Kidney Transplant - Adult

Donating a kidney is one of the greatest gifts we can give to a loved one.

Blood relatives, the spouse, or close friends of the kidney transplant recipients can be possible donors. Living donor transplantation is possible because we are born with two kidneys. After removal of one kidney, the remaining kidney takes over completely. Recent studies that examined the long-term effects of kidney donation have not demonstrated any increased risk of kidney disease or decreased lifespan compared to the general population.

An RMTI transplant family; The Carrington's: Gustav, heart transplant receipient 2005; daughter, Denise, kidney donor 2007; and wife Gloria, kidney receipent 2007.

The main advantage of living donation for recipients is that they do not have to wait for years on dialysis to receive a transplant. Many studies have shown better survival of kidneys transplanted from living donors.

Potential living donor candidates also undergo extensive medical and psychosocial evaluation before donation to ensure their safety and well-being.

Blood and tissue typing tests are the initial steps to decide the compatibility of the donor with the recipient. Subsequent testing of donors is necessary to show normal renal function and exclude health problems such as diabetes, hypertension, cancer, heart, liver disease, and infection.

A psychosocial evaluation is done to assess the donor's ability to understand all aspects and possible consequences regarding his or her decision to become a donor. The evaluation also should demonstrate that the potential donor’s decision was made without coercion of any kind.

The suitability of the blood vessels of your kidney for donation is determined with an MR or CT scan, which shows the kidneys, blood vessels, and ureters. This is performed in outpatient radiology as part of the evaluation procedure. Dye may be injected during the scan to help show the veins and arteries of each kidney.

The donor's medical expenses related to the evaluation, surgery, hospitalization, and immediate postoperative care are covered by the recipient's insurance company. If any problems arise in the future directly related to the kidney donor surgery, these are covered as well.

Living Donor Disqualifiers

• Younger than 18 years old
• Financial incentive
• High Blood Pressure
• Diabetes
• Active hepatitis B or C infection
• HIV
• Seriously overweight – can be considered a donor upon losing weight
• Active infection
• Kidney dysfunction
• Blood in the urine
• Kidney stones
• Solicited by advertisements or posted

Donors with a family history of kidney disease, such as polycystic kidney disease or Alport’s disease, or who have both parents with diabetes mellitus may be considered after specific studies are done.

Laparoscopic Kidney Removal
Currently, almost all living donor operations at Mount Sinai are performed laparoscopically, using a surgical telescope inserted through a very small incision. This technique significantly shortens the recovery time compared to the older technique of open flank incision. The donor is admitted to the hospital the morning of the surgery. Surgery is performed under general anesthesia.

Three or four small incisions are made in the abdominal wall. Under direct visualization through a surgical telescope, very narrow surgical instruments are used to dissect the kidney and remove it from its attachments. The kidney is extracted from the lower abdomen through a short incision about three inches long.

After the kidney is removed from the abdomen, it is chilled on ice, and prepared for immediate implantation into the recipient, who will already be anesthetized in a separate operating room.

The operation takes about two to three hours, with additional preparation time before for anesthesia and recovery time afterward. You will be allowed to drink a few hours after you wake up and will start light foods the next day. Abdominal surgery often slows normal bowel function, so return to a normal diet must be gradual. You may be able to go home the next day or the day after depending on how comfortable you are. You may able to return to work within 7-14 days.

It is common to experience discomfort in the neck or shoulders after laparoscopy. This usually disappears in about a day. Backache is also a common complaint and is due to the position on the operating table. This may last a week or more and is relieved with over-the-counter painkillers.

Donor Benefits and Risks
Laparoscopic kidney removal is a new-and-improved version of an established operation. You can expect much less pain, compared with open surgery. The risks of surgery are related to anesthesia, bleeding, and the potential for injury to the kidney or other organs during the procedure, which is rare. If at any time we encounter a problem that cannot be solved by laparoscopy, then a standard incision will be made and the procedure will be completed with open surgery techniques.

There is about a one percent chance of requiring a blood transfusion or a return to the operating room should bleeding occur after the surgery. In more than 500 surgeries performed at Mount Sinai since 1996, the incidence of complications requiring conversion to open surgery, reoperation, or bleeding that requires transfusion has remained at one percent without any death.