Kidney Failure

The kidneys are a pair of organs in the back of the abdomen. In an average day, about 200 quarts of blood flow through the kidneys, where excess fluid and waste products are filtered out and turned into urine. The kidneys regulate the levels of important minerals, like potassium, sodium and phosphorus, in the blood. In addition, the kidneys release three hormones: erythropoietin (EPO, which causes the bone marrow to make red blood cells), renin (regulates blood pressure) and calcitriol (a form of vitamin D, which maintains calcium for strong bones).

When the kidneys are damaged by disease or injury, they may not be able to function properly. Toxic waste products build up in the blood, the body retains fluid and blood pressure rises. Eventually, patients need dialysis (mechanical filtering of the blood) to stay alive. According to the National Kidney Foundation, more than 485,000 people in the U.S. are currently being treated for kidney failure.

Kidney Transplantation

Another option for kidney failure is a transplant, or removal of diseased kidneys and replacement with a donor kidney. Traditionally, donor kidneys have come from cadavers. But since people can survive with just one kidney, sometimes a living person is willing to donate a kidney. A living donor is typically genetically-related because he/she is more likely to be a tissue match for the recipient. Sometimes, however, a friend, co-worker or stranger can be a good tissue match and donate a kidney.

In addition to being a better match, using kidneys from live donors has other advantages. Recipients don’t have to wait until a cadaver kidney becomes available (most candidates spend one to two years on the waiting list). The transplant surgery can be scheduled at a time that is convenient for both the donor and recipient. A living kidney doesn’t have to be transported very far (usually just to the next surgical suite), so it is fresher and generally in better condition than a kidney from a deceased donor and starts functioning sooner.

According to the United Network for Organ Sharing, as of October 23, 2009, more than 82,220 people were on the waiting list for a kidney transplant. Last year, 16,520 kidney transplants were performed in the U.S. 5,968 (more than 36 percent) of those transplants were from living donors.

Living Kidney Transplants – Surgery for the Donor

The first successful living kidney transplant was done more than 50 years ago. For a long time, the surgery to remove a kidney was done through a large incision. Rolf Barth, M.D., Transplant Surgeon with the University of Maryland Medical Center in Baltimore, says it wasn’t uncommon for the donor to spend more time in the hospital after donating a kidney than the transplant recipient.

Eventually, doctors learned how to remove a donor kidney laparoscopically, by making a few small incisions in the abdomen and using a camera and miniature surgical instruments. For the donor, laparoscopic kidney donation is much easier. Recovery is much faster (one or two days in the hospital versus one or two weeks with open surgery). Patients have less pain and less scarring and are able to get back to work fairly soon.

More recently, a few surgeons have started performing laparoscopic kidney removal through a single incision in the belly button. Barth explains that once the incision is made into the belly button, a small port (open connection) is placed through the incision. Gas can be forced through the port to expand the abdomen and give the surgeon more room and access to the kidneys. The camera and surgical instruments are passed through another slot in the port.

Once inside, the surgeon cuts and seals off the blood vessels and connecting structures to the kidney. Then the port is removed. The opening into the belly button is stretched out, giving the surgeon enough room to pull out the kidney. The organ is then carried to the recipient’s operating room for transplant.

Barth says most people who are candidates for laparoscopic kidney donation are eligible for the single incision surgery. Once the surgery is finished, the incision and eventual scar is hidden inside the belly button. So donors have no visible scars.

For general information on kidney function, donation or transplantation:

National Institute of Diabetes and Digestive and Kidney Diseases

National Kidney Foundation

United Network for Organ Sharing