Adventures of a Kidney Donor

June 21, 2012

Beware Potential Donors: Ask Your Surgeon About This

Filed under: Medical — by anne315 @ 12:49 pm
Tags: , ,

Florinda Gotcher

It must be acknowledged that sometimes there are complications for kidney donors as a consequence of surgery. They are rare, but can be tragic. Florinda Gotcher donated a kidney to her sister. Tragically, right after surgery she bled internally and passed away. This was because the clip that was used to close her renal artery had slipped off. These tiny clips are not supposed to be used in laparoscopic kidney surgery. I had read about this before my surgery and asked the surgeon if he used these clips to close the renal artery and he said no, he did not use them.

The manufacturer has sent letters to surgeons warning them not to use the clips in laparoscopic kidney surgery. The clip packaging has a warning symbol advising doctors to look at the instructions that come with a separate tool used to apply the clips. The instructions, which are typically not kept in operating rooms, state the clips should not be used on kidney donors.

From the CNN article:

To remove a kidney for donation, surgeons have to cut the renal artery They then have to close it back up again, or the patient would bleed to death. There are various ways to close the artery. Many surgeons use staples, but some use tiny surgical clips to hold it closed.These clips are considered safe to use in many types of surgeries, but not laparoscopic kidney donor surgeries. In donors surgeries, surgeons leave only a tiny stump of renal artery, and the clips can slip off. That’s what happened to Gotcher: when doctors opened her back up, they found the clips had slipped off the stump and were floating in a pool of blood in her abdomen.

The article on CNN about the clip 

So potential donors, before your surgery ask your surgeon what they use to close the renal artery. 

Bless Florinda for her donation, and my thoughts go out to her family.

Go to List of Resources on Kidney Donation

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4 Comments »

  1. Thank Buddha they didn’t use these!

    Comment by Mrs Woodsy — June 21, 2012 @ 1:05 pm |Reply

  2. Actually, complications from live donor nephrectomy aren’t that rare. LODN shows a complication rate of approximately 20% (per the Consensus Report of OPTN’s Living Donor Data Task Force – 2009)

    Also, for Mrs. Woodsy above: unless you’ve read your medical records, don’t be certain these clips were not used in your procedure. The threat of failure is fairly immediate. During recovery, scar tissue grows over the clip, preventing its release. There are plenty of living kidney donors walking around with these clips in their abdomen.

    There is no excuse for transplant surgeons to not know the proper use of these clips. Letters were sent to every program in 2006 after multiple living kidney donors died. After even MORE LKDs died, OPTN and ASTS (American Society of Transplant Surgeons) sent notices in 2011 prohibiting the use of these clips. At this time, the FDA also forced the manufacturer to change the use directions and issued a formal contraindiction. What do the surgeons’ expect – a personal, at-home phone call from the FDA? It is the surgeons’ responsibility to ensure their patients’ safety.

    You can read more about the history of the hemolock clip here: http://livingdonorsarepeopletoo.com/proof-that-some-kidney-donor-deaths-are-completely-preventable/

    Comment by Cristy (@LivingDonor101) — June 24, 2012 @ 9:17 am |Reply

    • While it doesn’t take away the tragedy for Florinda’s family and others, kidney donor deaths are rare and long-term survival rates are good: http://jama.jamanetwork.com/article.aspx?articleid=185508 I agree that there is NO excuse for those clips being used in kidney donation surgery.

      Comment by anne315 — June 24, 2012 @ 11:02 am |Reply

      • The Segev article you quoted is highly flawed.

        1. The OPTN database from which the info was pulled was declared “woefully inadequate” and “useless” for research and analysis in 2009 – by OPTN’s very own living donor data taskforce.

        2. An OPTN presentation revealed 4.4 living kidney donor deaths every year from 2000-2009 within 12 months of surgery in the US (slide available here, with reference: http://www.livingdonor101.com/kidney-donor-death.shtml)

        3. Segev’s study only looks at an average of 6 years, which is not long-term. Long-term is defined as 20 or more years.

        4. Segev’s comparison cohort is wrong. It draws from the general population (rather than non kidney donors who are as ‘healthy’ as pre-donation LKDs), and it multiplies the comparison cohort 8x over.

        5. Segev is purely about mortality/death and not at all about complications.

        The Swiss living donor registry, the only one in the world, shows that 10 years later, 49% of LKDs have cardiovascular disease, 47% are hypertensive, and 45% have GFR in the stage 3-4 range of chronic kidney disease. (http://livingdonorsarepeopletoo.com/living-kidney-donors-health-well-being-10-years-later/)

        Meanwhile, Mjoen in Norway used a correct comparison cohort and found that after age 60, living kidney donors began dying more quickly than the control group, and even more so after 70. (http://livingdonorsarepeopletoo.com/living-kidney-donors-and-cardiovascular-mortality-one-more-time/ – with reference so you can read it for yourself)

        By all means, choose to believe that donating is safe, and/or doesn’t affect your health or life expectancy. But understand that the data doesn’t agree, not if one reads beyond the abstract and press release.

        Comment by www.livingdonor101.com — October 27, 2012 @ 4:13 pm


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