On the final day of the surgery workshop, I was invited to help some of the adult urologists with a kidney transplant! KNH is one of only three or so centers in Africa with transplant capabilities. Their first transplant in Kenya was performed in 1978; the recipient was a young gentlemen whose kidney was removed because it was identified as an abdominal mass on an imaging study (he had “horseshoe kidney”, which results when the embryonic kidney fails to split in development). After that first surgery, the poor guy obviously had “renal failure”, but fortunately his loving sister was willing to spare a kidney for him, and they both walked out of the hospital two weeks later (with fantastic spread collar suits and afros, as this was 1978).
I scrubbed for the donor nephrectomy (where they take out the good kidney that is to be transplanted). It didn't do much but retract, but it was really cool to see the process. The kidney is very deep in the back/side, so it takes quite a bit of effort to get good visuals on the slippery guy. While we were harvesting the kidney, a vascular surgeon was preparing the site on the recipient where the kidney was to be attached (it's in the pelvis).
The surgeons freed all around the kidney, ligated any extraneous arteries and veins (such as those going to the adrenal glands which sit on top of the kidneys like little hats), and finally, clamped and cut the renal artery and vein, which supply the bulk of blood to the kidney. The main determinant of graft survival is “ischemia time”, or the amount of time that the kidney isn’t attached to the blood supply. It was definitely short in this case! We got the kidney out, someone ran it over, and by the time we were done closing the incision on the donor, the kidney was in the recipient and already making urine! Pretty amazing.
Rather than an intraoperative picture, which may offend some stomachs, here's a picture of a cute kid:
And part of the team at the end of the day: