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Old 04-11-2005, 12:58 PM
Superdude Superdude is offline
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Why don't they remove the old kidneys during a transplant?

So I'm reading the latest issue of Maxim, and there's an article titled, "How to Transplant an Organ.*"

Allow me to quote:

Quote:
Time it right and the old organ is ready to come out just as the new one arrives (except with kidneys, which actually stay in the body).

<snip>

Plop the new organ in the hole (new kidneys get shoved into the groin area)
Why is this? Is there some practical reason for not removing the old kidneys? Too much trouble to put the adrenal glands on the new ones?



*They are certainly not suggesting that anyone TRY to transplant an organ on their own. The article merely explains in broad terms how it happens.
  #2  
Old 04-11-2005, 01:02 PM
USCDiver USCDiver is offline
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Why go through the potential hazards and prolonged anesthesia for a surgery that is unnecessary? No reason so subject the patient, the surgeon or the anesthesiologist to any more risk than is necessary.
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Old 04-11-2005, 01:03 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Kidneys are in a very inaccessible location in the body and it is a major big deal to get one out.

New kidneys are put in a nice, convenient location in the pelvis, easy to get to.

No reason to take out the old one just because it decided to call it quits. It would only add risk for no benefit to take one such out.
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Old 04-11-2005, 01:31 PM
ParentalAdvisory ParentalAdvisory is offline
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Wouldn't leaving a dead kidney in the body cause infection?

That sounds horribly odd.
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Old 04-11-2005, 01:37 PM
Stranger On A Train Stranger On A Train is online now
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Quote:
Originally Posted by ParentalAdvisory
Wouldn't leaving a dead kidney in the body cause infection?
The organ isn't dead (necrotic); it just isn't functioning properly, i.e. filtering urea and other acids out of the bloodstream.

When my former mother-in-law received a kidney from her mother, she was up and out of bed in a couple of days. She'd been on three times daily dialysis prior to the surgery, so she felt so much better, despite healing from the (relatively minor) surgery. Her mother, however, took several weeks to recover from the more intrusive removal of her kidney.

The appendix is non-functional, too, but we don't remove it unless it causes (or as significant potential to cause) distress. To rephrase what Qadgop the Mercotan said, why fix what isn't broken, and perhaps do more damage in the process?

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  #6  
Old 04-11-2005, 03:54 PM
MinniePurl MinniePurl is offline
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My late mother had a kidney transplant (that later failed), and I remember at some point seeing a description of an X-Ray that said her kidneys were "calcified masses". So I guess in some cases, the failed kidneys actually turn to "stone".
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Old 04-11-2005, 04:00 PM
pkbites pkbites is offline
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What if the problem was kidney cancer or polycystic kidney disease, both of which can spread to other organs. They'd take them out then, wouldn't they?
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Old 04-11-2005, 04:01 PM
ParentalAdvisory ParentalAdvisory is offline
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Quote:
Originally Posted by Stranger On A Train
The organ isn't dead (necrotic); it just isn't functioning properly, i.e. filtering urea and other acids out of the bloodstream.
Thanks, but I guess I'm still confused. I thought I knew the anatomy of the kidney better. If you're getting a transplant, I figure it would be a complete swap. This isn't the case? Is the old kidney still attatched doing some of the functions, while the donor kidney is doing the work of the failed function of the other?
  #9  
Old 04-11-2005, 04:09 PM
alphaboi867 alphaboi867 is online now
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Quote:
Originally Posted by pkbites
What if the problem was kidney cancer or polycystic kidney disease, both of which can spread to other organs. They'd take them out then, wouldn't they?
I would assume in that case or if they were necrotic they'd remove the kidneys. Are other organs removed during transplants? Hearts, lungs, livers, etc.
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Old 04-11-2005, 04:24 PM
KGS KGS is offline
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The new kidney's actually placed much lower in the body, nearly down in the pelvis. (Kinda surprised me when I saw that diagram.) Other organs, esp. the heart & liver, don't really fit any place else except where they're supposed to go.

But aren't kidney removal surgeries done laproscopically these days?
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Old 04-11-2005, 04:30 PM
Stranger On A Train Stranger On A Train is online now
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Quote:
Originally Posted by pkbites
What if the problem was kidney cancer or polycystic kidney disease, both of which can spread to other organs. They'd take them out then, wouldn't they?
PKD is a genetic disorder. I don't think it'll develop in transplanted organs (the cysts develop congenitally) but I'll stand to be corrected if someone in the medical field comes along and says differently. In any case, no, they don't remove the kidney in that case, as that is what my ex-mother-in-law suffered from.

