Removal of kidney from donor
The operation to remove the kidney from the living donor involves a fairly long incision in the region of the lowest rib. Either kidney can be used, but it is customary to remove the left because of a longer renal vein on that side.

In certain leading transplant units in the USA and Europe, the donor kidney is removed by laparoscopic (keyhole) surgery, with markedly reduced levels of discomfort for the patient. These techniques are not yet available in transplant units in South Africa.

Implantation of kidney in recipient
Many people quite understandably assume that a transplanted kidney directly replaces one of the recipient's own kidneys. This is actually not the case. The new kidney is implanted into the pelvis, near the bladder. The recipient’s own (native) kidneys are left in place.

With the recipient under general anaesthetic, an incision is made in the lower abdomen, usually on the right side. A space is formed outside the sac that contains the intestines. The main blood vessels to the lower limbs and the pelvic organs (iliac vessels) run through this space. The main artery and vein of the kidney are joined to the iliac artery and vein respectively. This provides the blood supply for the transplanted kidney.

The ureter (drainage tube) of the donor kidney is joined to the recipient bladder. A catheter is left in the bladder while the newly joined areas heal. You can expect to stay in hospital for 7-10 days. Full recovery takes approximately six weeks, depending on your underlying health.

How well does a kidney transplant work?
Kidney transplantation is one of the true success stories of modern medicine. The concept of transferring organs between people is not a new one, and the surgical procedure of kidney transplantation itself is also relatively straightforward. However, it was only with increased understanding of the immunology of rejection and the development of effective anti-rejection medication that this operation became a viable option for people with end-stage renal failure.

Kidney transplants work well. The overall patient survival is 95% at one year and 90% at two years. The one-year graft survival is 80%. Graft survival means that the transplanted kidney is still in the recipient and working. The one-year graft survival for living related transplants is 90%. Results are better with living donor kidneys because the genetic match is usually better between relatives, and these kidneys do not need to spend any time in storage.

Quality of life with a well-functioning kidney transplant is vastly superior to that on lifelong dialysis. Transplant recipients are independent and feel much better than they did while on dialysis. Haemodialysis has the problem of trice-weekly trips to the dialysis machine at the hospital, and peritoneal dialysis has the complication of daily fluid exchanges into and out of the abdomen. (See alternatives.)

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