The evaluation of the living renal donor, surgical techniques and results

Living-donor renal transplants from either genetically related or unrelated donors have proven to have superior short- and long-term results when compared with cadaveric transplants. Meticulous and comprehensive evaluation of the donor is necessary to eliminate all donors with possible underlying renal disease, and to minimize the risk of post-operative complications. Operative strategies are aimed at obtaining excellent exposure to the kidney and reducing trauma to the renal vessels. Techniques to use kidneys that in the past may not have been used (eg, multiple renal arteries, short right renal vein, ureteropelvic junction obstruction) are described. Vigilance during the preoperative medical and radiological evaluation, nephrectomy, and postoperative period needs to be maintained in order to eliminate any and all preventable morbidity associated with this procedure. Long-term follow-up of all living donors is important to continually reassess postnephrectomy risk.