A donor nephrectomy is a surgical procedure to remove a healthy kidney from a living donor for transplant into a person whose kidneys no longer function properly.
The kidneys are two bean-shaped organs located on each side of the spine just below the rib cage. Each one is about the size of a fist. The kidneys' main function is to filter and remove excess waste, minerals and fluid from the blood by producing urine.
People with end-stage renal disease need to have waste removed from their bloodstream through a machine (hemodialysis), via a procedure to filter the blood (peritoneal dialysis), or via a kidney transplant.
Living-donor kidney transplant is an alternative to deceased-donor kidney transplant. A living donor can donate one of his or her two kidneys, and the remaining kidney is able to perform the necessary functions.
The first successful organ transplant in the U.S. was made possible by a living kidney donor in 1954 and used traditional (open) surgery for the kidney donation surgery. Currently, the vast majority of kidney donation surgeries are performed using minimally invasive laparoscopic techniques and also robot-assisted technology.
Living kidney donation via donor nephrectomy is the most common type of living-donor procedure. About 5,000 living kidney donations are reported each year in the U.S.
Living kidney donation via a donor nephrectomy offers those in need of a kidney transplant an alternative to waiting for a deceased-donor organ to become available.
A kidney transplant is usually the treatment of choice for kidney failure, compared with a lifetime on dialysis.
Living-donor kidney transplants offer several benefits to the recipient, including fewer complications and longer survival of the donor organ when compared with deceased-donor kidney transplants.
The use of donor nephrectomy for living kidney donation has increased in recent years as the number of people waiting for a kidney transplant grows. The demand for donor kidneys far outweighs the supply of deceased-donor kidneys, which makes living-donor kidney transplant an attractive option for people waiting for a deceased-donor kidney to become available.
You may choose to donate your kidney in one of two ways:
If you and your intended recipient in a directed donation have incompatible blood types or are otherwise not a suitable match, paired-organ donation or donation chain programs may be an option.
In paired exchange donation, two or more organ-recipient pairs trade donors so that each recipient gets an organ that is compatible with his or her blood type. A nondirected living donor also may participate in paired-organ donation to help match incompatible pairs.
More than one pair of incompatible living donors and recipients may be linked with a nondirected living donor to form a donation chain in order to receive compatible organs. In this scenario, multiple recipients benefit from a single nondirected living donor.
In paired organ donation, living donors and their recipients aren't compatible for a transplant. However, the donor of each pair is compatible with the recipient of the other pair. If both donors and recipients are willing, your doctors may consider a paired donation.
More than one pair of incompatible living donors and recipients may be linked with a nondirected living donor to form a donation chain in order to receive compatible organs.
Donor nephrectomy carries certain risks associated with the surgery itself, the remaining organ function and the psychological aspects involved with donating an organ.
For the kidney recipient, the risk of transplant surgery is usually low because it is a potentially lifesaving procedure. But kidney donation surgery can expose a healthy person to the risk of and recovery from unnecessary major surgery.
Immediate, surgery-related risks of donor nephrectomy include:
Living-donor kidney transplant is the most widely studied type of living organ donation, with more than 50 years of follow-up information. Overall, studies show that life expectancy for those who have donated a kidney is the same as for similarly matched people who haven't donated.
Some studies suggest living kidney donors may have a slightly higher risk of kidney failure in the future. But this risk is still smaller than the average risk of kidney failure in the general population.
Specific long-term complications associated with living kidney donation include high blood pressure and elevated protein levels in urine (proteinuria).
Donating a kidney or any other organ may also cause mental health issues, such as symptoms of anxiety and depression. The donated kidney may fail in the recipient and cause feelings of regret, anger or resentment in the donor.
Overall, most living organ donors rate their experience as positive.
To minimize the potential risks associated with donor nephrectomy, you'll have extensive testing and evaluation to ensure you're eligible to donate.
Making the decision to donate a kidney is a personal one that deserves careful thought and consideration of both the serious risks and benefits. Talk through your decision with your friends, family and other trusted advisers.
You should not feel pressured to donate, and you may change your mind at any point.
The Centers for Medicare & Medicaid Services and the Organ Procurement and Transplantation Network (OPTN) require that living-donor transplant centers provide an independent living-donor advocate to protect the informed consent process. This advocate is often a social worker or counselor who can help you discuss your feelings, answer any questions you have and assist in protecting your best interests throughout the donation process.
General criteria for kidney donation include:
If you meet the requirements to be a living donor, the transplant center is required to inform you of all aspects and potential results of organ donation and receive your informed consent to the procedure.
Your physician or your living-donor kidney recipient's physician may recommend a transplant center for your donor nephrectomy.
You're also free to select a transplant center on your own or choose a center from your insurance company's list of preferred providers.
When considering a transplant center, you may want to:
Once you've gone through the living organ donor screening, evaluation and informed consent process, your donor nephrectomy procedure will be scheduled for the same day as the transplant surgery for the recipient. Separate medical teams and surgeons normally perform the donor nephrectomy transplant surgery, but they work closely together.
You'll receive instructions about what to do the day before and the day of your kidney donation surgery. Make note of any questions you might have, such as:
Donor nephrectomy is performed with general anesthesia. This means you will be asleep during the procedure, which usually lasts two to three hours. The surgical team monitors your heart rate, blood pressure and blood oxygen level throughout the procedure.
Surgeons almost always perform minimally invasive surgery to remove a living-donor's kidney (laparoscopic nephrectomy) for a kidney transplant. Laparoscopic nephrectomy is associated with less scarring, less pain and a shorter recovery time than is traditional open surgery to remove a kidney (open nephrectomy).
In a laparoscopic nephrectomy, the surgeon usually makes two or three very small incisions close to the bellybutton, which are used as portals (ports) to insert the fiber-optic surgical instruments. The equipment includes a small knife, clamps and a special camera called a laparoscope that is used to view the internal organs and guide the surgeon through the procedure.
A slightly larger incision is made below the bellybutton to remove the donor kidney.
In open nephrectomy, a 5- to 7-inch (13- to 18-centimeter) incision is made on the side of the chest and upper abdomen. A surgical instrument called a retractor is often used to spread the ribs to access the donor's kidney.
After your donor nephrectomy, you'll likely stay in the hospital for one or two days.
In addition, you can expect:
Care after your surgery. If you live far from your transplant center, your doctors will recommend that you stay close to the center for a few days after you leave the hospital so that they can monitor your health and remaining kidney function.
You'll likely need to return to your transplant center for follow-up care, tests and monitoring several times after your surgery. Transplant centers are required to submit follow-up data at six months, 12 months and 24 months after donation. Your doctor may conduct your laboratory tests one and two years after your kidney surgery.
Pregnancy. Kidney donation normally does not affect the ability to become pregnant or complete a safe pregnancy and childbirth. Some studies suggest kidney donors may have a small increase in risk of pregnancy complications such as gestational diabetes, pregnancy-induced hypertension, preeclampsia and protein in the urine.
It's usually recommended that women wait at least six months to a year after living donation before becoming pregnant.
During a living-donor laparoscopic nephrectomy, two or three very small incisions (ports) about 5 to 12 millimeters in size are used to insert the laparoscopic equipment. A slightly larger, 5- to 7-centimeter incision is made above or below the bellybutton for removal of the kidney. The removal incision may be vertical or horizontal depending on your situation.
In a living-donor laparoscopic nephrectomy, the surgeon uses a special camera called a laparoscope to view the internal organs and guide the procedure to minimize scarring and recovery time. The donor kidney is removed through a small incision below the bellybutton and transplanted into the recipient.