I'm sure they'd remove the kidney, or the malignancies from it, in the case of cancer if chemotherapy or radiotherapy was insufficient to destroy the tumor.

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  #12  
Old 04-11-2005, 05:03 PM
WhyNot WhyNot is offline
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So this explains why a kidney transplant is done with an anterior (front) incision and the removal done with a posterior (back) incision. But what I'm still not getting (like ParentalAdvisory) is what exactly happens to the old kidney. It's detached from the artery and vein so the new one can be attached, right? So it's no longer getting blood. So it...what? It must not decompose, or it would cause infection. Is it simply reabsorbed into the body?
  #13  
Old 04-11-2005, 05:09 PM
Bean Counter Bean Counter is offline
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Quote:
Originally Posted by WhyNot
It's detached from the artery and vein so the new one can be attached, right?
No. I am in the process of donating my kidney to a relative. The literature I received from the hospital says, "The surgical team will remove one of your kidneys, along with the renal artery, vein and ureter."

So it sounds as if they simply splice the artery and vein from the transplanted kidney into the existing ones without removing the old.
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Old 04-11-2005, 09:16 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Quote:
Originally Posted by Bean Counter
No. I am in the process of donating my kidney to a relative. The literature I received from the hospital says, "The surgical team will remove one of your kidneys, along with the renal artery, vein and ureter."

So it sounds as if they simply splice the artery and vein from the transplanted kidney into the existing ones without removing the old.
Bean Counter has it right. The transplanted kidney can be connected up quite easily to an artery and vein right in the pelvis, and the ureter can easily be attached to the existing ureter near the bladder. This location is convenient in case the transplanted kidney needs to be removed or serviced, too.

Here's a nice illustration: http://www.surgerydoor.co.uk/images/kidney.gif

And please lose the idea that there is a need to remove a kidney that is merely non-functioning. Removal would only be necessary for things like cancer, chronic infections that can't be eradicated, or severe polycystic disease with persistant risk of cyst rupture and spilling contents into the abdomen, and a few other uncommon entities. Otherwise, the nonfunctioning kidney will slowly shrivel down and perhaps calcify. Unless there are abscess problems, it's not gonna rot!
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Old 04-11-2005, 09:36 PM
WhyNot WhyNot is offline
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Very cool! Thanks for the picture, that really helped!
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Old 04-11-2005, 09:41 PM
cornflakes cornflakes is offline
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I seem to recall that there are some hormonal functions associated with the kidneys. Am I right about that, or are they just very specialized filters?
  #17  
Old 04-11-2005, 09:49 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Quote:
Originally Posted by cornflakes
I seem to recall that there are some hormonal functions associated with the kidneys. Am I right about that, or are they just very specialized filters?
You're right, they are involved with blood pressure regulation, thru a variety of methods, including the production of renin, among other things.

Folks with kidney failure often need many blood pressure meds to control them. They tend to have anemia too, as some kidney-produced substances encourage the bone marrow to make red and white cells. These folks may need erythropoetin shots to counter this.

Happily, with a successful transplant, many patients no longer need so many meds.
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Old 04-11-2005, 11:01 PM
ParentalAdvisory ParentalAdvisory is offline
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Yes, thank you for the illustration.
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Old 04-11-2005, 11:25 PM
Fish Fish is offline
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Quote:
Originally Posted by KGS
The new kidney's actually placed much lower in the body, nearly down in the pelvis. (Kinda surprised me when I saw that diagram.) Other organs, esp. the heart & liver, don't really fit any place else except where they're supposed to go.
It's a bit more complex than this, KGS.

When my transplant surgery was done, they explained to me that the doctor's preference was always to take the donor's left kidney and implant it on the recipient's right side.

When they take the donor organ, you see, they take the attached ureter (the urine drainage tubes, put crudely). A person's left kidney has slightly longer tubes since it's often a bit farther from center.

So they take the kidney with the long tubes and attach it in a place where there isn't so much need for long tubes so they have extra tube length to worth with. Like moving a speaker with ten feet of wire to a place only eight feet away from the receiver.
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