Open Recipient Kidney Transplantation Consent

Informed Consent For Surgical Operation / Procedure

Procedure: Open Recipient Kidney Transplantation

1. Patient Identification

I, ______________________________ (patient/next of kin/legal guardian), aged ____ years, in my full senses, voluntarily authorize and give my complete consent for performance of the following procedure(s)/operation(s)/treatment(s):

Procedure: _______________________________
Diagnosis: ________________________________
Major illness & comorbidities: ________________________________

2. Authorization for Procedure

I authorize Dr. __________________ to perform the above procedure, along with such assistants and associates as may be selected by him/her.

I understand that members of the surgical team, including residents or trainees under appropriate supervision, may perform parts of the procedure according to their training and competence.

3. Nature of Procedure

Kidney transplantation involves placing a healthy kidney from a living or deceased donor into the lower abdomen.

The donor kidney’s blood vessels are connected to the recipient’s blood vessels and the ureter is connected to the bladder.

The patient’s own kidneys are generally not removed unless medically indicated.

The procedure is performed under general anaesthesia.

A temporary DJ stent, urinary catheter, drains and intravenous lines may be required.

4. Benefits and Indications

Kidney transplantation is a treatment for patients with chronic kidney disease/end-stage renal disease (ESRD) who are suitable candidates for transplantation.

The intended benefits include:

  • Restore kidney function.
  • Improve quality of life.
  • Reduce or eliminate the need for dialysis.
  • Improve long-term survival in suitable patients.

No guarantee has been given regarding transplant success or longevity of the transplanted kidney.

5. Risks and Complications

  • Haemorrhage

Haematoma has been reported in approximately 0.2–25% of renal transplant cases.

Large haematomas compressing the graft may require surgical treatment in approximately 2–5%, with blood transfusion reported in approximately 10–20% of patients.

  • Haematuria

Haematuria may occur in approximately 1–34% of cases.

Treatment may include bladder irrigation and, in some cases, cystoscopy with clot evacuation and/or treatment of bleeding sites.

  • Vascular Complications

Renal Vein Thrombosis

Approximately 0.5–4%.

This may cause congestion and impaired graft function and may require urgent surgical exploration. Severe cases may result in graft loss and transplant nephrectomy.

Renal Artery Thrombosis

Approximately 0.5–3.5%.

This may result in sudden loss of graft blood flow and often results in graft loss despite urgent treatment.

Renal Artery Stenosis

Reported incidence: 1–25%.

Clinically significant stenosis may require angioplasty, stenting or surgical correction.

  • Lymphocele

Lymphocele occurs in approximately 1–26%.

Small asymptomatic collections may be observed, while symptomatic collections may require drainage, sclerotherapy or surgical fenestration.

  • Ureteric Complications

Urinary Leak / Urinoma

Reported incidence: 0–9.3%.

Treatment may include:

  • Urinary catheterisation
  • DJ stent
  • Percutaneous nephrostomy
  • Surgical repair when necessary.

Ureteric Stenosis

Reported incidence: 0.6–10.5%.

Treatment may involve balloon dilatation, ureteroscopic incision or reconstructive surgery depending on the length and severity of the stricture.

Successful placement and preservation of the testis cannot be guaranteed. Additional surgery, staged orchidopexy or rarely orchidectomy may be required.

  • Rejection

I understand that my immune system may recognise the transplanted kidney as foreign and attempt to damage it.

Acute Rejection

Approximately 6–15% within the first year.

It is often treated with stronger immunosuppressive therapy and may require kidney biopsy.

Chronic Rejection

Chronic rejection may progressively damage the transplanted kidney and contributes to long-term graft loss.

Strict adherence to anti-rejection medication is essential.

Delayed Graft Function

Approximately 10–30%.

Temporary dialysis may be required until the transplanted kidney begins functioning adequately.

  • Medical and Long-term Risks

Important medical risks include:

  • Infections due to immunosuppression: 20–60%
  • Sepsis: 5–10%
  • New-onset diabetes after transplantation: 10–30%
  • Hypertension: 30–70%
  • Weight gain.
  • Cardiovascular/cerebrovascular events: 5–10%
  • Calcineurin-inhibitor kidney toxicity.
  • Mortality

Perioperative mortality is stated as approximately 1–3%, with higher risk depending on comorbidities.

  • Psychosocial Risks

I understand that transplantation may be stressful for me and my family.

Possible psychosocial effects include:

  • Depression
  • Generalised anxiety
  • Post-traumatic stress
  • Feelings of guilt
  • Anxiety related to loss of control or dependence on others.

6. Postoperative Course

I understand that:

  • I may initially be monitored in the post-anaesthesia care unit/ICU.
  • ICU care may be required.
  • Intermittent pressure boots/sleeves may be used to prevent blood clots.
  • Pain will be monitored and treated.
  • An IV line, surgical drain and urinary catheter may be present.
  • The surgical drain may remain for approximately 2–3 days.
  • The urinary catheter may remain for approximately 5 days.
  • A JJ/DJ stent may be placed and removed later as a day-care procedure.
  • Mild dysuria or haematuria may occur because of the stent.
  • Bowel function may return within approximately 2–3 days.
  • Hospital stay depends on recovery; the source form states that most patients stay approximately 7 days.
  • Healing may take approximately 6 weeks.
  • Heavy work/lifting should generally be avoided for approximately 3 months.

Lifelong Follow-up

I understand that:

  • Lifelong immunosuppressive medicines are required.
  • Regular medical review and blood tests are mandatory.
  • Rejection or graft failure may occur.
  • I may eventually require dialysis or another transplant.
  • Some original kidney diseases may recur after transplantation.
  • Immunosuppressive medicines increase the risk of certain malignancies, including skin cancer and post-transplant lymphoproliferative disease.
  • Kidney stones and vesicoureteral reflux may occur after transplantation.

7. Alternatives to Procedure

I have been informed of alternatives including:

  • Haemodialysis.
  • Peritoneal dialysis.
  • Conservative/supportive management where appropriate.
  • I understand that I may refuse transplantation after discussing the consequences with the transplant team.

8. Anaesthesia and Pain Management

I understand the risks associated with local, regional, or general anaesthesia.

Pain management options have been explained.

9. Photography / Data Use

I consent to:

☐ Medical photography/video for academic purposes

☐ Use of anonymized clinical data

10. Intraoperative Decision Consent

I authorize the surgeon to perform additional procedures considered necessary if unexpected findings arise during surgery.

11. Team-Based Care

I understand that supervised residents, fellows, or assistants may participate.

12. Patient Statement

I confirm that:

  • The nature of surgery has been explained.
  • Risks, benefits, and alternatives have been explained.
  • My questions have been answered satisfactorily.
  • I voluntarily consent.

Patient to write in own handwriting:

“I have understood the procedure, risks, benefits and alternatives explained to me in a language I understand.”

Signatures

Patient Name & Signature: ______________________________________

Date: ____________________ Time: ____________________

Doctor Name & Signature: ______________________________________

Date: ____________________ Time: ____________________

Witness Name & Signature: ____________________________________

Contact No.: ______________________________

ATTENDANT CONSENT (If applicable)

Reason patient unable to consent:

Attendant Name: __________________________________________

Relationship: _____________________________________________

Signature: ________________________________________________

Contact No.: ______________________________________________

INTERPRETER STATEMENT (If applicable)

I confirm an accurate explanation in understandable language.

Name: _________________________________________________

Signature: ______________________________________________

Contact: ________________________________________________

HIGH-RISK CONSENT (If applicable)

High-risk factors explained due to:

Patient Signature: ________________________________________

Doctor Signature: _________________________________________

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