What you can expect

Before the procedure

Once you've gone through the living organ donor screening, evaluation and informed consent process, your donor nephrectomy procedure will be scheduled for the same day as the transplant surgery for the recipient. Separate medical teams and surgeons normally perform the donor nephrectomy transplant surgery, but they work closely together.

You'll receive instructions about what to do the day before and the day of your kidney donation surgery. Make note of any questions you might have, such as:

• When do I need to begin fasting?
• Can I take my prescription medications?
• If so, how soon before the surgery can I take a dose?
• What nonprescription medications should I avoid?
• When do I need to arrive at the hospital?

During the procedure

Donor nephrectomy is performed with general anesthesia. This means you will be asleep during the procedure, which usually lasts two to three hours. The surgical team monitors your heart rate, blood pressure and blood oxygen level throughout the procedure.

Surgeons almost always perform minimally invasive surgery to remove a living-donor's kidney (laparoscopic nephrectomy) for a kidney transplant. Laparoscopic nephrectomy is associated with less scarring, less pain and a shorter recovery time than is traditional open surgery to remove a kidney (open nephrectomy).

In a laparoscopic nephrectomy, the surgeon usually makes two or three very small incisions close to the bellybutton, which are used as portals (ports) to insert the fiber-optic surgical instruments. The equipment includes a small knife, clamps and a special camera called a laparoscope that is used to view the internal organs and guide the surgeon through the procedure.

A slightly larger incision is made below the bellybutton to remove the donor kidney.

In open nephrectomy, a 5- to 7-inch (13- to 18-centimeter) incision is made on the side of the chest and upper abdomen. A surgical instrument called a retractor is often used to spread the ribs to access the donor's kidney.

After the procedure

After your donor nephrectomy, you'll likely stay in the hospital for one or two days.

In addition, you can expect:

• Care after your surgery. If you live far from your transplant center, your doctors will recommend that you stay close to the center for a few days after you leave the hospital so that they can monitor your health and remaining kidney function.

  You'll likely need to return to your transplant center for follow-up care, tests and monitoring several times after your surgery. Transplant centers are required to submit follow-up data at six months, 12 months and 24 months after donation. Your doctor may conduct your laboratory tests one and two years after your kidney surgery.

• Recovery. Depending on your overall health, doctors will give you specific advice on how to take care of yourself and reduce the risk of complications during your recovery, including not sitting or lying in bed for long periods of time, not driving a car for one to two weeks, not lifting any objects heavier than 10 pounds (4.5 kilograms) for a month, caring for your incision, managing pain, and returning to a normal diet.
• Return to normal activities. After kidney donation, most people are able to return to normal daily activities after two to four weeks. You may be advised to avoid contact sports or other strenuous activities that may cause kidney damage.

• Pregnancy. Kidney donation normally does not affect the ability to become pregnant or complete a safe pregnancy and childbirth. Some studies suggest kidney donors may have a small increase in risk of pregnancy complications such as gestational diabetes, pregnancy-induced hypertension, preeclampsia and protein in the urine.

  It's usually recommended that women wait at least six months to a year after living donation before becoming pregnant.