Posted on April 18, 2001 at 11:15 a.m.

BIRMINGHAM, AL — UAB’s organ transplant program is using a simpler, minimally invasive surgery to make it easier for living persons to donate a kidney to friends and family members.

Over the past year Dr. Donald Urban, a UAB urologist, has used laparoscopic surgery to remove kidneys from more than 25 living organ donors. “Donors have embraced this surgery enthusiastically because they have less pain, quicker recovery and a more cosmetically acceptable scar,” said Urban.

The operation to remove a kidney by the traditional method is a major one, involving an 18-inch incision and visible scar, the removal of part of a rib, considerable pain after the operation and several weeks’ recuperation before returning to normal activity.

Laparoscopic kidney removal can take up to five hours as compared with less than two hours for the conventional surgery. “The longer surgery is very much offset by the advantages in less discomfort and shorter recovery time,” Urban noted.

“People have generous impulses to donate when they learn a family member or friend needs a kidney. Yet, many people with work and family responsibilities just cannot afford that sacrifice. That’s what makes the new technique so attractive and promises to further increase the number of live-donor operations,” he said.

“All of the kidneys donated with this surgery have functioned well in the recipients. Based on this success rate as well as feedback from patients, we plan to double the number we perform with this technique in the next year,” he said.

Not everyone can donate a kidney — the donor’s physical and psychological health has to be good, and the blood type has to match the recipient’s. For the minimally invasive type of surgery, the donor has to meet additional criteria. “Initially,” said Urban, “we required candidates be relatively thin and younger. There also are some technical requirements as to the number of blood vessels that may feed the particular kidney we are removing.”

Potential live-kidney donors undergo several tests at UAB Hospital to help doctors decide which type operation may be offered.

The operation uses miniature instruments and a video camera inserted into the body through incisions 1/4 to 1 inch. The surgeon manipulates the instruments from outside the body, watching his progress on a video monitor. After the kidney is separated from surrounding tissues, the artery and vein are stapled and divided using special instruments. The surgeon then inserts an expandable folded bag through a 3- to 4-inch incision in the “bikini line.” The bag is expanded to entrap the kidney, which is pulled safely from the body without injury or trauma through this lower abdominal incision. A member of the kidney transplant team immediately carries the donated kidney to a nearby operating room where it is transplanted into the recipient.

More and more people are on the waiting list for kidney transplants, according to Dr. Mark Deierhoi, UAB director of transplantation and a kidney transplant surgeon. “The average waiting time for kidney transplant is now three to four years for the 1,300 people on the waiting list in our program,” Deierhoi said. “While organ donation from deceased persons may increase slightly in some years, the need continues to outpace availability. The largest increase in organs has come from living donors.”

The number of living kidney donors has increased at UAB each of the last five years. In the last decade, UAB has transplanted more kidneys than any other center in the nation. Living donors generally provide the best outcome for kidney transplants, Deierhoi said.

“Transplant from a living donor provides the opportunity for a well-planned, elective surgery in which both donor and recipient are in the best possible health,” he said. “Perhaps most important, the kidney is only removed from its natural blood supply for a few minutes to carry it into a nearby operating room. A kidney from a cadaver normally will be separated from blood supply for at least several hours. It is generally acknowledged that this leads to delayed and even diminished functioning of the kidney in some cases.”