Current status of live donor renal transplantation

Nicholas R Brook, Colin H Wilson and Michael L Nicholson

Live kidney donation is assuming an increasingly prominent role in kidney transplantation programs. The traditional operative approach has been through an incision in the upper quadrant of the abdomen or in the loin, with potential postoperative complications associated with a large surgical wound. These problems may act as disincentives to prospective donors. The introduction of laparoscopic donor surgery in 1995 heralded a new era, offering reduced postoperative pain and improved cosmetic result. It is hoped that these benefits may counter some disincentives and thereby increase donation rates. Three minimal-access approaches, along with their advantages and disadvantages are described, including; classical laparoscopic, hand-assisted laparoscopic and retroperitoneoscopic surgery. All three approaches present specific challenges in the context of retrieving an organ that is fit for transplantation and safe for the donor. For minimal-access surgery to be accepted as the procedure of choice for live kidney donors, it must be demonstrated that morbidity is not transferred from donor to recipient when these techniques are used. Some concerns about these procedures are addressed. It appears that, with appropriate modifications, these techniques are safe for both the donor and the allograft. This review also covers other contemporary approaches to overcoming donor shortage by utilizing blood group-incompatible donor and recipient pairs.