Transplant
In the previous page, we we provided an anatomical insight into the kidney, its associations and the preferred site to implant a donor kidney.
The purpose was to help you grasp the Surgical procedures for both the kidney donor & the kidney recipient that we cover in this article.
Now let’s take you through an outline of the steps of Donor Surgery & the Recipient Surgery.
NOTE: The intellectual property rights of the videos shared below lie entirely with the respective YouTube channels as duly credited below the videos.
ON THIS PAGE
- Who constitutes the Transplant Surgical Team
- Anaesthesia in Kidney Transplant
- Harvesting the donor kidney: Donor Nephrectomy
- Pre-implant processing of the donor kidney
- Implanting the kidney: Recipient (patient) Surgery
I.Who constitutes the Transplant Surgical Team
Like every surgery, Kidney Transplant is a team effort of multiple health professionals & enabled by specialized equipment.
A typical Renal Transplant operating team consists of:
🔸️Transplant Surgeon – Head & Assistants
🔸️Anaesthesiologist
🔸️Nurses specializing in assisting in Transplant Surgeries
II. Anaesthesia in Kidney Transplant
For a major surgery like a Kidney Transplant, both the donor & the patient are put on General Anaesthesia or GA for their respective surgeries. This type of anaesthesia allows doctors to:
🔸️Put the patient to “dose-controlled” sleep throughout the surgical procedure
🔸️Ensure the patient doesn’t feel any pain or pressure during the operation (dampening all senses temporarily)
🔸️Maintain adequate muscle relaxation in the patient
Whatever you inhale, eat, drink or get an injection of, eventually circulates through your kidneys at some stage. It is the same for Anaesthesia medication as well. Some drugs even pass out of the body through kidneys via urine.
Patients undergoing a kidney transplant obviously have critically low function left in their native kidneys. So, Anaesthesia doctors need to precisely calculate the adequate anaesthesia dose before the surgery to ensure that the medication does not buildup to toxic levels in a backdrop of poor kidney function in kidney recipients. However, this is not the case with healthy kidney donors.
Please note, it is imperative to follow all pre-operative instructions strictly.
Both donors & patients must avoid taking any solid food or drinking a lot of liquids within 12 hours before their surgery. This is because, if there is food or liquid in the stomach at the time of the surgery, administering General Anaesthesia may bring-up the food/liquid to the patient’s mouth & the patient may even choke on it. This could be potentially life-threatening.
III. Harvesting the kidney: Donor Surgery
Surgeons almost always perform minimally invasive surgery to remove a living-donor’s kidney for a kidney transplant. The technical term for this is Laparoscopic Nephrectomy. The other type is Open Nephrectomy or the traditional open surgery. This is less common nowadays for greater complications involved.
In a laparoscopic kidney donation surgery, the surgeon usually makes two or three very small incisions close to the bellybutton. These serve as portals (ports) to insert the fiber-optic surgical instruments. The equipment includes a small knife, clamps and a special camera called a laparoscope. The camera helps the surgeon view the internal organs and guide the surgeon through the procedure. Additionally, the surgeon creates a slightly larger incision below the belly-button that is wide enough to remove the donor kidney.
Conversely, in open nephrectomy, a 5- to 7-inch (13- to 18-centimeter) incision is made on the side of the chest and upper abdomen to access & remove the donor’s kidney under direct view.
Whichever be the mode, surgeons harvest the Donor kidney under General Anesthesia. This means the donor is put to sleep with medicines (either inhaled or injected) during the typically 2-3 hour long procedure. The Anaesthesia doctor monitors your heart rate, blood pressure and blood oxygen level throughout the procedure to keep the patient stable.
Here, we share a video demonstration of a laparoscopic (keyhole) kidney donor surgery by Johns Hopkins Surgery. Correlate the steps in the video with the anatomical insight here to get a clearer idea.
Courtesy: Johns Hopkins Surgery
IV. Pre-implant processing of the Donor kidney
Once the Donor Kidney is safely removed with all necessary tubes, nurses immediately place the organ on an ice tray in the bench. This helps cool the organ temperature & keeps it viable for longer. This is sort of like storing our food in the refrigerator to increase it’s shelf life.
Keeping the Donor Kidney in the ice tray, the transplant team thoroughly flushes the kidney of any residual blood or urine within, using a preservation solution.
The so-called Preservation Solution has all necessary minerals to help prolong the survival of the kidney outside of the donor’s body until it “finds its new home” within the patient. The solution does so by:
🔸️ Lowering the temperature uniformly throughout the kidney. Cold temperature effectively prevents any harmful enzymes from decomposing any kidney cells until implantation into the patient.
🔸️ Neutralizing any acidic buildup or swelling within the donor kidney until implantation.
Once flushed & cleaned properly, the donor kidney is sent for implantation into the Patient. The donor kidney is safely transported within the Organ Preservation Solution in sequential plastic bags, placed on ice to maintain a low temperature & transported in a cooler (insulated container).
V. Implanting the kidney: Recipient Surgery
Just like the donor surgery, kidney transplant (implanting the kidney within the patient’s abdomen) is a major, complicated surgery. So, it is performed under general anesthesia, so the patient is asleep during the surgery. The surgical team continuously monitors your vitals like heart rate, blood pressure and blood oxygen level to keep you clinically stable during the procedure.
However, unlike the Donor surgery, the transplant surgery on the recipient is an Open Surgery. This means, the transplant surgeon surgically attaches the donor kidney under direct view via an elongated incision on your belly. Unless the patient’s native kidneys (the ones that stopped working) cause problems such as high blood pressure, kidney stones, pain or infection, they are left in place.
BRIEFLY:
- The surgeon makes a 14 cm incision on one side of your lower abdomen and inserts the new kidney into your body.
- A long incision allows for attachment of blood vessels and ureter (urine outflow tube) of the new kidney to the patient’s blood vessels in the lower abdomen and urinary bladder respectively under direct vision.
- The surgeon then checks the functioning (urine production) of the new kidney & the integrity of surgical attachments.
- Finally, the surgeon sutures the tissue layers, muscles and staples the skin to close the incision.
Find below, video demonstrations of kidney transplant (recipient) surgery.
The first video is an animated demonstration by Centre for Innovation, Leiden University Medical Centre, The Netherlands.
Following this, there is a real-life video demonstration by Northwestern Medicine. Both videos explain the steps of the surgery. Correlate the steps in the video with the anatomical insight provided in the previous article here to grasp the surgical steps better.
Courtesy: Centre for Innovation, Leiden University Medical Centre
Courtesy: Inside the OR | Northwestern Medicine
(Because of potential graphic content, YouTube requires you to sign in & confirm your age before you can watch the video)
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