When potential kidney donors meet transplant surgeons Marc I. Lorber, M.D., and Amy L. Friedman, M.D., many have already read on the Internet that laparoscopic nephrectomy is easier on the donor than the conventional open surgery. But according to Friedman and Lorber, the choice is seldom clear-cut. Among the 37 donors who chose to give a kidney at Yale during the first 11 months the advanced procedure was offered here (starting in June 2001), only eight chose the new approach.
The donors’ sophistication poses a challenge to Lorber and Friedman. True, laparoscopic nephrectomy offers advantages to people who wish to give a healthy kidney to a relative or friend in need. The technique minimizes scarring because the surgery is done through smaller incisions, including one for a tiny camera that surgeons use to watch their work on a monitor. Laparoscopy can speed recovery and reduce pain. But the technique may also pose risks, including an increased chance of damage to the intestines and spleen, intra-abdominal scarring and, rarely, bleeding. Whether it’s the best choice depends partly on the anatomy of the donor and partly on the donor’s decision regarding risks and benefits, according to Friedman, who performs laparoscopic nephrectomies with urologic surgeon Kevin R. Anderson, M.D.
Although laparoscopy may attract new donors, it won’t resolve the overwhelming kidney shortage. With 52,000 Americans waiting for kidneys—including 434 on Yale’s list—the rate of 14,000 transplants per year falls short. Last year, 2,800 Americans died awaiting kidneys. At Yale and nationwide, most kidneys come from people who are brain-dead following a stroke or trauma (including 25 of 62 kidneys transplanted at Yale from June 2001 through April 2002). Yet only about half of Americans consent to donate the kidneys of a relative who dies.
The pressing issue, says Friedman, is not which type of surgery donors should choose. “The real problem is that we have all these patients who should be helped with a transplant, and we don’t have kidneys for them.”