Journey for Living Kidney Donors
The following information should provide you with a guide to the donation process at Johns Hopkins.
After your comprehensive evaluation and approval by our transplant team you and your recipient along with the transplant coordinators will decide on a date for surgery. Your coordinator will schedule the surgery and verify the date with you. Live donor surgery is usually scheduled on Mondays. You will receive a letter for your pre-operative visit which is usually 2 weeks prior to the date of surgery. You need to come to the lower level of the Johns Hopkins Hospital Outpatient Center to the pre-operative area and check in.
At your pre-operative visit you will have blood work drawn and a urinalysis. An anesthesiology nurse practitioner or physician assistant will examine you and get a heath history. They may make recommendations for further tests to be done before surgery to ensure it is safe for you to go under anesthesia. Your coordinator will coordinate any further tests you may require. Your coordinator will present all final tests and lab work to our transplant team for final approval before surgery. Then within 7 days of surgery you will do a final crossmatch. A sensitizing event such as a blood transfusion or infection can cause the crossmatch to be positive. This could delay the surgery.
If you are taking birth control pills you need to stop taking them 6 weeks prior to surgery. Aspirin, motrin, ibuprofen, advil, alka seltzer, vitamin E, ticlid, coumadin, lovenox, celebrex, voltaren, vioxx, plavix and some other arthritis medications can cause bleeding and should be avoided 1 week prior to surgery. Please contact the prescribing doctor before stopping any prescribed medication.
Admission to JHH
You will need to come to the hospital on the day of surgery at the requested time. You will be given this at your pre-op visit. You will go to the Osler building on the seventh floor and check in. You will be escorted to the pre-operative area where you will be prepared for surgery. Your surgeon will visit you and get consent for the surgery and answer any questions you might have. You will have an IV placed.
Anesthesia
Anesthesia is a temporary state of sleep. You will have general anesthesia. It is reversed once the surgery is complete. You will meet your anesthesiologist in the pre-operative area. They will review the type of anesthesia you will be receiving and answer any questions you may have.
Nothing by Mouth
Please only have a clear liquid diet 24 hours prior to surgery. You must not eat or drink anything after midnight the night before surgery. If you take prescription medicine ask your doctor or nurse if it is OK to take them.
Personal Items
All personal items must be removed before going to the operating room. This includes all jewelry, clothing, dentures, glasses, hearing aids, money, and hair accessories. Please have your family or friends take the items home or do not bring them with you to the hospital unless they are necessary. The security office can lock up these items if no one is available to take them home for you. Please remove nail polish before coming to the hospital.
The Operation
You will be taken to the operating room on a stretcher. You will be transferred to the operating table. The anesthesiologist and OR nurses will be there. The anesthesiologist will put you to sleep. The procedure takes 3-4 hours. The procedure is done laproscopically through 4 small incisions in the abdomen. If you are unable to have it done this way you will be informed by your surgeon. You will have an anesthesiologist monitoring you, 2 surgeons performing the procedure and the OR surgical staff assisting in your care.
Post-Operative Recovery
Immediately after your surgery you will be taken to the recovery room. There you will awaken from anesthesia. Once you are fully awake and vital signs are stable you will be transferred to your hospital room. The typical hospital stay is 2 days.
Things to expect after surgery:
Puffy hands and eyes- will go down in 24 hours
Dry mouth
Can have a sore throat from the breathing tube during surgery
Will be very sore and have incisional pain
Pain: | Will be managed with pain medication. PCA (patient controlled anesthesia) pump that lets you have pain medication when you need it. |
Diet: | You will start with clear liquids and advance to a regular diet as tolerated. |
Activity: | While in bed you should turn every 2 hours. Out of bed with MD order. |
Pulmonary Care: | You will be given an incentive spirometer. You will be taught how to use it correctly. It needs to be done 10 times every hour while awake along with coughing and deep breathing. |
Catheter: | A foley catheter is a drainage tube that is inserted in your bladder in the operating room. It will remain in for one day to monitor your urine output. |
Discharge Home
You will need someone to pick you up and take you home when the transplant team discharges you from the hospital.
| Driving should be avoided for 2 weeks-while on pain medication No heavy lifting (10 lbs) for 6 weeks No exercising for 6 weeks-and cleared by urologist No tub baths for 2 weeks, showering permitted Walking is encouraged Prolonged sitting or lying should be avoided Pain medication will be provided |
Follow up appointment
You will schedule a follow up appointment to see the surgeon and to have bloodwork done if the appointment was not made at the time of discharge from the hospital. If you are from out of state, please make an appointment for 2 weeks post surgery with your primary care physician for follow up and blood work. You will need to have the results of the blood work sent to the Johns Hopkins transplant office. Once cleared by the surgeon, you will need to have a yearly check up by your primary care physician.
Diet
- Plenty of water and fluids
- No added salt diet
- Avoid high protein diets and low carbohydrate diets
- Use prescribed stool softener until Bowel movement regular
- If unable to move bowels an over the counter suppository may be used (pain medication may cause constipation)
Pain Control
- Pain medication as prescribed for pain
- Tylenol may be used when prescribed; pain medication not routinely needed.
Medications to avoid: Ibuprofen, Naprosyn, Motrin, Advil, Aleve, and all anti-inflammatory medications
- Showering permitted- pat incisions dry, no soap or lotions on incisions
- No driving for 2 weeks or while taking pain medication
- Steri strips will fall off in 5-7 days
Notify your living donor coordinator if you experience any of the following:
- Fever
- Wound drainage or wound opening
- Red, swollen incision
- Pain that is a change from incisional pain
- Nausea and/or vomiting
- Change in urination-decreased volume, inability to void, pain, urgency or frequency
