Once the assessments are complete then a date will be scheduled for surgery. This is a joint decision by the transplant team, the doctor looking after the person needing the transplant (the recipient), and of course the donor themselves. Where possible we will time the operation to be least disruptive to employment or family / social commitments. Both the donor and recipient come to level 11 in Belfast City Hospital the afternoon before surgery for admission and final checks. Only sips of water and some special pre-operative drinks are allowed from midnight, no other food or drink. The donor is brought to the operating theatre around 08:30 and the recipient typically goes to the same operating theatre in the afternoon. Typically, both donor and recipient operations each take 3-4 hours with 2-3 hours in recovery afterward for observation.
Surgical procedure
A kidney can be removed in either of two ways, the laparoscopic (“keyhole” or minimal access) technique or the traditional open surgery. We used the latter technique until the early 2000s but now all donors in Belfast the kidney is removed by the ‘key hole’ (laparoscopic) technique.
Occasionally if the surgeon is not happy with the progress or there is any concern regarding damage to the bowel or blood vessels then a bigger incision will be made. This is called ‘conversion to an open’ operation and happens in approximately 1 or 2 people in every 100 who donate. The purpose is always to maintain the safety of the donor, if you have an open operation you will take longer to recover than after keyhole surgery.
Wounds
Although ‘key-hole’ surgery, clearly there has to be a cut sufficiently long to allow the kidney to come out! This larger incision can be in a similar position to a C-section wound, or may be just below the ribs. Different surgeons sometimes have different techniques, so your own surgeon will discuss in detail where the incisions will be for your particular operation.
Pain relief
Following surgery, most patients report only moderate discomfort in the wounds. Additionally, discomfort is frequently felt in the shoulder as a result of irritation of the diaphragm, which is supplied by the same nerves as the shoulder.
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A variety of means are used to control pain. Often local anaesthetic is used which infiltrates directly around the wound for the first couple of days. Paracetamol is provided regularly, initially into the vein via a ‘drip’. Morphine is given as required, sometimes through an intravenous pump which gives a dose of morphine on the push of a button (“patient controlled analgesia” or PCA). Morphine may alternatively be given in tablet or liquid form by mouth.
Enhanced Recovery
We introduced a post-operative pathway to speed recovery in 2014. This has been pioneered internationally by the transplant team here, and has been based on prior experience in colorectal surgery. The process involves a few simple steps which aid patient mobility following the operation. These include removing the urinary catheter before the donor wakes up from surgery, not prescribing intravenous fluids after surgery, and minimising morphine which can cause nausea, with substitution of local anaesthetic instead. This means the patient feels more ‘normal’ and does not have so many tubes, drips etc. to trip over when first walking after surgery.
Complications
It is quite normal for a donor and the donor’s family to have fears and concerns about potential complications. This might be felt by some as reluctance to donate, yet it is natural reaction to a major surgery. Potential donors should speak openly with the transplant team about these fears. All conversations between the living donor and the transplant team and the results of medical testing will be kept confidential.
Fortunately major complications after this type of surgery are rare but they can occur. They can be considered as immediate or short-term problems, issues over the first few months, and long-term consequences years after donation. Click here for full details.
