CPT® Code 50365

The procedure described by CPT® Code 50365 refers to renal allotransplantation, which is the surgical implantation of a kidney graft from a donor into a recipient who has end-stage renal disease or other significant kidney dysfunction. This procedure involves the removal of the recipient's native kidney, which is performed concurrently with the transplantation of the donor kidney. The surgery begins with an incision in the lower abdomen, allowing access to the retroperitoneal space where the iliac blood vessels are located. The surgeon carefully dissects and prepares these vessels to facilitate the anastomosis, or connection, of the donor kidney's blood vessels to the recipient's vascular system. During the procedure, the surgeon ligates and divides lymphatic vessels surrounding the iliac blood vessels to ensure a clear surgical field. The external iliac vein is then incised, and the renal vein from the donor kidney is connected to it. If the donor kidney has multiple renal veins, each is anastomosed separately. The renal artery from the donor kidney is subsequently connected to either the internal or external iliac artery, with similar considerations for multiple renal arteries. After establishing the vascular connections, the ureter from the donor kidney is prepared for anastomosis to the bladder. This involves exposing and incising the dome of the bladder, trimming the ureter to the appropriate length, and ensuring a secure connection between the ureter and bladder. A temporary stent may be placed to maintain patency at the anastomosis site. The donor kidney is positioned in the parapsoas fossa, ensuring that there is no kinking of the blood vessels or ureter. Finally, the surgical incisions are closed, completing the procedure. This code is specifically used when the recipient's kidney is removed during the transplant operation, distinguishing it from similar procedures where the native kidney remains intact.