**2. Historical milestones**

The first true altruistic voluntary living donation happened in Paris at Necker Hospital on December 25, 1952, when a mother, Gilberte Renard, convinced the medical team to give her kidney to her son Marius, 16 years old, apprentice carpenter who had his right solitary kidney removed after falling from a scaffolding. Unfortunately, the graft remained functional for approximately 3 weeks despite the

**25**

*Laparoscopic Live Donor Nephrectomy: Techniques and Results*

ing 80%, due to better immunosuppression [12, 15].

in the recipient. Results were fairly optimal [16].

donor renal transplantation in Japan [17, 18].

**3. Living donor evaluation**

donors and has undoubtedly revolutionized kidney donation.

use of steroids and Marius died on January 27, 1953. His donating mother died in

The second important milestone happened 1 year later on December 23,1954 at Brigham Hospital in Boston USA, when Dr. Murray performed a successful renal transplantation on Richard Hersick, the donor being his monozygotic identical twin brother Ronald. The kidney was removed from Ronald by the urologist Harrison. No effort was made to preserve the isograft; but nonetheless, it functioned

promptly despite 82 min of warm ischemia [12]. The graft remained functional for 8 years and was lost due to a recurrence of the renal disease and causing the death of Richard. His brother Ronald died in 2010 at age 79, after a cardiac surgery, just 4 days after the 56th anniversary of his pioneering kidney operation [11, 13]. The next two following years, the Brigham team performed seven successful kidney transplants also between identical twins. The most famous was that of Edith Helm, the third case at Brigham, who got pregnant 2 years after her transplant and was the first kidney recipient to carry to term and give birth to a child. Edith Helm also holds the record of the best graft longevity of 55 years; she died in 2011 at age 76, with a functioning graft. Her donating identical twin sister, Wanda Foster, gave birth three times following her kidney donation and was still alive in 2016 [11, 14]. In 1960, the first kidney transplantation between genetically nonrelated patients was performed using immunosuppression. Late in 1963, a conference near Washington DC was held to present the overall findings from 216 recipients of renal allografts. The results were not gratifying: 52% of all those receiving grafts from related donors had died, and 81% of those with kidneys from unrelated or cadaveric donors. Joseph Murray concluded at that time that "kidney transplantation is still highly experimental and not yet a therapeutic procedure." By 1965, 1 year survival rates of allografted kidneys from living related donors were much better approach-

In 1987, Alexandre et al. in Belgium published a first series of ABO-incompatible (ABO-I) living donors using splenectomy and heavy immunosuppressive regimen

Then, since 1989 and due to organ shortage, most ABO-I kidney transplantations have taken place in Japan with recently published data showing an excellent long-term outcome. Currently, ABO-I reached approximately 30% of all living

From the surgical point of view, all donor nephrectomies were done by open techniques mostly using a lumbar retroperitoneal approach; and the first successful trial of removing a live donor kidney using a laparoscopic approach was in 1995 at John's Hopkins hospital by Ratner et al. [19]. Since then, considerable numbers of transplant centers worldwide have adopted laparoscopic donor nephrectomy (LDN) which is now considered as the gold standard approach for kidney retrieval on live

Suitability of the potential kidney recipient for transplantation must be established before starting donor assessment. There is a significant variability among transplant programs in the criteria used to evaluate donors. ABO blood grouping is an important early screening test. Initial assessment of donor and recipient histocompatibility status must be undertaken at an early stage in living donor kidney transplant workup to avoid unnecessary and invasive clinical investigation [4]. Although donors are not true patients, they must undergo a complete and extensive evaluation before considering kidney removal. This evaluation includes medical and

*DOI: http://dx.doi.org/10.5772/intechopen.80880*

1992 at age 85 [10, 11].

*Basic Principles and Practice in Surgery*

organs from stem cells.

**Figure 1.**

*Transplantation.*

living donors [5].

donations in 2016 [9].

health in the long term.

**2. Historical milestones**

Transplantation, is shown in **Figure 1** [8].

