Pre and Post-Op Instructions

Introduction

Thank you for your “gift of life.”  Donating a kidney is one of the greatest gifts a person can give.  By donating one of your kidneys, you have helped  someone live a more normal life, a life free from dialysis.

The goal after surgery is for you to be able to resume your normal activities without complications.  Please share this with your family members or friends who may be assisting you during the recovery period.

Prior to surgery

Avoid blood thinners including aspirin for at least one week prior to surgery.  The day before surgery, eat light meals until noon and then clear liquids.  Stay well hydrated; the day of surgery, you should drink clear liquids until two hours before arrival at the hospital.  Do not eat any solid food or complex liquids after mid-day before surgery.  Make sure that you have a good bowel movement either the night before, or the morning of surgery.  If you have difficulty with bowel movements start a clear liquid diet one day before surgery and if necessary, take a laxative (i.e. magnesium citrate, MiraLax®, Dulcolax®, or suppository).  Leave home with extra travel time due to the unpredictable traffic in Los Angeles.

Surgery

You will be admitted to the hospital the morning of  surgery.  You must report to the Admissions office in the main hospital.  The Admissions office is located on the first floor of the Ronald Reagan building.  The Admission staff will process the admitting paperwork and will direct you and the recipient to the Procedures and Treatment Unit (PTU).  All females between the ages of 10 and 60 will be asked to provide a sample for a urine pregnancy test.  While at the PTU, an intravenous (IV) line will be started in your arm so that the doctors and nurses may give you medications and IV fluids during and after surgery.  If your kidney will be shipped as part of the kidney exchange program, 5 – 6 additional tubes of blood will be drawn.  The donor surgeon and anesthesiologist will discuss the surgery with you, complete a pre-operative check-up, and ask you to sign the surgical consent.

You will be transported from the PTU to the Operating Room where the anesthesiologist will put you to sleep.  Once asleep, a tube will be placed down your throat to help you breath.  You may have a sore throat for about a week because of the breathing tube placement.  A tube called a Foley catheter will be passed into your bladder through your urethra (a tube from your bladder to the opening of your penis or vagina).  The Foley catheter is usually removed the day after surgery once you are able to walk to the restroom.

The removal of a kidney is called a Nephrectomy (nephros, kidney + ektome, excision).  Laparoscopic nephrectomy is the least invasive option that has

been in use at UCLA since 1999, and is now performed in the vast majority of donor surgeries.  Three or four tiny incisions are made in the abdominal wall.  Instruments  are inserted through these incisions.  A video camera enables the surgeon to direct the instruments to remove the kidney with its blood vessels.  An incision about three inches long is made above the pubic area through which the kidney is removed.  A typical hospital stay is 1-2 days, with minimal pain, and a return to normal activity within two to three weeks.  Eighty percent of donors undergoing laparoscopic nephrectomy are discharged the following day with a few donors staying for another day.  Many patients spend the second night after surgery at the Tiverton House, a hotel on the UCLA campus.

After Surgery

Once the surgery is completed, you will be taken to the recovery room where your condition will be monitored as you start to wake up from the anesthesia.  Once fully awake and stable, you will be transferred to your room on the Treatment Recovery Unit (TRU). 

You will be given medications as needed to help alleviate the pain associated with the surgery.  Your nurse will instruct you on coughing and deep breathing exercises to prevent pneumonia and will help you get out of bed several times a day to prevent blood clots from forming in your legs.

Your first meal after the surgery will be clear liquids and you will be given a regular meal once you are able to tolerate the clear liquid meal.  The IV will remain in your arm until you are able to tolerate fluids by mouth.

On the day of your discharge, the Inpatient Pharmacist will most likely bring you the medications you need to take.  If they are not available, you will need to stop by the Outpatient Pharmacy located on the B-Level in the East wing of the hospital.  You will have three prescriptions, which are provided without charge.  You will have to pay for these prescriptions if filled by an outside pharmacy.  One of the prescriptions is for pain and the other two are to prevent constipation caused by the pain medication.

Taking Care of Yourself

Pain control

Everyone has a unique pain tolerance.  Many non-medication techniques such as massage, heating, cooling, meditation, prayer, and distraction can be very effective.  Gentle stretching and walking may help.  For the first two days after discharge, you should take acetaminophen (Tylenol®) 325 mg two tablets every six hours.  If the pain is more severe substitute one or both tablets with the narcotic pills (Norco® or Percocet®).  These medications have acetaminophen in them.  You should not exceed a total dose of 3000 mg per day.  On the third day cut back on the narcotics if possible.

Prevention of constipation

Constipation due to the use of narcotic pain medication is one of the most common complaints following donor nephrectomy. Minimizing the use of narcotic pain medications and staying hydrated is the best way to prevent constipation. Additionally, the regular use of over the counter stool softeners such as docusate and laxatives such as senna or magnesium citrate will help to prevent constipation. Docusate may be taken as a 100mg capsule in the morning and evening. Senna may be taken as a 15mg tablet in the morning and evening.  A bottle of magnesium citrate (10oz) once daily may also be added if you have not had a bowel movement in over 48 hours despite the previous medications. All of these medications should be available at your local pharmacy. If you are moving your bowels regularly then you may stop these medications.

Wound care

Your incisions have been closed using an absorbable suture, which runs just underneath the skin and does not require removal. Additionally, your incisions may be reinforced using pieces of special tape called “steri-strips.”  If Band-Aids are also present, they can be removed once you get home, but the steri-strips should NOT be taken off.  You can shower with the steri-strips in place and there is no need to cover them.  Just let warm soapy water run through them.  The strips may be removed after 2 weeks if they have not already come off on their own.  Occasionally, skin glue will be used to cover the incisions rather than “steri-strips”. This glue will dissolve and flake off over the next few weeks. If you see suture material (looks like fishing line) poking out above the skin, it can be cut to skin level with nail clippers 3 days after surgery.  Do not soak your incisions in a pool or bathtub until they are completely healed, usually in 2-3 weeks.

