Kidney Transplantation

Procuring of Kidney:

-Live Donor

Simple nephrectomy — The procedure takes place on an angled operating table. You will lie on your side with your body bent sharply at the waist. This stretches your side and it makes the kidney more accessible to the surgical team. The surgeon makes an angled incision through the skin and muscle of your side, either along the lower border of your ribs, or near your 11th or 12th rib. This incision typically extends from your spine, around your side, to the front of your abdomen. If necessary, a portion of one or two ribs will be removed to expose your kidney. Nearby organs are moved aside gently. The kidney's blood vessels and ureter are tied off and cut, and the kidney is lifted out of your body. The internal layers of the incision are closed with sutures; the upper layer of skin is closed with sutures or surgical staples. In some cases, a temporary drainage tube will be inserted to drain fluids from the wound. After surgery, you are moved to the recovery room, where you will be monitored for several hours until you are stable enough to return to your hospital room. After about 24 to 48 hours, the drainage tube is removed. You probably will remain in the hospital for five to seven days.

Laparoscopic nephrectomy — A laparoscope and small surgical instruments are inserted into your abdomen through four small incisions (each incision is about 12 millimeters long). The surgeon uses a tiny camera on the laparoscope to guide the surgical instruments to detach your kidney from connecting blood vessels and your ureter. Toward the end of the procedure, one of the small incisions (usually one located just below the navel) is enlarged to allow the kidney to be lifted out of your body. Using surgical instruments, the surgeon maneuvers the edges of a soft sling underneath your kidney. By pulling on the edges of this sling, the surgeon can lift the kidney out through the incision. At the end of the procedure, the abdominal incisions are closed with sutures or surgical tape.

- Decreased Donor

· Brain Dead Donors. Although brain-dead, the donor's heart continues to pump and maintain the circulation. This makes it possible for surgeons to start operating while the organs are still being perfused. During the operation, the aorta will be cannulated, after which the patients' blood will be replaced by an ice-cold storage solution. Due to the temperature of the solution the heart will stop pumping.

· Donation after Cardiac Death (DCD) donors are patients who do not meet the brain-dead criteria, but have no chance of recovery whatsoever. In this procedure, life support shut off. After death has been pronounced, the patient is rushed to the operating theatre, where the organs are procured, after which the storage solution is flushed through the organs itself. Since the blood is no longer being circulated, coagulation must be prevented with relatively large amounts of anti-coagulation agents, such as heparin.

Placement of Kidney:

Dead Kidney Donor
Once a good donor match is found, the transplant team will notify you immediately. You will travel to the transplant center, where you will have some brief medical tests to confirm that you are still free of infection and ready for surgery. If necessary, you also will have a presurgery dialysis treatment to ensure that your blood chemistry and fluid balance are satisfactory before the procedure.

Once you are ready for surgery, an IV line will be inserted into your arm and you will be given general anesthesia. An incision will be made in the left or right side of your lower abdomen. The donor kidney will be positioned inside you, and its blood vessels connected to yours. Lastly, the donor kidney's ureter will be connected to your bladder.

Your new kidney probably will begin to filter blood and make urine almost immediately after it is transplanted. A plastic tube (catheter) will be inserted temporarily into your bladder to collect the urine that is being made. Your incision will be closed, and you will be taken to the intensive care unit. The entire procedure usually takes 3-4 hours. After a few days, the bladder catheter will be removed, and you will be allowed to go home. The total time in the hospital is usually 4-6 days.

Living Kidney Donor
If you are receiving a new kidney from a living donor, you and your donor probably will be in side-by-side operating rooms. In many medical centers, the donor's kidney is removed with laparoscopic surgery, which uses a tiny, camera to guide surgical instruments inside the body. The camera and surgical instruments are inserted into the body through several small incisions, rather than through a single, large incision. As a result, the donor's average hospital stay is about two days, which is fairly short, as compared to traditional surgery. And recovery is quicker. Traditional surgery requires a larger incision in the side between the ribs and the hip (flank), and it involves the removal of a donor's rib. The hospital stay for this procedure is usually four to five days.

Once the donor kidney has been removed, the rest of the transplant procedure is the same as for a dead kidney donor.