Have you recently had a transplantation or has your transplanted kidney been in its new home for a longer while? Have you ever wondered how your new kidney was put into your body and what exactly happened during the surgery? In this article, you will learn everything about your transplant surgery.
For many people with kidney failure, transplantation is an essential step towards a more normal everyday life. Whether the day of the kidney transplant came suddenly and unexpectedly, or was planned long before, depends entirely on which form of transplantation was performed on you. In 2021, just under 2,000 kidneys were transplanted in Germany of which about 500 were living donations. The rest of the kidneys came from so-called postmortem donors. Postmortem donors are individuals who consented to organ donation in the event of their death.
Regardless of whether your transplant surgery has been planned for a long time or not, once a suitable donor organ has been found, things usually happen very quickly. Ideally, your new kidney will be placed in your body and start cleaning your blood and producing urine as soon as possible. The prerequisite for this is, of course, the transplant surgery, in other words, the surgical procedure in which the new kidney gets placed into its new home (your body). In this article we describe what exactly happened during your transplantation surgery and which steps are or were particularly important. This should help you better understand the various steps involved in your personal follow-up with your transplant team and help you take good care of your new kidney.
Where did my new kidney come from?
Where your new kidney came from depends entirely on the type of donation. A distinction must be made between living donation and postmortem donation. In a living donation, the donor donates one of their healthy kidneys to the recipient. In a postmortem donation the donor organ comes from a recently deceased organ donor.
1. Living donation
In living donation, you receive your kidney from a relative or someone very close to you. This group of people includes first- and second-degree relatives - for example, parents, children, grandparents or grandchildren. In addition, spouses or persons living in a marriage-like relationship are eligible as potential donors. People who are obviously emotionally attached to you as a recipient can also be considered for donation. However, regardless of the relationship or emotional connection, all potential donors must be of legal age.
Removing a kidney from a living person is only allowed under very strict conditions. Under no circumstances may the living donor be put under any form of pressure to donate their organ. The person must also be in good health. In addition, the donor must be given a very detailed explanation of the procedure and possible risks by a physician who is not part of the transplant team.
To protect donors and avoid misuse of living donations (e.g. organ purchases), these rules are included in the German Transplantation Act (=TPG) (§ 8 para 3 Transplantation Act Germany). Whether all rules have abided by is usually decided by an expert option from the regional commission responsible for living donation.
A living donation is always a process that is planned far in advance and well prepared to protect you and your organ donor as best as possible. Once the living donation has been approved, both of you - donor and recipient - will undergo surgery at approximately the same time. The healthy kidney will be removed from your donor in the operating room so that it can be implanted into you in the next room. This keeps the time during which the kidney does not have oxygen (= ischemia time) as short as possible, which increases the likelihood your new kidney will function well.
Living donation also comes with possible risks for the donor. However, nowadays complications for the donor are fortunately very rare.
2. Postmortem donation
In a postmortem donation, the new kidney comes from a person who was registered as an organ donor and has recently died. Their death is followed by a conversation with their loved ones and a medical examination of the deceased person. As difficult as the death of a loved one is, the family and friends of the deceased person may find it comforting knowing that through organ donation, another person has been offered a second chance.
Once a suitable recipient has been found, speed is of the essence, as the kidney is often no longer adequately supplied with blood after the donor's death. In order to keep this time without blood flow (= ischemia time) as short as possible, the removed organ is cooled and transported to your transplant center. However, even with cooling, the kidney can only survive for a certain time outside the human body. Theoretically, the kidney has a time window of 36 hours. This is why everything has to go quickly.
The transport to the transplant center takes place either via air or with an express transport in the car. In Europe, the exact allocation of donor organs in post-mortem donation is regulated by the Eurotransplant foundation. In addition to the ranking of patients on the waitlist, regional factors often play a role in the decision process. For example, an organ removed from a German organ donor is would typically be re-transplanted in Germany in order to keep the transport time short.
The advantages of living donation (shorter waiting time, ability to plan the operation, short ischemia time) are of course not all present in post-mortem donation. Additionally, thorough testing and examinations before the transplantation is also not possible.
