Living Kidney Donation Surgery Play-by-Play

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Nov 27, 2018 | Kristin Eggebraaten | @keggebraaten

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 patients on our Connect page.

Dr. Caroline Jadlowiec is a kidney transplant surgeon from Mayo Clinic in Arizona. Dr. Jadlowiec has an interest in living donation, 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.

How can I best prepare for kidney donation surgery?

In the week leading up to your surgical date, the donor team will check in with you to make sure you haven't experienced any changes to your health. You won’t be asked to make any

specific changes in preparation for surgery other than continuing to maintain a healthy lifestyle. Most people undergoing removal of a kidney will spend one night in the hospital, so it’s 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 usually needs to be removed prior to surgery so it may be better to leave those 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. The recipient needs to be medically ready to undergo a kidney transplant. Sometimes a donor is approved to donate, but the recipient may still have items that need to be completed to ensure that they are ready to have the transplant and the surgery will be safe for both parties. If the recipient is ready for surgery, we typically try to pick a date that fits the donor’s schedule. Sometimes the recipient may be quickly approaching the need for dialysis. In these cases, we try to schedule the transplant sooner rather than later so that the recipient can avoid dialysis.

Living donor surgeries can occur at any time of the day. The timing depends on many variables such as the other surgeries happening that day as well as the type of donation occurring (e.g. non-directed donation or paired donation). For donors participating in paired donation, their kidneys are often sent out to other centers as part of an exchange for a different kidney for the recipient. In these situations, the surgery usually occurs in the early morning so the kidney can travel timely to its destination.

Is it common for surgery dates to be moved?

It is uncommon for surgical dates to be changed, but it does occasionally occur. The recipient undergoes an updated pre-anesthesia evaluation the week leading up to their scheduled surgery. We also check in with the donor to ensure there have not been any changes to their medical history and health. If a new concern is identified, then the surgical date may need to be changed.

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

After you check in, you will be brought to the preoperative area. You will be asked to change into a hospital gown and some blood work will be drawn. A small tube called an intravenous (IV) line will be placed into a vein in your arm or wrist; this line allows us 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.

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 the team and take care of all the final testing and interviews. The time is used to make sure everything is ready for your surgery. This time could vary depending upon other cases and other patients in the operating rooms 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, the plan is to perform the surgery laparoscopically through small incisions. If something were to be encountered during the surgery, and the surgeon felt that it was unsafe to continue laparoscopically, then a larger incision might need to be made. This is a very rare event and when it does occur it’s done for the donor’s safety. The goal, first and foremost, is to make sure the donor is safe. Rarely, a donor surgery is planned as an open surgery due to complexity. This is usually a result of prior operations that make the operative field difficult and unsafe for laparoscopy.

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 evaluation to ensure that it is safe for them to donate. They meet with a nephrologist, surgeon, social worker, donor advocate, donor nurse, and dietitian as part of the process. It’s an opportunity to learn more about donation and your overall health.
2. Although the surgery is done laparoscopically (through small incisions), people usually need 4-6 weeks to feel fully recovered.
3. Donors are our heroes! Without their generous gift, transplant wouldn’t be possible. In general, complications from donor nephrectomies are rare. Complications that can happen include a hernia, surgical site infection, and bleeding with possible need for blood transfusion.The actual surgery takes about 2 hours. Besides surgery, there is also preparation and time to wake from anesthesia. 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.

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?

The actual surgery takes about 2 hours. Besides surgery, there is also preparation and time to wake from anesthesia. 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 always have separate surgical teams caring for them. The timing of the recipient and donor surgeries varies. Sometimes the surgeries both happen at the same time in different operating rooms. This is the most common situation. In other instances, a recipient may follow the donor in the same operating room in a tandem fashion. It is also possible that a donor and recipient may have surgeries on different days or several hours apart. This occurs when donors and recipients participate in paired donation.

What can I expect upon waking up from surgery?

Many people don’t remember much when they initially wake up. It is common to feel tired. You may have muscles aches, a sore throat, or nausea shortly after surgery. These problems typically don’t last long. As soon as you are awake, you will be encouraged to get out of bed and walk around. Most donors feel ready to dismiss from the hospital 24 hours later.

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

Before you are dismissed from 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 it’s recommended to use stool softeners. Keys to a fast recovery include moving around as much as possible, good oral intake (especially fluids), and taking stool softeners.

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. Through their gift, someone’s life is forever changed. Thank you all for what you do!

HELPFUL LINKS

• Learn more about the donor's perspective, and share experiences and ask questions about many topics in our Transplants discussion group.
• Explore Mayo’s Transplant Center.
• Request an appointment.