Living Kidney Donation Surgery: What You Need to Know

At Mayo Clinic, we are lucky to have not just one, but three transplant centers with some of the best transplant doctors in the world. And not only do they have the best medical knowledge and bedside manner for our patients, they're also willing to share their knowledge so we can provide helpful donation information to those who might want to consider organ donation.

Dr. Caroline Jadlowiec is the Surgical Director of the Living Donor Kidney Program from Mayo Clinic in Arizona, so we thought an interview with her would provide valuable information to those interested in donating a kidney to someone in need. Recipients will also find this information helpful to understand what your donor may go through and as a resource to send to your potential donors so they can make an informed decision about organ donation. Living donor practices vary by transplant center and the below information is generalizable but may vary if you are at another transplant center or Mayo Clinic location.

How can I best prepare for kidney donation surgery?

In the week leading up to your surgical donation date, the donor team will check in with you to make sure you haven't experienced any changes to your health. Sometimes donors may need to modify their medications in preparation for surgery, but most of the time there are no changes that need to be made in preparation for surgery other than continuing to maintain a healthy lifestyle. Most people undergoing kidney donation surgery will spend one night in the hospital, so it is helpful to pack a small bag with items you may need during your stay. You can find more ideas about what to pack in your bag on our blog. All jewelry needs to be removed prior to surgery so it may be better to leave jewelry items at home. You will be asked to begin fasting (no food or drink by mouth) at a certain time the night before your surgery.

What factors go into choosing a surgery date and time?

Both the donor and recipient are considered when choosing a surgical date and time. Donor and recipient surgeries may occur on the same or different days. There are different donation pathways that exist which include directed donation, advanced voucher donation, or traditional paired donation. Your transplant team will help advise you on what pathway might work best for you and your intended recipient.

Living donor surgeries can occur at any time of the day. The timing depends on other surgeries happening that day as well as the type of donation occurring. For donors donating as part of a kidney exchange (voucher donation or paired donation), their kidneys often travel to other transplant centers. In these situations, the donation surgery usually occurs earlier in the day to allow the kidney time to travel to its destination.

Is it common for surgery dates to be moved?

Surgical dates can sometimes change. Kidney recipients undergo an updated evaluation in preparation for their upcoming transplant surgery 2-3 weeks prior to their surgical date. The timing of this process varies across transplant centers.  Transplant centers also use this time to do a well check with the donor to make sure there have not been any changes to their medical history and health. If new concerns are identified, then the surgical date may need to be adjusted.

What are the first things to happen upon arriving at the hospital the day of the surgery?

After you check in to the hospital, you will be brought to the preoperative waiting area. You will be asked to change into a hospital gown and additional blood work will be drawn. A small plastic tube called an intravenous (IV) line will be placed into a vein in your arm or wrist; this line allows the anesthesia team to give you fluids and medications intravenously. You will meet with several providers including the preoperative nurse, the anesthesia team, the surgical team, and the operating room nurse. They will ask you to confirm your medical history, medications, allergies, and the procedure being performed, as well as which kidney (right or left) is going to be donated. Many of these questions will get repeated by different providers from the above care teams during this time. This it is part of a routine final safety check that occurs before any surgery including kidney donation.

How long does it generally take upon arriving at the hospital to be in surgery?

Typically, the check-in process takes about 2 hours. During that time, you will meet with your surgical team (preoperative nurse, anesthesia team, surgeons, and operating room nurse). This time is used to make sure everything is ready for your surgery. This time may vary depending upon other surgical cases and other patients undergoing surgery that day.

Is there ever a time when the surgery has to be done as an open surgery, rather than laparoscopic? And in what cases would that be necessary?

An open surgery for kidney donation is a very rare event (<1%). Unless otherwise discussed, Mayo Clinic only offers minimally invasive kidney donation surgery, which occurs through small incisions. If something were to be encountered during the surgery, and the surgeon felt that it was unsafe to continue working through small minimally invasive incisions, a larger incision might need to be made. This is a very rare event and when it does occur it is done for the donor’s safety.

What are the top 3 things I should know from a surgical perspective if I am planning to donate my kidney?

1. Donors have a thorough medical evaluation to make sure that it is safe for them to donate. They meet with a nephrologist, surgeon, social worker, donor advocate, donor nurse, and other specialists as part of the process. It is an opportunity to learn more about kidney donation and your overall health.
2. Although the surgery is minimally invasive (performed through small surgical incisions), people usually need 4-6 weeks to feel fully recovered. Once recovered, donors can resume all of their normal activities without any restrictions.
3. Donors are our heroes! Without their generous gift, transplant would not be possible.

How long do the surgeries generally take? Are recipients and donors in the same operating room? Are they in surgery for the same amount of time?

Kidney donation surgery takes about 2 to 3 hours. In total time, it usually takes about 3-4 hours from when you leave your friends and family in the preoperative area to when you return back to the recovery room.

Recipients and donors have separate surgical teams caring for them. The timing of the recipient and donor surgeries vary. Sometimes the surgeries both happen at similar times in different operating rooms. It is also possible that a donor and recipient may have surgeries on different days or several hours apart.

What can I expect upon waking up from surgery?

Many people don’t remember much when they initially wake up from anesthesia. It is common to feel tired. You may have muscles aches, a sore throat, or nausea shortly after surgery. These symptoms don’t last long. Soon after surgery, you will be able to get out of bed and walk around. Most donors stay one night in the hospital and feel ready to leave the next day.

What are the top concerns I should watch for after surgery and dismissal from the hospital?

Before you leave the hospital, your nurse and the donor team will go over instructions regarding your diet, medications and care. There are no dietary restrictions after kidney donation. We recommend you slowly advance your diet as tolerated. Constipation is common in the first week after surgery, so using a stool softener is a good idea. Keys to a fast recovery include incorporating small amounts of activity with scheduled breaks, staying hydrated, and using pain medications and stool softeners as needed, particularly within the first few days of surgery.

And now a more personal question for Dr. Jadlowiec...

What has been your favorite moment of being a kidney donor surgeon?

Getting the chance to work with donors before, during, and after their donation is a real privilege. I am always struck by how incredibly generous donors are. I love hearing their motivation to donate and their experience as they go through the process. Through their gift, someone’s life is forever changed. Thank you all for what you do!

Have you donated a kidney or portion of your liver? What would you like other potential donors to know about the process?

HELPFUL LINKS

• Explore Mayo’s Transplant Center.
• Request an appointment.
• Get support from other transplant patients in the transplant discussion group on Connect.