The Surgical Experience
Female patients must be off birth control pills for a minimum of 6 weeks before surgery. Birth control pills have been shown to increase the risk of developing blood clots. An alternate birth control method should be used, and pregnancy testing will occur on the day of the pre-op visit.
Many activities will happen the day of your pre-op visit. The donor and recipient will first go to the hospital laboratory to have blood drawn for the final crossmatch and some updated lab testing. The recipient will also have a chest x-ray and EKG, and both donor and recipient will be seen in the anesthesiology clinic. Both the donor and recipient will be seen in the Transplant Clinic for a pre-operative visit.
If the recipient is on dialysis, he/she will require a dialysis run before the transplant, and the transplant coordinator will make those arrangements.
If you live some distance away from the transplant center, you may wish to stay in a hotel. There is a hotel within walking distance of the hospital. The hotel is Courtyard by Marriott at (916) 455-6800. They offer discounted rates for patients of UC Davis Medical Center if requested and there is room availability. Reservations must be made through the hotel directly, not on-line.
On the morning of surgery, both the donor and recipient will be admitted to Tower 1, which is the pre-surgery unit. Altruistic donors will not be admitted to Tower 1, rather to an alternate unit. The donor surgery will start first, and the recipient surgery will start shortly after.
Once you are in the operating room, you will receive an anesthetic to put you to sleep. Your abdomen will then be shaved and a catheter will be inserted into your bladder. This allows the doctors to closely monitor your urine output.
The actual surgical procedure for the donor will take about three hours. One kidney with its artery, vein, and ureter will be removed from you and prepared for transplant into your recipient.
Our transplant surgeons use the technique called hand assisted laparoscopic nephrectomy. With this technique, two small incisions and one large enough to remove the kidney are made in the abdomen. Special instruments and a miniature camera are inserted into the abdomen. The camera allows the surgeon to see the kidney on a TV monitor while it is cut free from the surrounding tissues. This technique results in a quicker recovery time as compared with an open incision.
After your surgery is completed, you will be taken to the recovery room where you will awaken from your anesthesia. While in the recovery room, your vital signs and blood tests will be monitored. When you are fully awake, you will be moved to the Transplant Unit. Altruistic donors will recover on a different unit than the recipient.
While you are in the operating room and recovery room, your family can wait in the second floor waiting room or main hospital lobby. Families of altruistic donors will be provided with an alternate waiting area from the recipient family. After the surgery is completed, the surgeon will talk to them and report on the surgery and your condition. Your family may visit you when you return to your room.
After you return to your room, you will continue to be monitored closely. Your vital signs will be checked frequently and you will be asked to breathe deep and cough periodically. You will still have an IV in your arm, but it will be taken out when you are able to drink fluids. Most donors are able to drink fluids about 24 hours after surgery and are able to eat a regular diet by the second day. The catheter will be left in your bladder for about 24 hours so all of your urine can be measured to make sure your kidney is working well. Blood tests will be done daily to check your blood count and kidney function.
You will experience pain in your abdomen after surgery but you will be given medication to make it more tolerable. You will stay in bed overnight but after that you will need to walk around the unit several times a day. This will help decrease pain and speed your recovery. You will be discharged 2-3 days after surgery.
The IDA will see you in the hospital before discharge to provide you with some written materials about care after donation and plans for follow-up.
After discharge you may continue to have some abdominal pain for approximately one week. You should not lift more than 20 pounds for six weeks, as full recovery from the surgery takes about six weeks. Donors can return to work after six weeks. Some donors who have desk jobs may feel ready to return to work after two weeks. You can resume driving after four weeks and can resume sexual activity whenever you feel comfortable participating.
You will be seen in the clinic by the transplant surgeon and the IDA one week after discharge from the hospital. If you have any problems after that time that are related to your donation, you may call the transplant center and talk to the living donor nurse. You will also be contacted by the IDA at 6 months, 1 year and 2 years after donation.
The transplant team does recommend that living donors avoid long-term use of a class of drugs called NSAIDS. The most common NSAID is Motrin or ibuprofen. These drugs can cause kidney damage over time. They can safely be taken for an injury for a period of two weeks but should not be taken long-term for treatment of problems such as arthritis.
Donors should always receive routine medical care and any treating doctor should know that you have one kidney. The transplant team recommends:
- A yearly physical exam with height, weight, and blood pressure measurement.
- Yearly laboratory studies with complete metabolic panel and urinalysis.
- That you maintain a normal weight and exercise at least 4 times a week for 30 minutes.
- That you get plenty of rest and eat a balanced diet avoiding saturated and trans fats and avoid excessive salt in your diet.
- That you talk to your doctor before taking any over the counter medications or supplements for more than a few weeks.
- That you avoid high impact sports.