Due to an increase of patients with end stage renal disease and accompanied increase on the United Network for Organ Sharing (UNOS) waiting list (www.unos.org), living related donation has become more important. Live donation achieves statistical success far beyond cadaveric donation. Live donors include family and non-family members within the same blood group as the recipient. Additionally, live donation not only provides better outcomes but the recipient usually needs less immunosuppressive medication therefore increasing quality of life and reducing the potential side effects of immunosuppression.
Our transplant program at Hartford Hospital has been involved in live organ donation since 1971, having performed over 366 since that time. In 1996, we adopted laparoscopic donor nephrectomy and, in 1998, added hand-assisted laparoscopic donor nephrectomy. These improved techniques make this operation safer and easier. The Hartford Hospital Transplant Program was the first in New England to apply these procedures and is one of the leaders in hand-assisted laparoscopic donor nephrectomy in Connecticut and New England. Operation times for hand-assisted laparoscopic donor nephrectomies are similar to open procedures. The use of a 3½-inch incision in the midline of the abdomen eliminates the large incision created during an open procedure that cuts through 4 abdominal muscle groups. We have established that hand-assisted laparoscopic donor nephrectomy is safe for the donor (we have accomplished this with donors having 1, 2, and 3 renal arteries) and also safer for the transplanted kidney. Post-operation pain and recovery is dramatically reduced.
In 1996, we replaced the arteriogram of donor evaluation with Magnetic Resonance Angiography (MRA) and Magnetic Resonance Imaging (MRI). This painless procedure without radiation eliminates the discomfort of arteriography, is less expensive, and quicker than traditional arteriography. MRA technology also renders more anatomic information important to the surgeons performing the procedure of donation and recipient implantation.
Hand-assisted laparoscopic donor nephrectomy coupled with donor evaluation using MRA/MRI has improved the traditional experiences of donor and recipient. In the past, open donor nephrectomy required longer hospitalization for the donor and a more difficult recovery time. Now the donor evaluation and recovery is far easier. Typically, the donor is able to be discharged home in 3 days and is ambulatory with minimal wound discomfort. The Hartford Hospital Transplant Program has also shared their successful experiences on hand-assisted laparoscopic donor nephrectomy for live kidney donation at national meetings.