I thought about asking this in GQ, but I’m not sure the actual procedure is accurate since it was on a TV show.
I’m doing a rewatch of all seven seasons of “The Good Doctor.” In episode 2 of the first season, a woman has a massive tumor that the doctors decide is inoperable because they can’t get a good view of it to avoid damaging other organs or vessels. Shaun comes up with the idea of removing one of the woman’s healthy kidneys in order to give a better view, since the alternative would be her death in only a few weeks. They do this, the operation is successful, and the woman is saved.
My question is: when organ donors die and their organs are harvested, they implant them in recipients, often after having to transport them to some other hospital. Why, when someone has a healthy kidney removed in order to provide space for another surgery, can’t the doctors just reattach the kidney (her own kidney, which is right there, so not even any chance of rejection)?
Did the episode’s writers just conveniently ignore this to make a better story, or is there genuinely a reason why it can’t be done?
I think the whole premise doesn’t make sense. My mom had a large tumor (“the size of a grapefruit”) on one kidney, and they removed the kidney along with the tumor, so as not to damage the encapsulation around the tumor. I just don’t think anyone would say, “aha! we can remove/move the kidney to get at that tumor” in any real situation, because I think that would be an obvious option.
Also, if the kidney is really not at all implicated, I bet they could just move it. They moved a lot of my mom’s intestines to get at the kidney. Moving stuff around when doing major surgery also seems like standard procedure. She had some issues after that because the guts didn’t end up all neatly attached where they belong, but they were minor issues.
Sorry for the edit. I misread the question. It doesn’t make sense to remove a kidney to get a better view. As noted above, sometimes you have to remove the kidney if the tumor is wrapped around it. Meanwhile, it is not an easy thing to reattach a kidney. It would add a few hours to an already complicated surgery. In addition, there is the question of micrometastases. You do not want to reattach an organ that may have resudual cancer cells.
Thanks, psychobunny! The episode had some medical treknobabble about why they had to remove the kidney (something about not being able to see large vessels and fear of cutting them accidentally) and I was okay accepting that part even if it was BS. It was the “why can’t they just put it back in” part that was giving me trouble.
I have no idea if it was what the writers were thinking, but your explanation sounds plausible enough to me that I’m happy to accept it as why they didn’t reattach the kidney.
Just so you are aware, when they do a kidney transplant they do not put it in the place of the old kidney. They actually attach it in the front of the pelvis. I looked it up to see how long it took and it hasn’t changed since my training days. It is still 3-5 hours to attach everything. I would imagine it might take even longer if you wanted to put it back in the retro peritoneal space since that area is harder to access.
And they don’t remove the old kidneys, unless the patient has, for instance, cancer in at least one kidney, or some other diseases that would compromise the patient’s health were the kidneys to be left in place.
My cousin, who has a genetic disorder he inherited from his mother, has 4 kidneys - the two he was born with, the one he got from his father about 20 years ago, and the one he got a couple years ago when that 80-year-old kidney began to fail.