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Donor Nephrectomy Renal Protection — FRCA Final MCQ

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ModerateGeneral AnaesthesiaDonor Nephrectomy Renal ProtectionFRCA Final

A 40-year-old man (ASA I) donating a kidney undergoes laparoscopic donor nephrectomy. The surgeon reports the renal artery is ready for ligation. Before renal artery clamping, which drug is typically administered to the donor to promote diuresis and protect the remaining kidney?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Mannitol 0.5 g/kg IV

Mannitol (0.5 g/kg IV) is commonly administered before renal artery clamping during donor nephrectomy. It promotes osmotic diuresis in the remaining kidney, helps maintain renal perfusion, and acts as a free radical scavenger. Some centres also administer furosemide. The goal is to protect the solitary remaining kidney from ischaemic injury. Adequate hydration (CVP 10-12 or equivalent using goal-directed fluid therapy) before clamping is equally important. Low-dose dopamine has no proven renal protective benefit (ANZICS trial).

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