Only persons who have voluntarily referred themselves as willing kidney donors are considered for this operation. Donor candidates undergo psychosocial and medical evaluation to determine their suitability for donation. In general these donor candidates must be of sound mind and in good health, nondiabetic, normotensive, nonobese, and with preserved renal function.
Candidates that have been deemed suitable for donation undergo abdominal imaging with CAT scan angiography, magnetic resonant angiography, or less commonly bilateral renal artery arteriography. Imaging must verify the presence of two kidneys. In patients with multiple renal arteries, determination of kidney suitability for donation is based upon the experience and comfort of the donor, as well as the recipient and surgeon.
Intravenous access is obtained prior to administration of general anesthesia and endotracheal intubation. Antibiotics are administered intravenously within 1 hour prior to procedure commencement. Intravenous volume loading with crystalloid (25–50 cc/kg) is given prior to incision. This obviates compromised renal blood flow during abdominal insufflation which can result in acute tubular necrosis of the donated kidney after reperfusion in the recipient. Following intubation a urinary catheter is placed for bladder decompression and continuous urine output monitoring. An oral gastric tube is placed and kept on suction to evacuate and decompress the stomach. Deep venous thrombosis prophylaxis should be employed.
General and endotracheal anesthesia is required.
The patient is placed in the lateral decubitus position with the left side up for left-sided nephrectomy and right side up for right donor nephrectomy. A kidney rest is centered under the patient’s flank and axillary roll under the dependent axilla. A bean bag may be used for holding the patient in place. The lower arm is placed on an arm board and the upper arm is supported on stacked padding or an elevated arm rest. The dependent leg is flexed at the knee and hip while the upper leg is kept straight. Padding is placed between the legs. The trunk is kept at right angle to the table and the pelvis and chest are strapped to the table to prevent movement during the procedure. The table is flexed 20 degrees and placed in slight Trendelenburg. The head should be supported to avoid lateral cervical flexion (figure 1a).
Hair within the surgical field is removed with clippers immediately prior to positioning the patient in the lateral decubitus position. The midline of the lower abdomen is also marked prior to lateral decubitus positioning, especially for obese patients. The abdomen is prepped from the xiphoid process to symphysis pubis and laterally from the table dependently to the midaxillary line. The surgeon and assistant stand facing the patient’s abdomen with video monitors placed behind the patient facing the surgeon and behind the surgeon and the surgeon’s assistant.