c. Donor Operation.
In living donors, angiography assists in selection of the preferred donor
(2) The donor nephrectomy is done much as the procedure already
described in paragraph 3-14, but the surgeon will do a delicate dissection to prevent
trauma to the renal vessels and ureter.
(3) The patient may be given intravenous mannitol before the kidney is
excised, and the surgeon may inject 1percent lidocaine (Xylocaine) about the renal
pedicle before its dissection to prevent vasoconstriction. The scrubbed nursing team
member should have sterile iced normal saline available to cool the kidney immediately
after it is removed.
(4) If the donor kidney is cooled by intraarterial perfusion, cold (15 C),
sterile, lactated Ringer's solution to which heparin and procaine have been added will
be introduced into the vessels by means of small polyethylene catheters under strict
aseptic conditions. The sterile basins and donor kidney should be covered with a sterile
drape and taken to the recipient operation by the surgeon.
d. Recipient Operation.
The incisional approach is carried out.
(2) The donor kidney is placed in the contralateral iliac fossa of the patient
and rotated 180 degrees so that the posterior surface is anterior in the patient. Placing
the organ extraperitoneally may prevent peritonitis if an infection develops.
(3) The renal artery is anastomosed to a branch of the hypogastric artery
and the renal vein to the external iliac vein.
(4) The ureter, depending on its length, may be implanted into the bladder
directly by a tunneling technique, or it may be anastomosed to the recipient ureter. A
cystostomy tube may be inserted into the bladder.
Bilateral nephrectomies and splenectomy may be performed on the recipient
at the time of transplant or at another time, depending on the patient's general
condition and the surgeon's program of management. This is done to prevent
hypertension or urinary tract infection.
3-20. RECONSTRUCTIVE OPERATIONS ON THE URETER
a. General. Reconstructive operations may be indicated because of a
pathological condition of the urinary bladder or lower ureter that interferes with normal
drainage. Conditions requiring urinary diversion or reconstruction of the urinary tract