How to cite: Alba FM. Living Kidney Donor Surgery: Selection, Preparation, Surgery. Grand Rounds in Urology. September 19, 2025. Accessed Jan 2026. https://grandroundsinurology.com/living-kidney-donor-surgery-selection-preparation-surgery/
Summary
Frances M. Alba, MD, Associate Professor, University of New Mexico, Albuquerque, New Mexico, presents a detailed review of living kidney donor surgery. She shares that living kidney donation remains the preferred approach for eligible patients with end-stage kidney disease, providing improved short- and long-term graft survival compared with deceased donor transplantation.
Dr. Alba notes that approximately 30% of kidney transplants in the US involve living donors and highlights the renewed growth in paired donor programs. She reviews donor eligibility criteria, emphasizing normal renal anatomy, absence of malignancy or infection, and completion of multidisciplinary evaluations. She discusses how advanced donor age, high body mass index, and psychosocial factors may influence candidacy.
Dr. Alba compares open, laparoscopic, hand-assisted, and robotic nephrectomy techniques. Laparoscopic methods reduce analgesia needs and hospital stay, while hand-assisted approaches may shorten warm ischemia time. Dr. Alba prefers hand-assisted laparoscopy to maximize vessel length and enhance safety.
She outlines intraoperative principles including patient positioning, trocar placement, vascular preservation, and the mandatory use of staplers for vascular ligation. Postoperative management focuses on pain control, fluid balance, and early ambulation, with most donors discharged on postoperative day one. Long-term follow-up includes monitoring renal function, hypertension, and albuminuria.
Dr. Alba asserts that meticulous preoperative evaluation, careful technique, and structured postoperative care are crucial to safeguard donor health and maximize transplant outcomes.
About The 29th Annual Innovations in Urologic Practice:
Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management and prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma, men’s health topics like male infertility and sexual dysfunction, and ways to diagnose and treat infections in the urology patient.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Frances M. Alba, MD, is an Associate Professor for the Division of Urology and the Director of the Urology Program at the University of New Mexico in Albuquerque. Dr. Alba’s clinical interests encompass all aspects of general urology, with a particular expertise in bladder, kidney, and testis cancer.
