1 The precise number of laparoscopic live donor operations is unknown, although almost certainly over 600 of the donor procedures have used this technique. Two donors are known to have died as an operative this website or postoperative complication; one of these occurred during an open procedure and was related to bleeding from the renal artery. In this case, clips similar to those

used in many cases of laparoscopic nephrectomy were used to secure the renal artery; these became dislodged in the early postoperative period. This local operative mortality risk is consistent with the internationally reported rate with donor nephrectomy.2,3 The first living donor transplant was performed in 1954 between identical twins by Joseph Murray and colleagues at Peter Brent Brigham Hospital in Boston.4 During the ensuing 40 years,

live donor nephrectomy was performed predominantly via a large open flank incision, usually with a retroperitoneal approach to the kidney. Alternative techniques involve a transperitoneal approach via either a midline or subcostal abdominal incision. The disadvantages of open surgery include pain, a long convalescence, potential pneumothorax, and long-term wound complications.5–7 Laparoscopic ablative nephrectomy was first reported in 19918 and subsequently applied to donor nephrectomy in 1995.9 As with open nephrectomy, a number of techniques have evolved with laparoscopy Sunitinib and include transperitoneal and retroperitoneal approaches. Hand-assisted variations of both of these have also been described.10–16 The technique used appears to be based on the individual surgeon’s or institution’s preference. The introduction of laparoscopic donor nephrectomy resulted in the dissemination of the technique without clear evidence of the true merit of this compared with open surgery.17 The potential for reduced morbidity, consumer enthusiasm

and what may be interpreted as commercial promotion of individual transplant programmes drove the rapid escalation of this technique, despite unresolved concerns regarding donor safety as well as technical complications (vascular thrombosis, ureteric below ischaemia) and functional outcome in recipients.6 Living donor nephrectomy is a unique and very demanding procedure. The reason for the high level of difficulty is related to the nature of the surgery, in which the removed organ has to function normally in the recipient. In addition, the donor is a healthy individual who is being subjected to major surgery for the benefit of another person without direct advantage, and possibly harm, to their own health. Consequently, it is of utmost importance that no harm is inflicted on the donor.