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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.
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PREOPERATIVE PREPARATION
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Candidates who have been deemed suitable for donation undergo abdominal imaging with computed tomography, angiography, or, less commonly, bilateral renal artery arteriography. Imaging must verify the presence of two kidneys. The size of each kidney; the number, size, and locations of arteries and veins; and the distance between the origin of the artery and the first branch are evaluated. In addition, the presence of any abnormalities in the kidney is evaluated. In candidates in whom both kidneys are similar, the left kidney is usually chosen because of the extra length and thickness of the left renal vein compared with the right renal vein. If there is size discrepancy between the kidneys or there are anatomic abnormalities, the donor should be left with the better kidney. In candidates with multiple renal arteries, determination of kidney suitability for donation is based on the experience and comfort of the donor as well as the recipient and surgeon.
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Intravenous access is obtained prior to administration of general anesthesia and endotracheal intubation. Antibiotics are administered intravenously within 1 hour of procedure commencement. Intravenous volume loading with crystalloid (25–50 mL/kg) is given during the procedure. This obviates compromised renal blood flow during abdominal insufflations, 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.
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General and endotracheal anesthesia is required.
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Patients are placed in the lateral decubitus position with the left side up for left-sided nephrectomy and right side up for right-side nephrectomy. A kidney rest is centered under the patient’s flank and an axillary roll under the dependent axilla. A beanbag 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, whereas the upper leg is kept straight. Padding is placed between the legs. The trunk is kept at a 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 a slight Trendelenburg position. The head should be supported to avoid lateral cervical flexion (FIGURE 1A).
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