Last updated: 11/24/2009

Kidney transplantation involves surgically attaching a functioning kidney, or graft, from a brain-dead organ donor (a cadaver transplant) or from a living donor to a patient with ESRD. Living donors may be related or unrelated to the patient,...

but a related donor has a better chance of having a kidney that is a stronger biological match for the patient.

Open nephrectomy

The surgical procedure to remove a kidney from a living donor is called a nephrectomy. In a traditional, open nephrectomy, the kidney donor is administered general anesthesia and a 6–10-in (15.2–25.4-cm) incision through several layers of muscle is made on the side or front of the abdomen. The blood vessels connecting the kidney to the donor are cut and clamped, and the ureter is also cut and clamped between the bladder and kidney. The kidney and an attached section of ureter are removed from the donor. The vessels and ureter in the donor are then tied off and the incision is sutured together again. A similar procedure is used to harvest cadaver kidneys, although both kidneys are typically removed at once, and blood and cell samples for tissue typing are also taken.

Laparoscopic nephrectomy

Laparoscopic nephrectomy is a form of minimally invasive surgery using instruments on long, narrow rods to view, cut, and remove the donor kidney. The surgeon views the kidney and surrounding tissue with a flexible videoscope. The videoscope and surgical instruments are maneuvered through four small incisions in the abdomen, and carbon dioxide is pumped into the abdominal cavity to inflate it for an improved visualization of the kidney. Once the kidney is freed, it is secured in a bag and pulled through a fifth incision, approximately 3 in (7.6 cm) wide, in the front of the abdominal wall below the navel. Although this surgical technique takes slightly longer than an open nephrectomy, studies have shown that it promotes a faster recovery time, shorter hospital stays, and less postoperative pain for kidney donors.

A modified laparoscopic technique called hand-assisted laparoscopic nephrectomy may also be used to remove the kidney. In the hand-assisted surgery, a small incision of 3–5 in (7.6–12.7 cm) is made in the patient's abdomen. The incision allows the surgeon to place his hand in the abdominal cavity using a special surgical glove that also maintains a seal for the inflation of the abdominal cavity with carbon dioxide. The technique gives the surgeon the benefit of using his or her hands to feel the kidney and related structures. The kidney is then removed through the incision by hand instead of with a bag.

Once removed, kidneys from live donors and cadavers are placed on ice and flushed with a cold preservative solution. The kidney can be preserved in this solution for 24–48 hours until the transplant takes place. The sooner the transplant takes place after harvesting the kidney, the better the chances are for proper functioning.

Kidney transplant

During the transplant operation, the kidney recipient is typically under general anesthesia and administered antibiotics to prevent possible infection. A catheter is placed in the bladder before surgery begins. An incision is made in the flank of the patient, and the surgeon implants the kidney above the pelvic bone and below the existing, non-functioning kidney by suturing the kidney artery and vein to the patient's iliac artery and vein. The ureter of the new kidney is attached directly to the kidney recipient's bladder. Once the new kidney is attached, the patient's existing, diseased kidneys may or may not be removed, depending on the circumstances surrounding the kidney failure. Barring any complications, the transplant operation takes about three to four hours.

Since 1973, Medicare has picked up 80% of ESRD treatment costs, including the costs of transplantation for both the kidney donor and the recipient. Medicare also covers 80% of immunosuppressive medication costs for up to three years. To qualify for Medicare ESRD benefits, a patient must be insured or eligible for benefits under Social Security, or be a spouse or child of an eligible American. Private insurance and state Medicaid programs often cover the remaining 20% of treatment costs.

Patients with a history of heart disease, lung disease, cancer, or hepatitis may not be suitable candidates for receiving a kidney transplant.