The Gift
At this stage, you’ve passed the donor evaluation, and it’s time to donate.
Before the Surgery
A date for the surgery will be scheduled. Note that the date will depend in part on the health of the recipient since he or she must be ready for surgery, too. You will also be scheduled for a “preoperative visit,” which is yet another physical exam. This exam, which usually happens a couple of weeks before the surgery date, is a final check before your surgery to make sure you are well and you are still compatible with your intended recipient. The exam typically includes a blood draw (for a final crossmatch), urinalysis, chest X-ray, and EKG. You will be checked to make sure you aren’t sick — no cold, no flu, or other infections. If female, you’ll also have a pregnancy test. If any concerns are identified, you’ll be notified and the transplant may be canceled or delayed.
Here are some tips for preparing for and recovering from surgery in the hospital: Surgery Tips.
You will be put on special restrictions as you get close to the surgery date. Females using birth control pills will need to stop taking pills for 30 days prior to the surgery. (You will need to use barrier forms of contraception in the meantime.) If you use nicotine products (cigarettes, cigars, vaping, chewing tobacco, etc.), you’ll need to stop at least four weeks before the surgery date. You’ll be asked to stop taking aspirin and nonsteroidal anti-inflammatory drugs such as ibuprofen (e.g., Advil) at least a week before.
You should stop eating solid food starting at noon the day before, and then no food or drink starting at midnight. You may be instructed to take a laxative the day before so you have a bowel movement before the surgery. Check with your team about taking your prescription medications.
On The Big Day
You and the intended 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 includes inserting an IV, dressing in a hospital gown, even taking a mild sedative. You’ll be wheeled into the operating room. The surgeon will greet you and the nurses will get you situated for the surgery. The anesthetist will start the anesthesia through the IV, you will count backwards, and “away we go.”
While you’re unconscious, a tube will be put down your throat to help you breath. (The tube is removed when the surgery is complete, but you may have a scratchy throat for a few days afterwards.) A small tube called a catheter will also be run from your urethra into your bladder. The catheter is needed to drain your bladder right after surgery while your body is still “sleepy” from the anesthesia.
The surgeon will remove one of your kidneys, most likely your left one, using a procedure called laparoscopic nephrectomy. This procedure uses a laparoscope—a device inserted into a small hole (called a “port”) in your abdomen allowing the surgeon to see and operate. This technique involves making several small (a couple of inches each) ports to allow insertion of the laparoscope and other instruments. Your abdomen is filled with air to make room for the instruments inside your body. The camera and instruments are used to cut the kidney away from surrounding tissue after clamping off the arteries and ureter. The kidney is removed through an incision below your belly button. Most of the air is removed from your body, and then you’re closed up. Surgery takes about three to four hours.
There are variations on the surgery, such as “hand-assisted laparoscopic” and “mini-open” nephrectomy. In a very limited number of situations, the surgical team will shift from a laparoscopic procedure to open nephrectomy if complications arise during the laparoscopic procedure. Open nephrectomy involves making a large (five to eight inch) incision along the flank to remove the kidney.
Post-Op Recovery
After surgery, you will be moved to a recovery room for an hour or two. Once you fully regain consciousness, you will be wheeled into your hospital room. You will be instructed on how to use a deep-breathing instrument to prevent pneumonia. You’ll be encouraged to sit up and walk as soon as you are able to get you mobile and to avoid blood clots. You will also transition from IV to oral pain medications.
The IV will be removed once you’re able to take nourishment by mouth. The catheter will be removed when you feel you’re ready to urinate on your own.
Your ability to go home is a function of your ability to deal with the pain and your recovery from the anesthesia. Generally, you’re able to leave when you can eat, walk, and urinate. Many living kidney donors report they went home as soon as the next day; others stayed in the hospital for up to five days.
Your Recovery at Home
Note that your recovery is far from over even though you have left the hospital. The effects of anesthesia can last for days. One effect is that you might feel surprisingly good shortly after the surgery despite having had a kidney removed. That’s because the anesthesia has not left your body and is masking the pain you otherwise would feel. So be prepared to feel worse a few days later, and have your pain medications ready. Another effect is your inability to defecate. It may be several days before you’re able to poop again. Stool softeners and laxatives can help move things along.
You’ll also be on those pain medications for a while and they have side effects. One is nausea, so you might not have much of an appetite for a few days.
Some living donors have recommended wearing an abdominal binder after the surgery. Your abdomen will be healing and will benefit from additional support. For example, it can limit the pain following a laugh or a sneeze.
Be sure to keep an eye on your incisions. You’ll be given instructions on how to take care of them and what to look for if there are problems.
You will likely be unable to do many activities for a couple of weeks. Be sure you have your support network in place to help you with meals, cleaning, driving, taking care of kids and/or pets, and other household activities. A survey of living kidney donors revealed that only about a third of donors were able to return to normal activities within two weeks. Most everyone (94%) was back at it within six weeks.
Your ability to return to work depends on many factors, not the least of which is the nature of your work. If you do office work, you should be able to return sooner than someone with a physically demanding job. The living donor survey showed only 14% of donors were back to work within two weeks. About half were on the job within four weeks, with 76% returning to the job within six weeks. But nearly a quarter of donors needed more than six weeks before going back to work.
For planning purposes, you might plan on six weeks and hope for something shorter.
You will still not be 100% at the six-week mark. Most donors say it takes two to four months before getting back to your pre-donation self.
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 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:
- Pain. This is a certainty, and it is one aspect of donation that donors tend to underestimate. Fortunately, pain can be managed through medication after surgery.
- Complications. Medical research shows about 15% of donors report some form of complication shortly after surgery. The complications include infection of the incision, allergic reaction to the tape used to bind the incision, minor bleeding, urinary tract infection, and blockage of the intestine. One special complication of laparoscopic nephrectomy reported on LDO is feeling bloated. This happens because the abdomen is inflated with gas during the surgery to give the surgeon more room to manipulate the laparoscope and surgical tools. It takes a while after the surgery for the body to eliminate the gas, so the donor can feel uncomfortable for a while. LDO donors report that walking and being active help to speed the elimination of the gas.
- Reoperation. Some complications may be significant enough that you need to go back into surgery. Research shows reoperation occurs in 2% or less of donations. Examples of the kinds of major complications that require reoperation include incisional hernia, bleeding, bowel obstruction, and bowel injury.
- Readmission. You may have problems after you leave the hospital that require you to return to the hospital. About 2% of donors return to the hospital because of ailments like nausea, vomiting, bleeding, constipation, diarrhea, and infection.
- Death. It happens. Fortunately, it is exceedingly rare. The mortality risk is estimated to be about 0.03% (that’s three deaths for every 10,000 procedures.)
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:
- An increase in self-esteem for having done something extraordinary for someone else.
- Positive feelings after seeing the improved health of the recipient.
- A temporary mild depression, perhaps because attention tends to shift to the recipient after the donation and because of a lower level of excitement than the level that preceded the surgery.
- A change–sometimes positive and sometimes negative–in the relationship with the recipient, family members, and others close to the donor and recipient.
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-rejection drugs. There is a risk that the recipient will lose the organ. Fortunately, UNOS statistics show that about 98% of living donor organs survive after a year. That means 2% 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 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.