CPT® Code 50300

1. Indications

The donor nephrectomy procedure is indicated for the following conditions:

• Organ Transplantation This procedure is performed to procure kidneys from a cadaver donor for transplantation into patients with end-stage renal disease or severe kidney dysfunction.

2. Procedure

The donor nephrectomy procedure involves several critical steps to ensure the successful removal of the kidneys from a cadaver donor.

• Step 1: Preparation of the Donor The cadaver donor is medically maintained to ensure the viability of the kidneys until the surgical transplant team arrives. This preparation is crucial for the success of the organ procurement.
• Step 2: Dissection of Major Vessels The surgical team begins by dissecting the inferior vena cava, aorta, and both renal pedicles free of surrounding structures. This step is essential to access the blood supply to the kidneys.
• Step 3: Clipping and Dividing Veins The gonadal, lumbar, and adrenal veins are clipped and divided to facilitate the removal of the kidneys. This ensures that the vascular structures are properly managed during the procedure.
• Step 4: Identification of the Renal Artery The renal artery is identified and carefully dissected free from surrounding tissue. This step is critical to preserve the blood supply to the kidney until it is ready for removal.
• Step 5: Preservation of Kidney Attachments Lateral, posterior, and inferior kidney attachments are left intact to prevent torsion of the kidney and damage to its vascular pedicle. This precaution helps maintain the integrity of the organ during the procedure.
• Step 6: Dissection of the Ureter The ureter is dissected free of surrounding tissue to the level of the iliac vessels and then divided. This step is necessary to completely detach the kidney from the urinary system.
• Step 7: Final Dissection of the Kidney The kidney is further dissected free from the remaining lateral and inferior attachments. The lower pole of the kidney is elevated and dissected free of posterior attachments to facilitate its removal.
• Step 8: Division of the Vascular Pedicle The vascular pedicle, which contains the renal artery and vein, is divided. This step marks the final detachment of the kidney from the donor's body.
• Step 9: Cooling of the Kidneys If cardiocirculatory arrest is initiated, retrograde cannulation of the aorta above the renal arteries is performed. The kidneys are then cooled in situ by perfusing them with cold preservation solution, which is vital for maintaining organ viability.
• Step 10: Removal and Packing The kidneys and ureters are removed from the donor's body, packed in ice, and delivered to the recipient transplant team(s) for transplantation.

3. Post-Procedure

Post-procedure care involves ensuring that the harvested kidneys are kept at appropriate temperatures to maintain their viability until transplantation. The kidneys are packed in ice immediately after removal and must be transported swiftly to the recipient transplant team. Continuous monitoring of the organ's condition during transport is essential to ensure successful transplantation outcomes. Additionally, documentation of the procedure and the condition of the organs is critical for compliance and tracking purposes.