CPT® Code 50300

Donor nephrectomy is a surgical procedure that involves the removal of one or both kidneys from a deceased (cadaver) donor. This procedure is performed under specific conditions where the donor has been medically maintained to ensure the viability of the organs until the surgical transplant team arrives. The process begins with the careful dissection of the inferior vena cava, aorta, and both renal pedicles, which are the structures that supply blood to the kidneys. During the surgery, the gonadal, lumbar, and adrenal veins are clipped and divided to facilitate the removal of the kidneys. The renal artery is then identified and meticulously dissected free from surrounding tissues to ensure that the blood supply to the kidney is preserved until the point of removal. To prevent any torsion of the kidney and to protect its vascular pedicle, the lateral, posterior, and inferior attachments of the kidney are intentionally left intact during the initial stages of the procedure. The ureter, which is the duct that carries urine from the kidney to the bladder, is also carefully dissected free from surrounding tissues up to the level of the iliac vessels before being divided. Following this, the kidney is further dissected free from its remaining lateral and inferior attachments. The lower pole of the kidney is elevated, allowing for the dissection of any posterior attachments. Finally, the vascular pedicle, which includes both the renal artery and vein, is divided to complete the nephrectomy. In cases where cardiocirculatory arrest occurs, a retrograde cannulation of the aorta above the renal arteries may be performed. This technique allows for the kidneys to be cooled in situ by perfusing them with a cold preservation solution, which is critical for maintaining the organs' viability for transplantation. Once the kidneys and ureters are removed, they are packed in ice to preserve them until they can be delivered to the recipient transplant team(s) for transplantation into a patient in need of a kidney transplant.