Advances in TransplantationOrgan donation and procurementChallenges for the Travelling Donor: Variability Between Donor Workup and Donor Surgery in the Canadian Kidney Paired Exchange Program

- Donor travel versus kidney shipment remains a debated topic amongst national kidney paired donation programs.
- Donor travel is fraught with several challenges, one of which includes incongruences between donor assessment and the final donor surgery.
- Proposed surgery for kidney donors differed from surgery performed in the Canadian kidney paired donation program 31% of the time.
- Fifty percent of incongruences between surgery proposed during donor workup and surgery performed were significant deviations in surgical approach, such as laparoscopic to open or right to left side.
- Improvements to the Canadian kidney paired donation program or alternatives to the travelling donor approach are discussed.

BackgroundA primary obstacle to providing renal transplantation is limited access to donated kidneys. The living-donor pool for renal allografts was greatly expanded through implementation of a kidney paired donation program. Whereas some programs ship donor kidneys to the site of renal transplantation, others send the donor to the site of transplantation. Performing the nephrectomy and transplantation at the same location may optimize functional renal outcomes, but preferred surgical approaches may differ between surgical teams performing the donor workup and donor surgery. Our objective was to identify incongruence between the surgery planned by the team that performed the donor's workup, and the surgery that took place at the site of donation.MethodsA retrospective chart review was performed between the site of preoperative surgical planning, and the site of surgery for kidney donors in the Canadian kidney paired donation program.ResultsFifty-one donors were preoperatively prepared in any of six Canadian provinces, and then underwent surgery in a different province. The surgical procedure performed for 31% of the patients' nephrectomies differed from the procedure suggested by the surgical team who conducted the preoperative workup. Half of these differences were between left laparoscopic and left laparoscopic hand-assisted, but the remainder included more substantial changes of sides and/or laparoscopic versus open procedures.ConclusionOptimal patient care is challenged in a kidney paired donation program that uses the “traveling donor” approach due to differing surgical techniques selected by the surgeon at the site of donor workup and the surgeon at the site of donation.