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At this stage, you've passed the donor evaluation, and it's time to donate. A date for the surgery is scheduled. Note that the date will depend in part on the health of the recipient since he or she must be able to withstand surgery, too. You will be put on eating and drinking restrictions and may be instructed to take a laxative the day before.
Here are some tips for preparing for and recovering from surgery in the hospital: Surgery Tips. And here are suggested questions a prospective living organ donor might ask of medical professionals: Questions.
You and the recipient will be admitted to the hospital the day before or the morning of the surgery. On the day of the surgery, you'll be "prepped," which may involve inserting an IV, dressing in a hospital gown, even taking a mild sedative. You'll be wheeled into the operating room. The surgeon greets you and the nurses get you situated for the surgery. The anesthetist starts the anesthesia through the IV, you count backwards, and "away we go."
While you're unconscious, the surgeon will follow one of two procedures:
Medical studies have compared the effect of open and laparoscopic procedures on donors and have generally found that the laparoscopic procedure results in less pain, shorter hospital stays, and faster recovery and return to normal activities. Here are the results of a study (Waller, at al., 2002) comparing the recovery times for 20 "laparoscopic" donors to 34 "open" donors in the United Kingdom:
Results favoring the laparoscopic procedure were also found in a Johns Hopkins study (Ratner, et al., 1999) comparing 25 laparoscopic donors to 37 open donors:
This study also found no significant differences in the results for the recipient. Surgical complications, rejection rates, need for dialysis, and hospital stays where comparable for an organ donated by the open or laparoscopic method.
There are data showing a slightly higher incidence of
complications to donors arising from laparoscopy, but the difference is
small. (See the summary of medical studies below.)
is now the more common form of
procedure. There are also variations, such as "hand-assisted
laparoscopic" and "mini-open" nephrectomy that incorporate features of
both laparoscopic and open nephrectomy. In a very limited number of
surgical team will shift from a laparoscopic procedure to open
nephrectomy if complications arise during the laparoscopic procedure.
The incidence of switching from the laparoscopic to open procedure was
2.1% in a study of 381 procedures at Johns Hopkins over a six-year
period from 1995 to 2001 (Su, et al., 2004).
Surgery takes about three to four hours. (Surgery under the laparoscopic method may be at the high end of that range.) After surgery, you are moved to a recovery room for several hours. Once you regain consciousness, you will be wheeled into your hospital room. Your ability to go home is a function of your ability to deal with the pain and your recovery from the anesthesia.
You are helped in dealing with the pain with medication, such as a morphine drip. (Don't worry about addiction; the dosages are tightly controlled.) The other "pain" you'll deal with is those nicely nagging nurses who will aid with your recovery. They'll insert and maintain an IV for nourishment since your gastrointestinal tract is "sleepy" from the anesthesia. A catheter is inserted to remove fluid from your bladder. (The output is measured to ensure your remaining kidney is functioning adequately.) Special socks will be put on your legs to aid circulation and prevent clotting. And you'll be asked to inhale deeply using a special device to reduce the risk of pneumonia. You'll be encouraged to get up and walk as soon as you're able.
Once your gastrointestinal tract is operational (you can defecate and urinate on your own), you are mobile, and you can manage any pain, you can go home. Generally, recovery—from the time of surgery to the time of your discharge—is three to four days. You will likely be unable to perform any work, especially heavy lifting, for about six weeks.
Medical Risks of Living Donation Surgery
There are risks to the donor during and after the surgery. Unlike most other surgeries, you--the patient--are actually in excellent health when undergoing surgery. Therefore, the risks are attributable primarily to the surgery itself and the removal of a kidney. These risks are small and manageable, but in the interest of full disclosure, here are some of the possible complications and consequences:
What the research tells us is that
the majority of donation surgeries go well. However, there are a few
situations where the donors suffer complications from the
surgery. If you'd like to learn more about the potential
complications, you can read a comprehensive digest of medical research on living
donor surgery on LivingDonor101.
Psychosocial Consequences of Donation
There is limited research on the psychosocial impact of donation immediately following donation surgery. However, LDO participants who have donated report these kinds of psychosocial and relationship changes:
About the Recipient
Of course, the living donor is not the only one who undergoes surgery during a successful transplant operation. The recipient also undergoes major surgery. The obvious benefit of the surgery to the recipient is getting a functioning kidney that cleans the blood and produces urine. The change in the recipient's health immediately following donation can be dramatic. Longer term, the recipient benefits from a better lifestyle free from dialysis and with prospects for a longer life expectancy.
The recipient can also face risks from the surgery. Infection, bleeding, and complications just like the donor surgery are possible. It's not unusual for the recipient to have a "rejection episode" where their body fights the newly donated organ despite receiving anti-rejections drugs. There is a risk that the recipient will lose the organ. UNOS statistics show that about 95% of living donor organs survive after a year. That means 5% of them are rejected. Recipients can also struggle with the side effects of the anti-rejection drugs. They may experience tremors, hair growth, headaches, high blood pressure, fluid retention, and increased susceptibility to infection. Some of these side effects can be addressed by changing the level of medication. Over the long run, the donated kidney may be lost due to a return of kidney disease or cancer and other complications from taking anti-rejection drugs.
Despite these risks and the side effects of the anti-rejection drugs, recipients report that the results of living donation are far superior to dialysis.
© 2012 International Association of Living Organ Donors, Inc.