MGH now offers minimally invasive
kidney donation procedure

Procedure greatly reduces donor recovery time

BOSTON – August 14, 1998 – The Massachusetts General Hospital (MGH) has initiated a program that offers kidney donors the option of laparoscopic removal of their donated organ. With this technique – called laparoscopic live donor nephrectomy – donors undergo much less discomfort and disability. They are able to resume normal activities within two weeks of the operation, compared with a month or more of recovery for the traditional donor operation, a difference that could make it possible for more individuals to become donors. The MGH is the first hospital in the state to perform the procedure and is believed to be the first in the region.

The MGH laparoscopic nephrectomy program combines the skills of the hospital’s transplantation team, which performs about 60 kidney transplants annually, with expertise developed within the Center for Innovative Minimally Invasive Therapy (CIMIT), an MGH-based consortium dedicated to identifying and developing new technologies for medical care. One of the underpinnings of CIMIT is the extensive laparoscopic surgery experience of MGH surgeons. The new procedure is being carried out through the combined efforts of David Rattner, MD, clinical director of CIMIT; Dicken Ko, MD, of the transplantation unit; and Francis Delmonico, MD, director of the MGH kidney transplant program, operating as a three-surgeon team.

Delmonico explains that living kidney donors are a critically important part of any transplant program. "Kidney transplants from living donors are more successful than those from cadaver donors. Furthermore, donations of kidneys from cadaver donors cannot keep pace with the ever-expanding number of patients waiting for a kidney. Living donors have become the source of renal transplants for 50 percent of our recipients, including donors unrelated to their recipients." Delmonico also serves as medical director of the New England Organ Bank.

Traditional kidney donation involves making a 12- to 15-inch incision in the donor’s side, cutting through abdominal muscles and often removing a portion of a rib. The donor spends four or five days in the hospital and as long as six weeks recuperating before completely resuming normal activities.

In the new procedure, surgeons make four tiny incisions in the donor’s abdomen and side through which a laparoscopic camera and tiny instruments are inserted to separate the kidney from its blood supply and to disconnect the ureter, which carries urine from the kidney to the bladder. After all connections are severed, the kidney is removed through a 2 1/2-inch "bikini" incision in the lower abdomen. Donors can usually go home in one to two days and resume normal activites within two weeks.

Ko, a multiorgan transplant surgeon with a urology background and special training in the technique, explains that removing a kidney this way is especially challenging. "The operation is technically very demanding. It has to be done perfectly so that you have a perfect organ for the recipient. That’s why the continuing collaboration with Dr. Rattner and the CIMIT team is so critical to our success."

Leader of the hospital’s laparoscopic surgery program for several years, Rattner adds: "Our transplant team wanted to bring this new benefit to their donor patients, and we had the expertise and resources to bring that process along more quickly than it might have otherwise. It’s a great example of the kind of teamwork CIMIT is built around."

The combined team performed the first MGH operation Aug. 4 and followed up with another Aug. 11. Both donors went home on the second day after surgery and experienced no problems or complications.

"Now that there is a successful laparoscopic nephrectomy program under way here at the MGH, we expect that interest in the procedure will increase," says Ko. "For some prospective donors, this option may make the difference between whether they can or cannot donate. But the bottom line for us is giving our donors – healthy people who are making a gift of life to a loved one – the best chance of resuming their normal lives as quickly as possible."

The Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $200 million and major research centers in AIDS, the neurosciences, cardiovascular research, cancer, cutaneous biology, transplantation biology and photomedicine. In 1994, the MGH joined with Brigham and Women’s Hospital (BWH) to form Partners HealthCare System, an integrated health care delivery system comprising the two academic medical centers, specialty and community hospitals, a network of physician groups and nonacute and home health services.

Contact: Susan McGreevey in the MGH Public Affairs Office

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