When to call the doctor

You should see your surgeon if you have any of the following signs or symptoms:

• Fever
• Burning during urination
• Drainage from the incision sites
• Increased frequency of urination
• Urine with an unusual, strong smell
• Cloudy urine
• Pain or soreness at or around the incision for more than two months.
• Shortness of breath, isolated leg swelling, or difficulty breathing

If you have any of the above signs and symptoms of infection or are experiencing any problems with worsening pain that is uncontrolled by pain medication, please contact us immediately.

During regular business hours, Monday through Friday, 8 am to 5 pm, call your transplant coordinator, or Dr. Gritsch’s office (310) 267-7727.  If they are unavailable, call the Hospital Page Operator and ask to speak to the Urology Consult Resident. You can also ask to speak with the attending surgeon that performed your surgery if the resident is not able to solve your direct issue.  The business card with the name of the surgeon that performed your surgery is attached to the inside of your discharge packet provided to you by your coordinator.

Nights, holidays and weekends, please call the Hospital Page Operator directly at (310) 825-6301 and ask to speak to the Urology Consult Resident. Again, you can also ask to speak with the attending surgeon that performed your surgery if the resident is not able to solve your direct issue. 

Activity

Avoid lifting heavy objects (15 pounds or heavier) for about one month after surgery.  Lifting and straining may result in the opening of your wound or the formation of a hernia that usually requires surgery to repair.

Begin a daily routine of walking for exercise.  Walking will improve and maintain your health while you are recovering from surgery.

Driving is permitted once you are no longer requiring narcotic pain medications and feel that you can move your foot quickly and safely between the pedals.

Disability forms

If you have paper copies of them, bring your disability forms with you the day of the surgery.  UCLA’s Social Worker will process the disability forms while you are in the hospital; it may also be done online.  These forms cannot be processed before admission to the hospital.  Notify your Transplant Coordinator if you need a letter for your employer or school regarding the length of time you need for medical leave.

Returning to work or school

Depending on your occupation, you may return to work or school within two to six weeks.  You will need to discuss this with the donor surgeon.  The surgeon will be able to give you more specific instructions during your follow-up appointment.

Follow-up appointment

We recommend that living kidney donors stay in the local Los Angeles area for a minimum of one week.  Delayed complications are rare, but can be serious.  If there is a problem, we prefer to see you at UCLA, but in an emergency always call 911.  Any care at UCLA is financially covered.  If you have care at another institution, you may get hospital bills.  If the complication is related to kidney donation, we will work with you to get these charges covered by the recipient insurance.  Transplantation billing is complex and occasionally errors occur.  If you have a problem with hospital bills please call the Kidney Transplant Office at (310) 267-6922.

You need to see one of the surgeons in about two weeks for a follow-up visit after being discharged from the hospital.  Call the surgeon’s office at (310) 267-7727 to schedule the follow-up appointment.  A routine annual medical check-up performed by your primary health care provider is strongly recommended.

Telemedicine follow-up

We are now offering the option of having your post-operative consultation using a video conference from the privacy of your home or office in the State of California.  To use this service you must have a computer (with camera and speakers) or “smart” cell phone with a direct or Wi-Fi internet connection and an E-mail account.  You will need to download a free application from Zoom (https://zoom.us), the Apple store, or Android equivalent.  The application can be removed after the appointment.  You must also have access to a blood pressure cuff, thermometer, and scale.  Take these measurements prior to your appointment, write them down, and have them available next to your computer (phone) at the time of your appointment.

When you schedule the follow-up appointment, request the telemedicine option.  Instructions for using the Zoom conferencing software will be sent to your E-mail address, as well as the time and date of the conference call.

Long-Term Instructions for Kidney Donors

You gave one of your kidneys to save someone’s life. This was a wonderful gift. Most kidney donors live normal lives with one kidney. Once you recover from surgery, you will be able to return to your normal activities. Here's what you need to know about home care after surgery and to keep yourself and your kidney healthy.

Activity

• Continue to live an active, healthy life. It is important to exercise regularly, eat a healthful, balanced diet, and maintain a healthy weight.

Medications to Avoid

• "NSAIDs" (Non-Steroidal Anti-inflammatory Drugs) should not be used for more than 2-3 days. Examples of these drugs include: aspirin, ibuprofen, Motrin, Advil, Aleve, naproxin. You may take aspirin on a regular basis if your doctor has prescribed it. 

• New prescription medications. Be sure to remind your doctor and/or pharmacist that you have only one kidney when starting a new medication.

Follow-Up

Please see your primary care doctor at 6 months, and then every year after your surgery to check:

• Blood Pressure
• Weight
• Serum Creatinine (this is a blood test to check your kidney function)
• Urine analysis with protein/creatinine ratio 

Telephone numbers

24-hour Emergency Number (310) 825-6836 (After hours press “0” and ask for the Page Operator)

Surgeons

• Dr. Hans Albin Gritsch (Laparoscopic) 310-267-7727
• Dr. Jeremy Blumberg (Laparoscopic) 310-267-7727

Donor Transplant Coordinators

• Suzanne McGuire,  310-267-6907
• Jennifer Terenzini,  310-267-6911
• Rhonda Hutley,  310-267-6908
• Sheila Alcantara, 310-267-6910
• Myrlin Agunod, 310-267-6913

Donor Social Worker

• Mara Hersh-Rifkin,  310-267-6909

Connie Frank Nephrology Clinic 310-267-2555