Laparoscopic Live Donor Nephrectomy: A ???23-Hour Stay??? Procedure?

The shortage of cadaveric kidneys for transplantation has stimulated live donation, and the recent promotion of laparoscopic harvesting is expected to increase the supply of willing donors. To decrease the “cost” to donors even further, PC Kuo et al. propose performing it as a “23-hour stay” procedure. They recently published their protocol with very encouraging preliminary results (1). If they are to be congratulated for this successful feasibility study, we feel, however, that “to introduce this idea to the transplantation community” is premature. Laparoscopic donor nephrectomy is still a new operation, and the long-term quality and function of the grafts remain highly controversial issues (2). What we need to settle this controversy is some maturation and standardization of the procedure and a critical, scientific assessment of the method, not material for the Guinness Book of World Records. More specifically, an extreme reduction of the duration of hospital stay does not necessarily equate with improved care, comfort, and satisfaction of the donor. Our own policy is to leave the discharge decision with the donor, who often wishes to spend the first postoperative days with the loved recipient. This has resulted in a length of stay of 4–7 days among our first 8 celioscopic donors. The few possibly superfluous days of hospitalization required minimal nursing care, and the extra cost can be regarded as negligible in the global context of end-stage renal failure management. In addition, our donors have been away from work for 2–3 weeks, as were the 10 reported by Kuo et al. This indicates that same-day surgery feasibility cannot be used per se as a persuasive argument in favour of donation. Over the next few years, the major duty and responsibility of the transplantation community in the development of donor laparoscopic nephrectomy will be to demonstrate that its safety and long-term results are equivalent or better than those obtained by the conventional open approach. Only if and when this is achieved may it become appropriate to develop marketing-type strategies to convince hesitant potential donors. F. Mosimann1 V. Bettschart R. Schneider