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CHAPTER 8









                                 THE OPERATION







           THE DONOR NEPHRECTOMY
                (Removal of kidney)




                nder general anaesthetic, the
                donor kidney is removed by an
        Uoperation in the same way as if the
        kidney was diseased. Most surgeons
        remove the kidney through an incision in
        the side, other surgeons prefer to remove
        the kidney through an abdominal incision.
        The kidney is located at the back wall of
        the abdomen behind the bowel and the
        stomach.
           Generally, for purposes of living kidney
        donation, the surgeon chooses to remove
        the left kidney as it has slightly longer
        blood vessels, which facilitate the
        transplant. Sometimes kidneys have more
        than one blood vessel, or there may be a
        slight discrepancy in the size of the kidney,
        and, therefore, the right kidney might be             kidney. They will then divide the ureter to go with
        removed. The donor is always left with the “better    the donor kidney.
        kidney” of the two.                                      The artery, bringing blood to the kidney, comes
           If the left kidney is to be removed, the bowel is  off the main artery of the body - the aorta.
        first put to one side out of the way and then the        The donor kidney vein comes off the main vein
        fat around the kidney is cleared away. The kidney     in the body - the inferior vena cava. When the blood
        is mobilised and the artery, vein and ureter          vessels are clearly identified and dissected, to give
        (drainage urine tube) are identified and dissected    maximum length by dividing any branches not
        free.                                                 supplying the kidney, the surgeon first secures the
           Neighbouring structures to the left kidney are     artery, either by tying it off or stapling it shut. The
        the spleen, the adrenal gland, the pancreas, the      vein is then tied off in a similar fashion and the
        colon and small bowel and the stomach.                donor kidney is removed.
           Neighbouring structures to the right kidney are       Once the artery is tied off, the kidney is removed
        the liver, the adrenal gland, the inferior vena cava  as quickly as possible, as the blood in the kidney
        (a very large vein) and the bowel.                    can clot while it is not circulating. Once the kidney
           The surgeon takes great care not to injure any of  is removed, the surgeon checks that there are no
        these adjacent structures as they free up the         areas of bleeding and then closes the wound.


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