12 years, respectively [2]. Kidney transplantation from a living donor, when possible, is the best treatment for most patients with end-stage renal disease. This is related to multiple factors such as less time from dialysis to transplantation, shorter cold ischemia time, and better quality of the graft. The third reason stands for pediatric recipients where a prompt transplantation from a living donor, mostly a parent, can help for a better growth, quick return to school, and a good psychological stability; it is considered today as the gold standard therapy for children with end-stage renal disease. The fourth argument is that living donation provides a good opportunity to perform a preemptive transplantation avoiding the need of going through dialysis. A fifth reason is that we are still too far to overcome organ shortage by using xenografts from transgenic animals, or engineered

*Worldwide kidney transplant from living donors in 2017. International Registry in Organ Donation and* 

Currently, 40% of kidney grafts in the United States are from living donors [1].

In some countries, namely Middle Eastern and Eastern, kidney transplantation is relying only or mostly on living donors [6, 7]. Worldwide kidney transplant from living donors in 2017, based on the International Registry in Organ Donation and

Women traditionally outrank men in their enthusiasm to donate one of their kidneys. Although most recipients are male, women represented 63% of all living

In regard to these facts, living donors have exceptional courage and nobility; they go through a major surgery, accepting all surgical and medical risks and of no medical and physical benefit for them. It is our vocation and duty to provide them a safe and good practice according to legal and ethical bylaws and to protect their

The first true altruistic voluntary living donation happened in Paris at Necker Hospital on December 25, 1952, when a mother, Gilberte Renard, convinced the medical team to give her kidney to her son Marius, 16 years old, apprentice carpenter who had his right solitary kidney removed after falling from a scaffolding. Unfortunately, the graft remained functional for approximately 3 weeks despite the

In Europe, the level is highly variable between countries, standing for approximately 10% in France and up to 60% in Norway and Sweden [2, 3]. Approximately, one in three kidney transplants performed in the UK are from living donors [4], and according to the Global Observatory on Donation and Transplantation (GODT), 84,347 kidney transplants were done worldwide in 2015, of which 41.8% were from

**24**

use of steroids and Marius died on January 27, 1953. His donating mother died in 1992 at age 85 [10, 11].

The second important milestone happened 1 year later on December 23,1954 at Brigham Hospital in Boston USA, when Dr. Murray performed a successful renal transplantation on Richard Hersick, the donor being his monozygotic identical twin brother Ronald. The kidney was removed from Ronald by the urologist Harrison. No effort was made to preserve the isograft; but nonetheless, it functioned promptly despite 82 min of warm ischemia [12]. The graft remained functional for 8 years and was lost due to a recurrence of the renal disease and causing the death of Richard. His brother Ronald died in 2010 at age 79, after a cardiac surgery, just 4 days after the 56th anniversary of his pioneering kidney operation [11, 13].

The next two following years, the Brigham team performed seven successful kidney transplants also between identical twins. The most famous was that of Edith Helm, the third case at Brigham, who got pregnant 2 years after her transplant and was the first kidney recipient to carry to term and give birth to a child. Edith Helm also holds the record of the best graft longevity of 55 years; she died in 2011 at age 76, with a functioning graft. Her donating identical twin sister, Wanda Foster, gave birth three times following her kidney donation and was still alive in 2016 [11, 14].

In 1960, the first kidney transplantation between genetically nonrelated patients was performed using immunosuppression. Late in 1963, a conference near Washington DC was held to present the overall findings from 216 recipients of renal allografts. The results were not gratifying: 52% of all those receiving grafts from related donors had died, and 81% of those with kidneys from unrelated or cadaveric donors. Joseph Murray concluded at that time that "kidney transplantation is still highly experimental and not yet a therapeutic procedure." By 1965, 1 year survival rates of allografted kidneys from living related donors were much better approaching 80%, due to better immunosuppression [12, 15].

In 1987, Alexandre et al. in Belgium published a first series of ABO-incompatible (ABO-I) living donors using splenectomy and heavy immunosuppressive regimen in the recipient. Results were fairly optimal [16].

Then, since 1989 and due to organ shortage, most ABO-I kidney transplantations have taken place in Japan with recently published data showing an excellent long-term outcome. Currently, ABO-I reached approximately 30% of all living donor renal transplantation in Japan [17, 18].

From the surgical point of view, all donor nephrectomies were done by open techniques mostly using a lumbar retroperitoneal approach; and the first successful trial of removing a live donor kidney using a laparoscopic approach was in 1995 at John's Hopkins hospital by Ratner et al. [19]. Since then, considerable numbers of transplant centers worldwide have adopted laparoscopic donor nephrectomy (LDN) which is now considered as the gold standard approach for kidney retrieval on live donors and has undoubtedly revolutionized kidney donation.
