The University Hospital and The Christ Hospital in Cincinnati routinely perform laparoscopic living kidney donation. Laparoscopic donation is a new surgical procedure that has markedly reduced the pain and discomfort associated with giving a living donor kidney. By using an instrument known as a laparoscope, it is now possible to perform the operation through only a few small incisions.

Frequently Asked Questions

What is a laparoscope, and how is this procedure done?

A laparoscope is a long thin wand, generally about 18 inches long and ¼ inch in diameter. There is a microscopic lens at the end of the wand that projects images back to a camera.

The laparoscope is inserted into the donor's abdomen using a tiny incision, and air is put in the abdomen in order to separate the patient's organs, so the surgeons can see more easily. Then, two surgical instruments, each also about 18 inches long and less than a ¼ inch wide, are placed into the abdomen.

During the procedure, the donor is lying on his or her side, and the only other incision that is usually needed is a small horizontal incision, near the groin, for removing the kidney. This incision is generally about three inches long and is placed low in order to hide the scar and to use an area where muscle can be pushed aside without having to be cut.

In the "open" procedure, an incision that started at the patient's navel and extended around to the back for about 8 inches was used. In both the laparoscopic technique and the old open technique, the left kidney is the preferred kidney for removal, because its vein is longer than the one on the right side. Still, at times, there may be medical reasons to remove the right kidney. With minor modifications, the laparoscopic technique can be used on the right side also.

How long is the procedure?

The entire procedure takes about three and a half hours, which is very similar to the old method of operation. Because the intestines must be moved out of the way to remove the kidney, it can sometimes be two or three days before donors feel like eating again. However, the laparoscopic approach has resulted in shorter hospital stays and significantly less pain and discomfort for the donor and a quicker return to normal activity (usually within two to three weeks). Most living kidney donors will be eligible for the laparoscopic procedure.

What is recovery stage like for the donor?

Patients experience pain even after the laparoscopic approach and generally may need pain medicine for about a week. This medication will be supplied upon discharge. Shoulder pain, which is caused by the air pushed into the abdomen during the procedure, is not uncommon and can persist for several days to a week after the surgery. Driving can be resumed when the donor no longer needs pain medicine. Only very vigorous physical activity such as weight lifting, other very heavy lifting or full contact sports need to be restricted for more than a week or two. A follow-up visit with the patient's surgeon is arranged for two weeks after the operation. Complications are unusual, but may occur as with any surgery. The surgeon will review potential complications with you in detail before the operation.

Who pays for the kidney donor's medical evaluation, surgery and follow-up care?

Most costs for the living donor are covered by the recipient's insurance coverage. However, this may vary with individual insurance payors. If you have questions about payment, please ask to speak to one of our financial counselors, and they will be happy to assist you.

What are the types of living kidney donors?

There are two types of living kidney donors, related and unrelated:

Living related donors are healthy blood relatives of the patient requiring a transplant. The donor can be:

• a twin

• a sibling

• a parent

• a child over 18 years of age

• other blood relatives (half-sisters, half-brothers, nieces, nephews, aunts, uncles, cousins).

Living "unrelated" or "emotionally-related" donors are not blood relatives and usually do not share tissue similarities with the recipient. The donor can be:

• a spouse

• an in-law

• a close friend

• an adoptive parent

• an adopted child (over the age of 18)

• a significant other.

What are the benefits of living donation?

• Close to 95 percent success rate at one year after transplantation

• Living unrelated transplantation offers a significantly better success rate than a cadaver kidney transplant

• Early kidney function

• Few rejections

• Fewer medications

• Avoidance of dialysis before transplantation in some patients

• Immunosuppression can be started prior to the transplant

• Long waiting periods that can occur with cadaver donor transplants are eliminated

• Surgery can be scheduled when the recipient is in optimal medical condition

• Provides a significant psychological benefit to the donor.

What are the benefits of laparoscopic living kidney donation?

• Less discomfort following procedure

• Reduced length of hospital stay

• Earlier return to previous activity level

What criteria must a living donor meet?

Potential donors must:

• have compatible blood type with the recipient

• have excellent medical health with perfect kidney function

• be willing to donate a kidney.

The evaluation of the living donor includes a medical history and physical exam, as well as tests for kidney function (blood and urine tests), liver function, cholesterol, hepatitis, HIV and other viral antibody tests.

Within a few months after the removal of one kidney, the remaining kidney enlarges and assumes approximately 90 percent of the function the kidneys had prior to donation. The life expectancy and general health of the living donor are not affected by the donation of one kidney. Therefore, life insurance premiums are not altered by kidney donation.

What are the steps in the living donation process?

Process: You have a genuine willingness to donate.
Follow-up: Call our Transplant Office to let us know you are interested in donating a kidney to your loved one or friend.

Process: We test your blood to determine if you are compatible.
Follow-up: Basic information about your health status will be requested at this time to determine if you are healthy enough to be tested as a donor. If this initial screening is passed successfully, plans will be made to test your blood.

Process: If you are willing to proceed, arrangements are made for blood testing.
Follow-up: Your transplant nurse or doctor will call you and discuss the results. It may take eight to 10 days to obtain the blood test results.

Process: If you are a suitable donor and if you are willing to proceed, arrangements are made for your medical evaluation.
Follow-up: The transplant office will arrange an appointment at the transplant clinic for your medical evaluation. If you live out of town, the transplant nurse will try to arrange workup at the nearest transplant center or your family doctor's office.

Process: Your completed tests and reports are reviewed by the transplant physicians and nurses.
Follow-up: Any additional testing that is necessary will be arranged by the transplant nurse.

Process: If you are accepted as a living donor, final X-ray and compatibility testing is scheduled.
Follow-up: Your transplant nurse will schedule these tests. The final X-ray is called a renal angiogram. It is an invasive procedure done as an outpatient, but you will need to spend the day in the hospital. The findings will help the surgeons determine if the kidney can be removed laparoscopically.

Process: If your tests are satisfactory, the transplant is scheduled.
Follow-up: The transplant office will schedule a date with you and the transplant team.

If you would like to talk to someone who has been a living donor, the transplant nurse will be happy to provide you with the name of a contact person with whom you can discuss the donation process.

If you have any further questions or if you would like more information about any of the topics discussed here, please call our transplant office at the University Hospital 513-584-4956; toll free 1-866-268-4265 or the Christ Hospital 513-585-2493; toll free 1-800-527-8919 ext. 52493.

	Read about John Feck's fight with IgA Nephropathy, a kidney disorder that required a living donor kidney transplant from his mother.  full story...