Patients whose kidneys lose the ability to filter waste products from the blood develop kidney failure, or end stage renal disease (ESRD). Treatment for these patients involves the time consuming and life-altering process of hemodialysis or peritoneal dialysis many hours each week to clean and remove toxins from the body using chemicals or mechanical technology, or they may also consider a kidney transplant.
Kidney transplants can come from two sources: a living donor or a deceased donor. Living donor transplants offer recipients better long-term survival rates compared to kidneys donated from a cadaver and allow patients faster receipt of a new kidney without the average two to five year wait. Today medical providers are even able to transplant kidneys from unrelated living donors (like a spouse or friend) with success similar to kidneys donated from a blood relative. New medications make it possible to donate without a family link to the recipient but the donor and recipient must have compatible blood types.
Anyone who is generally healthy and has normal kidney function can donate. Donors will live healthy lives with just one kidney because the remaining organ enlarges to compensate for the donated organ. Living donor kidneys have a lower rejection rate than cadaver kidneys and start to function more quickly as well.
One of the first tests a live donor has identifies their compatibility for becoming a donor for their intended recipient. Sometimes, due to blood typing, or history of infections or transfusions, it is not safe to give a specific recipient your kidney. In some selected cases, though it may be possible to give your kidney to someone else, and in return, your friend can receive a kidney from the other patient’s donor.
In the end, while you are not directly giving your kidney to your friend, your gift allows your friend to get transplanted quickly, and with a better kidney than they would have received waiting for a standard, brain-dead donor.
Once a kidney donor has completed all testing and is determined to be a good match for a particular recipient, both patients will be scheduled for surgery at a time that is convenient for both parties. While donation used to be a significant and painful procedure, new techniques use a laparoscopic approach to remove the kidney through smaller incisions. This means a shorter healing time, less blood loss and less pain than traditional approaches. Keep in mind though that not everyone may be a candidate for a laparoscopic nephrectomy (kidney removal) and may have to have the traditional surgery. Physicians will discuss the approach that is best prior to surgery.
Using a laparoscope, doctors make a small cut (about an inch long or less) and insert a camera into the body that allows them to see in real time the organs and internal structures of the body on a television screen in the operating room. This scope also utilizes small tools that make it possible to disconnect a healthy kidney and prepare if for removal through an incision lower on the abdomen. This minimally invasive disrupts fewer muscles or structures of the body compared to traditional methods, allowing donors to heal more quickly, lose less blood, and experience less pain.
To remove the kidney, a sterile needle is inserted into the abdomen for inflation and to make more room for the instruments. About the diameter of a pencil, the laparoscope is inserted through incisions in the upper left side of the abdomen and the surgeon inspects the inside of the abdominal cavity before beginning the procedure. If everything looks normal, two more small incisions are made in a line below the first so instruments can be used during the surgery. Once the kidney is free, it is removed from the body through a 7 centimeter cut below the belly button or in the bikini area. The procedure takes two to three hours to complete and many patients will stay 1-3 days in the hospital and are able to return to work in 2-3 weeks.
This illustration demonstrates the mostly likely placement of your new kidney. Although kidneys are usually transplanted on the right side of the lower abdomen, yours may be placed on the left side depending on vascular status. Your new kidney will receive blood flow from your external iliac artery in your pelvis.
Download kidney transplant illustration (PDF, 578 KB).
Urine created by your new kidney will drain into your bladder via your new ureter. Although native kidneys are occasionally removed (for example, with uncontrollable blood pressure, extremely large polycystic kidneys, or renal cancer), your native kidneys will most likely not be removed.
Traditional or Open Incision
If the donor kidney cannot be removed with the laparoscope, an open technique may be used. The approach involves an incision about 5-7 inches long down the side of the body near the low back in an area called the flank. Muscles are divided and the twelfth rib is removed to reach the kidney. The procedure can take three hours or more to complete. Recovery time averages 4-5 days in the hospital and 6-8 weeks off work.
There are a few conditions that inhibit donation of a living kidney:
- History of uncontrolled high blood pressure.
- Bleeding disorders.
- Mental illness.
- Morbid obesity.
- Younger than 18.
- Recurrent kidney stones.
- Chronic kidney disease.
- Chronic lung disease.
- HIV infection.
- Uncontrolled heart disease.
- Metastatic cancer.
- History of melanoma.
Potential donors who are not a match for a specific recipient may wish to participate in a donor swap, or paired kidney exchange transplant. This approach allows a willing but incompatible donor to be matched with another recipient who also has an incompatible donor. Donors then give or “swap” their donated kidneys with the opposite recipient.
List exchanges are another way to move a loved one up on the waiting list for a kidney. If a donor does not match their intended recipient, the donor may give their kidney to another person on the waiting list. In exchange, their loved one moves into that person’s place on the list.
Find out more by reading A Guide to Living Kidney Donor Transplantation (link below). This information will help you and your family understand what it means to be a living donor for a kidney transplant. We will discuss this with you and give you a booklet to read.
A Guide to Living Donor Kidney Transplantation (PDF, 1.3MB)