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Urological Nephrectomies for Benign Disease: A Possible Missed Resource in Organ Donation
Shamik Dholakia1, Sanjay Sinha, Georgios Vrakas
1From the Nuffield Department of Surgical Science, Oxford Transplant Unit, University of Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
Insights
Native nephrectomies can create new kidney donors for transplant patients. This approach may help address the global organ shortage, but requires careful patient selection and robust salvage procedures.
Area of Science:
- Nephrology
- Transplant Surgery
- Urology
Background:
- The global shortage of donor organs for renal transplantation is a significant healthcare challenge.
- Nephrectomy (kidney removal) is performed frequently, with a substantial number of procedures for benign or functional reasons.
- Understanding potential secondary uses for removed native kidneys is crucial.
Observation:
- A prospective case series of 6 patients undergoing native nephrectomy was conducted.
- Three patients subsequently received successful kidney transplants from these native nephrectomies.
- All transplant recipients maintained normal renal function at 12 months post-transplant.
Findings:
- Native nephrectomies, in selected cases, can yield viable organs for renal transplantation.
- Patients undergoing nephrectomy for non-life-threatening conditions maintained normal renal function and symptom resolution.
- Successful transplantation from native nephrectomies contributes to expanding the donor organ pool.
Implications:
- This strategy offers a potential solution to mitigate the critical shortage of organs for kidney transplantation.
- Careful patient selection and robust pre-operative assessments are essential for this approach.
- Further research with larger sample sizes is warranted to validate these findings and optimize donor selection criteria.
Objectives:
The deficit of organs for renal transplant is a global issue. The United Kingdom Hospital Episode Statistics indicates there that were 8168 nephrectomies undertaken in 2014. Furthermore, according to the British Association of Urological Surgeons 2014 nephrectomy report, 71.8% of patients undergoing a nephrectomy had creatinine levels of less than 120 IU/L and roughly 20% had the procedure for benign and functional causes.
Materials And Methods:
We report a prospective case series from March 2014 to March 2016 involving 6 patients showing 3 successful transplants performed following 3 native nephrectomies.
Results:
All recipients had normal creatinine levels with good function at 12 months, and all nephrectomy patients, in addition to maintaining normal renal function, had definitive resolution of symptoms. The main limitation of this series was the small sample size.
Conclusions:
There is no doubt that all should be done to save native organ function, and all salvage procedures and psychological testing must be robust before considering this route. However, within the group that proceeds to nephrectomy, some cases may have the potential to generate a new pool of donor organs suitable for transplant, helping to tackle the organ deficit in renal transplantation.
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