Live Kidney Donation: a plea for the laparoscopic approach

In Chapter One we described the development of live kidney donation. Currently, live donor kidney transplantation is the best solution to attack the persistent organ shortage in the Western World. Because of this shortage live kidney donation is still interesting over fifty years after Joseph Murray and Rene Kuss performed the first live kidney donor transplantations. The revival of live kidney donation in the 1990s still continues. Developments in immunosuppressive therapy, crossing the blood barrier, intelligent logistic solutions, improvements of peri-operative care and last but not least less invasive surgical techniques all attribute to the successes of live kidney donor transplantations. In this thesis we focused on the latter aspect, but one have to keep in mind that improvements in surgical and peri-operative care of the donor can only exist within a solid system providing screening of potential donors, selection of transplant candidates and accurate medical treatment of the recipients. In the United States Ratner and colleagues introduced laparoscopic donor nephrectomy in 1995. This technique has greatly revolutionized live kidney donation. Presently the majority of live kidney donors is operated on using a (modified) laparoscopic approach. However, the introduction of minimally invasive surgery has also encouraged refinement of open techniques. Most studies up to now aimed to prove the feasibility of a new surgical technique for live kidney donation. In this thesis, we compared these novel techniques, therewith addressing short term surgical outcomes, quality of life, costs and transplant outcome.