The events of the day(s) leading up to the kidney transplant operation are a little different depending on if you are receiving a live donor kidney transplant versus a deceased donor kidney transplant. Both will be outlined here.
Live Donor Kidney Transplant
On the day prior to your scheduled living donor kidney transplant, you will be admitted to hospital for final preparation for the procedure. This includes final bloodwork, urine testing, and review by the Medical, Surgical and Anesthetic Teams. You will not be allowed to eat or drink anything after midnight of the night prior to your procedure.
On the morning of your procedure, immunosuppression medication may be started, and other preoperative medications administered for blood pressure, blood sugar, antibiotics, etc. The donor operation is usually done by noon, and your operation will start around that time. In preparation for this, you will be moved from your ward bed in the Hospital to the Pre-Anesthetic Care Center (PCC) to await the surgery around 10am. PCC nursing staff will review final preparations and you will be wheeled to the OR suite when ready. There, the Nursing Team will introduce themselves to you (Scrub, Circulating, Relief nurse), and you will be reacquainted with the Surgical and Anesthetic Teams (Attending physicians, fellows, residents, students). Be aware that in an Academic Teaching Hospital, there will always be learners around, but that the procedures and operations being performed are always done with the close supervision and direction of the attending Physician.
The transplant operation takes roughly 3-5 hours to complete, and you will be administered medications which will make you unaware of the procedure, and in fact likely not remember the procedure at all as well as feel no pain.
An incision is made in the lower pelvis on one side or the other as decided previously, and connections to the donor kidney are made from the donor renal artery to your external iliac artery, donor renal vein to your external iliac vein and from the donor ureter to a new spot on your bladder. A ureteric stent will be left in place between the kidney and the bladder inside the ureter to allow healing in the junction between the new ureter and bladder which is critical to prevent urinary complications. The fascia and skin will be closed in layers. A subcuticular skin closure is used in which fine sutures are placed to reapproximate the skin edges and which dissolve on their own in 8-12 weeks time. There are no sutures or staples to remove after the operation.
After the operation, you will be moved to the Post Anesthetic Care Unit (PACU) where you will be closely monitored for the next 5 hours. Blood pressure, heart rate, oxygenation status, kidney function will all be monitored to make sure that the new graft is working as expected. If you are well enough, you will then be transferred back to your ward bed on the Inpatient unit of the Hospital around 10-11pm and likely rest until morning. Family can visit in the PACU and in the room later as well.
Deceased Donor Kidney Transplant
The events leading up to a deceased donor kidney transplant are analogous to that of the living donor transplant experience, except that these operations are not scheduled well in advance. Instead, although you will not know exactly which spot you occupy on the waitlist, you will come to know that you are getting closer to the top of the list when requests for screening bloodwork start coming every month. You may also periodically get kidney offers from the Transplant Center with sporadic but increasing frequency up until the time of your confirmed operation.
A typical scenario might be: you spend several years on the waiting list and note that your Nephrologist is now requesting monthly bloodwork instead of every 2 or 3 months. As well, you have been requested to update some routine tests that you have not had for a long time such as EKG and ECHO and to see your Cardiologist again. You had some calls of potential kidneys that might be going to be offered to you, but they fell through. This time, the Transplant Center Nephrologist calls you at 11pm while you are out to dinner at friends’ house, and tells you that there is a kidney being offered to you and any particulars of the donor that you need to made aware of (no identifying information). The Nephrologist will quickly review your health condition on the phone with you, and if you are in stable health, you will be asked to make your way to the Transplant Center as soon as possible for admission for surgery within the next 24 hours. It will be up to you to make the trip to the Transplant Center in due course, and if we are unable to contact you to let you know of the kidney offer, have unresolved heath issues or are unable to travel to the Center, then you will be bypassed in favor of the next patient on the waiting list for the that kidney. You will then remain on the waitlist for the next available compatible kidney.
Assuming you have been admitted to Hospital under the Transplant Team, you will meet the Medical, Anesthetic and Surgical Teams and be prepped for surgery as soon as possible. If you require dialysis prior to the transplant, this will be arranged for you in Hospital.
The remaining experience is as above for the Live Donor Transplant experience. The main difference between the two types of transplant in terms of process, is that there is much more “running around” on the part of the Transplant Center to arrange everything quickly, as well as on the part of the recipient to get themselves ready and travel to the site and get prepped for surgery. More often than not, Deceased Donor Kidney Transplants occur in the middle of the night and on weekends, but can occur at all hours, any day of the week. So long as there are Deceased Donors available for transplant retrieval, there will be transplant operations.