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Donor Nephrectomy: An Overview

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A healthy kidney from a living donor is surgically removed during a donor nephrectomy and transplanted into a patient whose kidneys are failing.

Written by

Dr. Aysha Anwar

Medically reviewed by

Dr. Karthic Kumar

Published At April 16, 2024
Reviewed AtApril 19, 2024

Introduction:

Kidney transplantation is the recommended course of action for a patient who qualifies. Either a living donor or a cadaver's kidney is removed for transplantation. To alleviate the shortage of cadaveric kidneys available for transplantation, living donor nephrectomy has been created.

What Is a Donor Nephrectomy?

  • A healthy kidney from a living donor is surgically removed during a donor nephrectomy to transplant it into a patient whose kidneys are failing.

  • An option for kidney transplants from deceased donors is a living donor kidney transplant. One of a living donor's two kidneys can be donated, and the remaining kidney can still function as needed.

  • A living kidney donor made the first organ transplant in American history feasible in 1954 when the kidney donation procedure was performed under open surgery. Nowadays, robot-assisted technology may be used throughout most kidney donation procedures, which use minimally invasive laparoscopic techniques.

  • The most popular kind of living-donor operation is donor nephrectomy for living kidney donation.

Why Has It Been Completed?

The kidneys are two bean-shaped organs located beneath the rib cage on both sides of the spine.They are all roughly the size of a fist. The kidneys produce urine to filter and eliminate extra waste, moisture, and minerals from the circulation.

Individuals suffering from end-stage renal illness, also known as end-stage kidney disease, require dialysis (a machine that removes waste from the blood), peritoneal dialysis (a blood filtering process), or kidney transplantation. When it comes to treating renal failure, a kidney transplant is typically preferable to a lifetime of dialysis.

With more individuals waiting for kidney transplants than ever before, donor nephrectomy has become more common for living kidney donation. People in need of a kidney transplant find the living donor option to be an appealing choice because the availability of deceased donor kidneys is significantly less than the demand for living donors' kidneys.

What Kinds of Kidneys Can Be Donated Live?

There are two methods by which one can decide to donate a kidney: The donation is directed to a certain transplant recipient. This is the most typical organ donation from a living donor. Donating an organ without specifying the recipient is a non-directed donation, sometimes called a good Samaritan or altruistic donation. Compatibility and medical needs determine the match.

Donation chain programs or paired-organ donation may be an alternative if an intended recipient in a directed donation is not a good fit due to blood type incompatibilities.

  • Gift of Paired Organs: To ensure that each recipient receives an organ compatible with their blood type, two or more organ recipient pairings switch donors. A non-directed living donor may participate in the paired-organ donation to match incompatible couples.

  • Donation Chain: To create an organ donation chain for compatible recipients, a non-directed living donor may be connected to many pairs of incompatible living donors and recipients. In this case, a single non-directed living donor benefits many recipients.

What Dangers Exist?

There are hazards linked with donor nephrectomy related to the procedure itself, the function of the remaining organs, and the emotional implications of organ donation. As kidney transplant surgery has the potential to save a patient's life, the danger to the kidney recipient is typically minimal. However, a healthy individual may have to undergo and recover from a major surgery if they donate a kidney. The following are immediate surgical hazards associated with donor nephrectomy:

  • Infection with pain.

  • A hernia.

  • Blood clots and bleeding complications from wounds and, in rare instances, death.

How to Get Ready and Choose Wisely?

The choice to donate a kidney is a private one that should be carefully considered, taking into account the benefits as well as the significant risks. Discuss choice with loved ones, close friends, and other reliable advisors. Donating is something one should feel obligated to do and be free to decide not to do. The general requirements for kidney donation consist of the following:

  • Eighteen years of age or older.

  • Overall well-being.

  • Two kidneys in good working order.

  • A readiness to make donations.

  • No prior history of diabetes, renal illness, high blood pressure, certain malignancies, or significant risk factors for heart disease.

  • Completing a comprehensive physical and psychological assessment at the transplant facility.

  • The transplant center must acquire informed permission for the surgery and explain all aspects and possible outcomes of organ donation if it meets the requirements to be a live donor.

What Precaution Should Be Taken During the Procedure?

  • General anesthesia is used during donor nephrectomy procedures. The patient will be unconscious for the treatment, which typically takes two to three hours. The surgical team monitors blood pressure, heart rate, and oxygen levels throughout the procedure.

  • Laparoscopic nephrectomy is the least invasive procedure that surgeons nearly invariably use to remove a living donor's kidney in preparation for a kidney transplant. When a kidney is removed with laparoscopic nephrectomy as opposed to open surgery, there is less discomfort, scarring, and recovery time.

  • A laparoscopic nephrectomy often involves the surgeon making two or three tiny abdominal incisions. The surgical devices that use fiber optics are inserted through tiny incisions called portals or ports. The donor's kidney is removed through a slightly bigger incision.

  • During an open nephrectomy, an incision of 5 to 7 inches (13 to 18 centimeters) is made on the side of the chest and upper abdomen. Spreading the ribs to expose the kidney donor is a common surgical technique involving a retractor.

What Precautions Should Be Taken After the Procedure?

Following a donor nephrectomy, one may need to spend one or two days in the hospital. Following surgery, one should take care of oneself. Medical professionals may advise the patient to remain near the transplant center for a few days following hospital discharge if they live far away. This will allow them to monitor the condition and kidney function.

  • Recuperation: Healthcare specialists will provide specific recommendations on taking care of oneself and lowering the chance of complications during recovery based on general health. This can involve not driving a car for a week or two, not lifting anything heavier, and not spending a lot of time in bed or sitting down.

  • Go Back to Regular Activities: Most recipients of kidney donations can resume their normal daily activities two to four weeks after the procedure. Contact sports and other physically demanding activities that put kidneys at risk should be avoided.

  • Maternity: Generally speaking, kidney donation does not affect one's capacity to conceive or carry a pregnancy to term or deliver a child safely.

Conclusion:

With recognized intraoperative and postoperative morbidity, LDN is a safe procedure. It provides faster recovery, improved cosmesis, and a brief hospital stay. When used by skilled practitioners, it can treat a variety of vascular and ureteral malformations. Although it may be higher in certain cases, such as younger donors and black males, the risk of end-stage renal disease (ESRD) at 15 years after donation has been observed to be low without sacrificing early graft function.

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Dr. Karthic Kumar
Dr. Karthic Kumar

Nephrology

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