What happens before transplantation?
Before the transplant, you will be thoroughly informed about the operation, the procedure, possible risks and about the anesthesia. In the case of living donation, you and your donor will normally be called to the clinic the day before the operation or on the morning of the operation. Here, you will be calmly prepared for surgery. The procedure starts with you receiving general anesthesia.
For postmortem donation, the timing of the transplant depends on when a new kidney becomes available for you. As such, the date of the operation is likely to be spontaneous. After you are informed that a kidney is available, you will head to the clinic where your current state of health will be checked again. For this purpose, your complete laboratory (=blood panel) will be evaluated again. You may even be dialyzed again to prepare your body for the surgical procedure.
You may also find yourself wondering why you are getting catheters and IVs put in before your surgery. Often, you will be given a cervical catheter and a bladder catheter before the transplant. Through them, your fluid balance is monitored and medications are given if needed.
Which of the two kidneys will be removed in living donation?
Because your donor needs a kidney for themselves, only one kidney is removed for transplantation. If your are getting your kidney via postmortem donation, you will also receive only one kidney. In living donation, the new kidney is taken from the donor on site. Nowadays, this procedure is often performed in a minimally invasive way. This means that the surgeon only makes a few small incisions in the abdominal wall to detach the donor's kidney from the corresponding vessels. A large incision is then only necessary to remove the kidney from the body.
Which kidney is removed is determined before the transplant. For this purpose, a number of examinations - such as an ultrasound or functional tests - are performed. Decisive for the selection of the kidney are abnormalities such as cysts, the blood supply to the kidney and the location of the ureter. Finally, the goal is for you to get a top functioning organ and your donor should also have a kidney that works well. In 65% of cases, the left kidney is harvested. The left kidney has a longer renal vein and therefore can be better used in the recipient.
If you receive a living donation, the transplant is flushed with a preservation solution and stored at 4 degrees Celsius. Within 1-3 hours, the kidney will be implanted into your body. If everything goes normally, your donor can usually leave the hospital after 7-10 days and return to a daily life without restrictions after 1-3 months.
Where will my new kidney be implanted?
Regardless of whether you received a living donation or a postmortem donation, you will have been transplanted with only one kidney. This is enough for your body to replace the function of your two old kidneys. The new kidney will be placed in what in the region called the “small pelvis”. In other words, your new kidney will be one floor lower than your old kidneys, and there it will be in close contact with your urinary bladder and rectum.
To insert your new kidney, an arch-shaped incision is made above the groin. Here the surgeon will connect the vessels of your pelvis to the vessels of your new kidney. This allows the new kidney to be supplied with blood so it can do its job. As a final step, your ureter, which connects your new kidney to your bladder, is attached. This will also allow your new kidney to produce and excrete urine.
Before the wound is closed, a plastic tube (=drain) is inserted. The job of this drain to remove wound fluid from the surgical area during the first days after your operation.
What happens to your old kidneys?
Your two old kidneys remain in your body as removing them only puts extra stress on your body. They can usually stay in place without causing harm to your your body. A case when your old kidneys would be removed is if they are filled with large hollow spaces (= cystic kidneys). Such kidney are a burden to you and your body and may be removed.
What happens in the hospital after the transplant?
The insertion of the new kidney takes only a few hours (2 - 3 hours) in the best case. After the transplant, you will be transferred to the intensive care unit as a precaution and for closer monitoring. It often takes a while for your new kidney to work properly and produce urine. If this is the case, you may need to have additional dialysis for a few days.
If your condition is stable, the drains and tubes will be removed and you will be transferred back to the normal ward. Here, your team of doctors, physiotherapists and nurses will accompany you until you are discharged and make you fit for your daily life.
For your new kidney to hold as long as possible, it is important that you take your medication regularly, drink enough fluids and pass enough urine. Nowadays the chances of success of a transplanted kidney are very good. On average, a transplanted kidney survives well over 10 years under good monitoring. It is also becoming more and more common for a kidney to hold more than 20 years.
You should always discuss what rules you should follow after surgery with your medical team. You can also find more information about life post-transplant in a lot of other content on the Mizu app.
