Kidney Transplant
Procedure

Kidneys for transplantation may come from either living or deceased donors.

Living Donors

In the past, most living kidney donors had an open surgical procedure requiring a large incision to remove the kidney, which usually resulted in a two-month recovery period. A new procedure, called laparoscopic donor nephrectomy, uses tiny incisions and miniature instruments to remove the kidney. We offer the laparoscopic procedure through a cooperative program involving transplant surgeon Dr. Chris Freise, general laparoscopic surgeon Dr. Quan-yang Duh and urologic surgeon Dr. Marshall Stoller. Our team has performed approximately 60 procedures since November 1999.

Only left kidneys are removed with this procedure, due to considerations of blood vessel length. Most laparoscopic nephrectomy patients need to stay at the hospital only two or three days after the surgery, compared to four or five days for a conventional open nephrectomy. In our experience, the laparascopic procedure is just as safe for both donor and recipient, and recovery is easier for the donor. Laparoscopic nephrectomy is now offered to any patient with suitable anatomy.

Deceased Donors

A cadaveric kidney comes from a person who has suffered brain death. The Uniform Anatomical Gift Act allows all of us to consent to donate organs when we die and allows our families to provide such permission as well. After permission for donation is granted, the kidneys are removed and stored until a recipient has been selected. All donors are carefully screened to prevent any disease transmission.

If you want your child to undergo a cadaveric kidney transplant and this is a medically acceptable option, your child's name will be placed on a cadaver waiting list. A sample of blood for antibody level is sent monthly to the medical center. The waiting period for a cadaver kidney depends upon the availability of a cadaver donor compatible with your child's blood type and antibody level.

When a kidney becomes available, your child's referring kidney specialist is contacted for medical approval. The transplant service will verify that you have no recent infections or medical problems that would interfere with safe transplantation. The transplant service will tell you when a cadaver kidney is available and will assist in making arrangements for your transplantation.

Transplant Surgery

Your child's surgery may last from two to four hours. During the operation, the kidney is placed in the pelvis rather than the usual kidney location in the back. Your child's own kidney will remain undisturbed. The artery that carries blood to the kidney and the vein that removes blood from it are surgically connected to two blood vessels already existing in the pelvis. The ureter, or tube that carries urine from the kidney to the bladder, is also transplanted through an incision in the bladder.

After the operation, your child will be taken to the recovery room for a few hours and then will return to the Kidney Transplant Unit. The surgeon will inform you when the procedure is over.

Your child will be encouraged to get out of bed 12 to 24 hours following surgery to walk around the Kidney Transplant Unit as much as he or she can. Nurses will help teach your child how to take medications, about side effects and about nutrition guidelines after a transplant.

A cadaver kidney will occasionally perform as a "sleepy" kidney, a condition called acute tubular necrosis, or ATN. This means that the kidney is temporarily slow in functioning. Your child may need dialysis a few times, which will not harm the kidney. The "sleepy" kidney usually starts working in two to four weeks.

Reviewed by health care specialists at UCSF Benioff Children's Hospital.
Last updated July 14, 2010