.
5. The transplant center’s organ donor and recipient survival rates.
6. The number and type of transplants the center perform each year.
7. The center’s commitment to keeping up with the latest transplant technology and techniques.
8. Transplant center participants in paired-organ donation or donation chain exchange programs.
9. Compare the center’s stats through a database maintained by the Scientific Registry of Transplant Recipients.

THE DONOR NEPHRECTOMY PROCEDURE

Specialty	Urologist, Transplant surgeon, Surgeons.
Venue	Transplant center.
Duration	2 – 3 hours.

 

1. Before The Procedure.
2. Your donor nephrectomy will be scheduled, once you’ve undergone screening, evaluation, and informed consent process. 
3. Your donor nephrectomy will be scheduled the same day as the transplant surgery for the recipient.
4. The nephrectomy and transplantation will be headed by separate teams and surgeons, although working closely together.
5. Instructions on what you’re to do the day before and on the day of your kidney donation will be passed to you.
6. Feel free to ask questions concerning fasting, medications, and time of arrival at the hospital.
7. Ask about the dos and don’ts, before, during, and after the procedure.
8. During The Procedure.

The procedure is performed with anesthesia (meaning that you will be asleep during the procedure). The medical team monitors your heart rate, blood pressure, and blood oxygen level throughout the procedure. 

Surgeons usually perform minimally invasive surgery to remove a living donor’s kidney (laparoscopic nephrectomy) for a kidney transplant. It takes 2─3 hours to perform.

1. 2─3 small incisions are made close to the navel, which are portals to insert the surgical instruments.
2. A slightly large incision is made below the navel, to remove the donor’s kidney.
3. The process to remove the donor’s kidney is guided by a special camera called a laparoscope. 
4. When the donor’s kidney is removed, the incision is closed.

Small knives and clamps are also used in the process. With an open nephrectomy (which is uncommon), a 5─7 inch (13─18cm) incision is done on the side of the chest and upper abdomen. Using a retractor, a surgical instrument, the ribs are spread to assess the donor’s kidney.

1. After The Procedure.
   1. After successful donor nephrectomy, you will likely remain in the hospital for one or two days.
   2. Your doctor will recommend that you stay close to the transplant for some days after leaving, for a close monitor of your health and kidney function.
   3. You’re expected to turn in for follow-up care, tests, and monitoring, several times after the surgery.
   4. Transplant centers are required to submit follow-up data at 6 months, 12 months, and 24 months, after the donation.
   5. Your doctor may request you come to enable the conduct of your lab tests one and two years after your donation surgery.
   6. You’ll be advised on how to take care of yourself to reduce the risks of complications during recovery. These may include:
2. Manage your pain.
3. Care for your incision.
4. Return to a normal diet.
5. Don’t drive for one or two weeks.
6. Don’t sit or lie on the bed for a long time.
7. Don’t lift any objects of more than 10 pounds (4.5kg) for a month.
8. You may go back to your normal daily activities after 2─4 weeks.
9. Avoid sports or other strenuous activities.
10. You should wait for about 9─12 months before becoming pregnant, to avoid the risk of pregnancy complications.

DONOR NEPHRECTOMY COST

The estimated cost of a kidney transplant was $18,000 in India, $32,000 in Nigeria (most active centers), $78,000 in UK, and $117,000 in USA.

FAQs

• What is the oldest age to get a kidney transplant?

Nobody is too old to get a kidney transplant. Some countries don’t even have age restrictions to the procedure. Almost half of all Americans suffering from kidney disease are older than age 65, and the wait time for hopeful recipients aged 65 and older is nearly four years.

• Can a 75-year-old donate a kidney?

Kidney transplants using organs of live donors from age 75 and older are safe for the donors and a lifesaver; as neo-researches suggest.

• How many living kidney donors are there?

In the United States, more than 6,440 living donors donated their kidneys in 2018. It is estimated that more than 5,000 living donors donate their kidneys annually.

• Can an O-positive donate a kidney to anyone?

Donors with the blood type-O can donate to recipients with blood types A, B, AB, and O. According to biology, blood type-O is a universal donor, and can be compatible with any other blood type.

• Can a male receive a female kidney or vice versa?

Only in some exceptional conditions can males donate kidneys to females successfully. Female-to-male kidney donations aren’t suggested, especially in aged patients with a history of dialysis.