The open donor nephrectomy through the lumbotomy approach has been the classical method of procuring kidney grafts from living donors for many decades. This technique is safe, both for the donor and for the kidney, and it is the gold standard all new techniques are compared.


  • The donor is positioned in a lateral decubitus position on the operating table and is flexed at the level of the umbilicus to expose the flank fully. The open donor nephrectomy is performed by retroperitoneally by a 15 – 25 cm flank cut below the 12th rib.

  • Resection of the distal part of the lower rib is usually applied to allow enough access to the kidney. After transection of 3 layers of abdominal muscles, Gerota’s fascia was exposed and kidney will be freed from the nearby tissues.

  • The renal vessels are extracted and the ureter with enough periureteral tissue is separated as distally as possible. After the renal vessels are ligated, it is possible to immediately extract the kidney from the operational field and start cold perfusion on the back-table.

  • In this way the warm ischaemia time is very short. With this method there is narrow risk of postoperative intraperitoneal complication, such as splenic injuries, adhesions, intestinal perforations, bowel obstructions.

  • However, open donor nephrectomy drastically damages the abdominal wall results in significant postoperative pain, slow convalescence, a long hospital stay and cosmetic problems.

  • In the long term side effects may includes denervation of the abdominal wall, incisional hernias and less often intractable pain. These unfavorable events are a disadvantage for potential donors to donate a kidney.