RENAL TRANSPLANTATION - DONAR SCRENING AND OPEN NEPHRECTOMY

Routine live kidney donor screening

 Urinalysis –

•  Dipstick for protein, blood & glucose
• Microscopy & culture
• Protein excretion rate

Assessment of renal function-

• Estimation /measurement of GFR

Blood tests

Haemogram,coagulation profile

Haemoglobinopathies& G6PD  deficiency (when indicated)

Biochemical profile

       Blood urea, S.Creatinine, S.electrolytes, LFT, FBS, GTT(if indicated)

       Lipid profile,Thyroid profile, Pregnancy test & S.PSA

Virology& infection screen

        Hep.B, Hep.C, Toxoplasma, HIV, HTLV,CMV, EBV 

Cardio-respiratory system

       Chest X-ray, ECG, Stress test, 2D-ECHO(when indicated)

Assessment of renal anatomy& function

       KUB-IVP series, DTPA-Renogram, Renal Angiogram

• PAC (Pre Anesthetic Checkup) and
• Pre –Operative  Preparation

                                 ---For both donor & recipient

      

Donor Nephrectomy

• Open              [ODN]
• Laparoscopic   [LDN]

Open Donor Nephrectomy(ODN)

• Endotracheal  intubation for GA
• Kidney/flank position
• 11th or 12th  rib incision (with rib excision when needed)
• Ext.oblique, Int.oblique,Transversus abdominis with fascia divided
• Retroperitoneum entered
• Kidney mobilized all around
• Tributaries of renal vein ligated
• Renal vein & Renal artery are mobilized up to their origins
• Ureter mobilized up to pelvic brim and transected
• Brisk diuresis ensured from the cut ureter
• Renal artery & Vein are clamped, cut and ligated
• Kidney is handed over to perfusion team for placing in ice slush & perfusion  with chilled RL & heparin
• Wound closed in layers with or without a drain