Kidney Transplant is a multi-step surgery. This article includes videos of both the donor & the recipient surgery from authentic sources. But first, we present some “anatomical” points that will help you grasp the surgical procedure better:
I. Which parts make a donor kidney implantable?
You know how, when you fix a new washbasin in your home, a tap alone won’t do, right? You need an inlet pipeline connected to the main line, a faucet/tap to get you water as needed & an outlet pipeline connection?
Similarly, for a donor kidney to work in a recipient’s body, simply severing out a kidney alone isn’t enough. Your surgeon needs to secure the following parts to make the donor kidney implantable:
1️⃣ A blood flow inlet to get oxygen rich blood to the donor kidney for filtration & nourishment of kidney cells.
The Renal Artery of the Donor Kidney is the vessel for this job.
2️⃣ A Faucet to “release blood wastes” as and when needed.
This will happen via urine formed within the Donor Kidney. The Ureter of the Donor Kidney is the “tube” necessary for it.
3️⃣ A blood flow Outlet to ferry out cleansed but oxygen-depleted blood.
The Renal Vein of the Donor Kidney carries out cleansed blood and sends it to the heart & lungs for an oxygen refill.
In a nutshell, an implantable Donor Kidney needs to retain the following:
🔸️Native Renal Artery
🔸️Native Renal Vein
🔸️Ureter (urine outflow tube)
II. What needs to be clamped & cut to harvest an implantable Donor Kidney with all necessary tubes?
Like all other organs, mother nature secures our native kidneys in place by means of tissue layers wrapping it, a network of blood vessels & in case of the kidney, the ureter i.e. the Urine outflow tube as well.
So, to harvest a viable donor kidney, the surgeon first needs to carefully dissect out the “protective” tissue layers of muscle & fat to reach to the kidney.
Following this, the kidney is gently separated by clamping & cutting off the “associations” as illustrated & explained below:
1️⃣ The Ureter is clamped & cut at a sufficient length from the kidney, nearer to the donor’s urinary bladder.
This is to allow for a comfortable implant of the kidney in the patient without unnecessarily stretching the donor Ureter.
2️⃣ The Renal Artery branches coming from the main blood vessel trunk (Aorta).
The renal arteries are clamped & cut right before more branches emerge while going towards the kidney.
Upon harvesting the kidney, the surgical team sews these artery branches into one vessel before implanting the kidney into the patient.
3️⃣ The Renal Vein emerging out of the kidney is cut-off at a spot beyond the smaller tributary veins after clamping their pore.
This allows to harvest a Renal Vein segment of adequate length. Additionally, it ensures that no tributary vein draining into the trunk of the Renal Vein is left open & bleeding. Else, there could be complications.
III. Where do surgeons attach the Donor Kidney in the patient’s belly?
During a kidney transplant, in most cases, the patient’s unwell kidneys remain in place, unless they pose a harm to the patient if retained. Transplant surgeons connect the donor kidney within the patient’s right or left lower part of the patient’s abdomen. The technical name for this space is Iliac Fossa.
Iliac Fossa is Latin for a shallow pit-like space by the Ilium (pelvic) Bone.
This is a preferable part because:
1️⃣ Accessing this location surgically does not require the surgeon to cut-up the tissue sac that houses most of the intestines of the recipient.
2️⃣ It is close to the urinary bladder to attach the Ureter of the Donor Kidney.
3️⃣ There are a number of major blood vessels (both arteries & veins) in this area.
Surgeons can comfortably attach both the Renal Artery & the Renal Vein of the Donor kidney to a major artery & vein of the patient respectively.
With this anatomical insight into the kidney, its associations and the preferred site to implant a donor kidney, let’s take you through a kidney transplant surgery workflow.
Click on the tab below to get to video demonstrations of kidney donation & kidney implantation surgeries made available by renowned Transplant Centres:
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III. Harvesting the kidney: Donor Surgery
IV. Pre-implant processing of the Donor kidney
V. Implanting the kidney: Recipient Surgery
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