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Living Kidney Donor Anaesthesia — FRCA Final MCQ

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ModerateGeneral AnaesthesiaLiving Kidney Donor AnaesthesiaFRCA Final

A 45-year-old man (ASA I) donates a kidney to his brother. He undergoes a laparoscopic donor nephrectomy under general anaesthesia. What is the primary physiological concern unique to the living kidney donor?

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Correct answer: E — Risk of renal failure in the remaining kidney from intraoperative hypotension

In a living kidney donor, the primary concern is protecting the remaining kidney. Intraoperative hypotension, hypovolaemia, or nephrotoxic insults could damage the sole remaining kidney. Goals include: liberal IV fluid administration (2-3L crystalloid), maintaining MAP >65 mmHg (some advocate >80 mmHg), avoiding NSAIDs and nephrotoxic drugs, and using mannitol before vessel clamping to promote diuresis in the remaining kidney. Long-term donor outcomes are generally excellent, but intraoperative management is critical.

Reference: NICE – 2013 – CG169 Renal replacement therapy; RCOA – 2023 – Renal/urological anaesthesia