Kidney Transplantation

Definition

• The implantation of a kidney from a living donor or cadaver donor (kidney harvesting) to a tissue-matched recipient.

Discussion

• Kidney transplantation is usually performed on an otherwise healthy patient who suffers from renal failure.
• The donor should be a close family member (twin, sibling, parent).
• Two surgical teams may work simultaneously if the procedure involves a living donor.
• If the transplant is from a cadaver donor, a team from the transplant centers removes the cadaver’s donor’s kidney for external perfusion prior to implantation, to minimize the time that elapses between the recipient’s nephrectomy and the implantation of the donor kidney (4-6 hours after removal, with a maximum time of 72 hours).
• Contraindications for kidney transplantation include:
  • Systemic disease that precludes major surgery.
  • Active cancer.
  • Oxalosis (an autosomal recessive hereditary disease).
  • Fabry’s disease (an inherited metabolic disease resulting in excessive amounts of glycolipids in the kidney).

Positioning

• Supine

Packs/ Drapes

• Basin sets
• Blades
• Foley catheter with drainage unit
• Suction
• Needle counter
• Drain
• Solutions
• Sutures
• Medication

Procedure

1. The kidney is brought to the recipient team by the donor’s surgeon or designee.
2. The recipient’s surgeon makes a long inguinal incision that is carried down to the iliac fossa by blunt and sharp dissection.
3. The kidney is usually placed in the patient’s iliac fossa to avoid peritonitis.
4. The surgeon identifies the external iliac vein and hypogastric artery.
5. Anastomoses are then performed between the renal artery and hypogastric artery and between the remal vein and external iliac vein (4-0 or 5-0) non absorbable vascular suture.
6. Prior to anastomoses, the patient is given a systemic dose of I.V. heparin by the anesthesiologist.
7. The surgeon will implant the donor ureter into the bladder.
8. The bladder is grasped with two or more Allis clamos and then incised.
9. A separate incision is made to accommodate the ureter.
10. The surgeon sutures the ureter through the first incision (3-0 or 4-0 chromic; Dexon).
11. A penrose drain is placed near the bladder wall, and the first incision is closed in three layers.
12. The wound is closed in three layers as for an inguinal hernia repair.

Perioperative Nursing Considerations

1. Permission to harvest the kidney must be obtained from the family and the medical examiner.
2. Support systems for the families of the donor family especially following a traumatic death, the recipient family, and the patient should be activated since psychologic changes may develop that need professional intervention.
3. A harvesting procedure (cadaver donor), especially on a young patient, may be traumatic on the participating nursing staff, since once the kidney is out, the need for life support from anesthesia is no longer required.
4. Ample support should be available to assist the staff in overcoming any potential psychologic problems that could interfere with the efficient execution of care required.
5. Following the harvesting procedure, postmortem care is performed according to hospital protocol.