Before the procedure
Once you've gone through the living organ donor screening, evaluation and informed consent process, your donor nephrectomy procedure will be scheduled for the same day as the transplant surgery for the recipient. Separate medical teams and surgeons typically perform the donor nephrectomy and the transplant surgery, but they work closely together.
You'll receive instructions about what to do the day before and the day of your kidney donation surgery. Make note of any questions you might have, such as:
- When do I need to begin fasting?
- Can I take my prescription medications?
- If so, how soon before the surgery can I take a dose?
- What nonprescription medications should I avoid?
- When do I need to arrive at the hospital?
During the procedure
Donor nephrectomy is performed with general anesthesia. This means you will be asleep during the procedure, which usually lasts 2 to 3 hours. The surgical team monitors your heart rate, blood pressure and blood oxygen level throughout the procedure.
Surgeons almost always perform minimally invasive surgery to remove a living donor's kidney (laparoscopic nephrectomy) for a kidney transplant. Laparoscopic nephrectomy is associated with less scarring, less pain and a shorter recovery time than is open surgery to remove a kidney (open nephrectomy).
In a laparoscopic nephrectomy, the surgeon usually makes two or three small incisions in the abdomen. Very small incisions are used as portals (ports) to insert the fiber-optic surgical instruments. A slightly larger incision is used to remove the donor kidney. The equipment includes a small knife, clamps and a special camera called a laparoscope that is used to view the internal organs and guide the surgeon through the procedure.
In open nephrectomy, a 5- to 7-inch (13- to 18-centimeter) incision is made on the side of the chest and upper abdomen. A surgical instrument called a retractor is often used to spread the ribs to access the donor's kidney.
After the procedure
After your donor nephrectomy, you'll likely stay in the hospital for one or two days.
In addition, you can expect:
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Care after your surgery. If you live far from your transplant center, your health care providers will likely recommend that you stay close to the center for a few days after you leave the hospital so that they can monitor your health and remaining kidney function.
You'll likely need to return to your transplant center for follow-up care, tests and monitoring several times after your surgery. Transplant centers are required to submit follow-up data at six months, 12 months and 24 months after donation. Your primary care provider may conduct your laboratory tests one and two years after your kidney surgery and send the information to the transplant center. Ongoing regular visits at least annually with your health care provider are recommended.
- Recovery. Depending on your overall health, your health care providers will give you specific advice on how to take care of yourself and reduce the risk of complications during your recovery. This can include not sitting or lying in bed for long periods of time, not driving a car for 1 to 2 weeks, not lifting any objects heavier than 10 pounds (4.5 kilograms) for a month, caring for your incision, managing pain, and returning to your regular diet.
- Return to typical activities. After kidney donation, most people are able to return to their regular daily activities after 2 to 4 weeks. You may be advised to avoid contact sports or other strenuous activities that may cause kidney damage.
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Pregnancy. Kidney donation typically does not affect the ability to become pregnant or complete a safe pregnancy and childbirth. Some studies suggest that kidney donors may have a small increase in risk of pregnancy complications such as gestational diabetes, pregnancy-induced hypertension, preeclampsia and protein in the urine.
It's usually recommended that women wait at least six months to a year after donor nephrectomy before becoming pregnant. Discuss pregnancy plans with your health care provider.