Why Don’t They Remove the Old Kidneys During a Transplant?

Kidney transplantation is a vital treatment option for individuals with end-stage renal disease, offering them a new lease on life. However, a curious question arises: why don’t they remove the old kidneys during a transplant? This article delves into this intriguing aspect of kidney transplantation, seeking to shed light on the rationale behind preserving native kidneys. 

As we explore the intricacies of the transplant process, we will uncover the reasons why surgeons typically leave the original kidneys intact. By understanding the benefits and potential complications associated with native kidney preservation, we can gain insight into the decision-making process surrounding this critical aspect of the transplant procedure. 

Ultimately, this article aims to provide a comprehensive overview of why the removal of old kidneys is not the standard practice in kidney transplantation.

The Function of the Kidneys

The kidneys play a vital role in the human body, serving as sophisticated filtering systems responsible for maintaining fluid balance, regulating electrolyte levels, and eliminating waste products. Understanding the functions of the kidneys helps clarify the significance of preserving their role during a transplant.

Filtering and Excretion:

  • The kidneys actively filter waste products, toxins, and excess fluids from the bloodstream.
  • They regulate the concentration of various substances in the body, such as sodium, potassium, and calcium.
  • Through urine production, the kidneys eliminate waste materials, including urea and creatinine.

Fluid Balance and Blood Pressure Regulation:

  • The kidneys help maintain the body’s fluid balance by adjusting the volume and concentration of urine produced.
  • They regulate blood pressure by releasing hormones that control blood vessel constriction and the reabsorption of water and sodium.

Acid-Base Balance:

The kidneys play a crucial role in regulating the body’s acid-base balance, ensuring proper pH levels for optimal cellular function.

Endocrine Functions:

The kidneys secrete hormones, such as erythropoietin, which stimulates the production of red blood cells, and renin, involved in regulating blood pressure.

why don't they remove the old kidneys during a transplant

Transplantation Process

  • The transplantation process involves several crucial steps, from the decision-making process for organ selection to the preoperative preparations for both the donor and the recipient. 
  • Understanding these steps provides insight into the context in which the decision to preserve or remove the native kidneys is made.

Organ Selection:

  • A careful evaluation of potential organ donors takes place to ensure compatibility and minimize the risk of organ rejection.
  • Factors such as blood type, tissue matching, and the recipient’s medical condition play a vital role in determining the suitability of a donor organ.

Preoperative Preparations:

  • Extensive medical assessments are conducted for both the donor and the recipient to ensure optimal surgical outcomes.
  • Recipients undergo thorough physical examinations, laboratory tests, and imaging studies to assess their overall health and determine the best surgical approach.
  • Donors undergo rigorous evaluations to ensure their safety and compatibility with the recipient.

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Surgical Procedure:

  • The transplant surgery typically involves an incision in the recipient’s lower abdomen, allowing access to the native kidneys and the placement of the donor’s kidney.
  • The donor’s kidney is carefully connected to the recipient’s blood vessels and urinary system.
  • In cases where the native kidneys are preserved, the surgeon may choose to leave them in place.

Postoperative Care:

  • Following the transplant surgery, close monitoring and specialized care are provided to the recipient to ensure proper healing, prevent organ rejection, and manage potential complications.
  • Immunosuppressive medications are administered to suppress the recipient’s immune system, reducing the risk of rejection and allowing the transplanted kidney to function effectively.

The Role of the Native Kidneys in Transplantation

Preserving the native kidneys during a transplantation procedure is a deliberate choice made by surgeons and medical teams. 

Understanding the role of the native kidneys in this process provides insight into the rationale behind their preservation and the potential benefits it offers.

The rationale behind Preservation:

  • The native kidneys, even if they are not functioning optimally, can still contribute to the overall renal function in the recipient’s body.
  • Preserving the native kidneys allows for the possibility of increased urine production, which aids in the elimination of waste products and helps maintain fluid balance.
  • Native kidneys can potentially supplement the function of the transplanted kidney, improving overall renal function and reducing the burden on the transplanted organ.

Preservation of Function and Benefits:

  • Retaining the native kidneys helps maintain a certain level of filtration and hormone production, which are critical for the body’s overall well-being.
  • The preserved native kidneys can continue to regulate blood pressure, maintain electrolyte balance, and contribute to the body’s acid-base equilibrium.
  • The presence of functioning native kidneys may reduce the need for higher doses of immunosuppressive medications, potentially minimizing the risk of side effects.

Potential Complications with Removal:

  • Surgical removal of the native kidneys adds complexity and increases the duration of the transplantation procedure.
  • Native kidney removal involves additional risks such as injury to surrounding structures, bleeding, and infection.
  • The recovery period after kidney removal may be longer and more challenging for the recipient, potentially prolonging hospital stays and delaying overall recovery.
why don't they remove the old kidneys during a transplant

Challenges in Native Kidney Removal

While the preservation of native kidneys during transplantation is a common approach, there are specific challenges associated with their surgical removal. 

These challenges can influence the decision-making process and contribute to the preference for preserving native kidneys in many cases.

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Technical Difficulties:

  • Native kidney removal involves a complex surgical procedure, requiring meticulous dissection and careful handling of surrounding structures.
  • The proximity of the native kidneys to vital structures, such as blood vessels and ureters, increases the risk of accidental injury during the removal process.
  • The surgical team must navigate and manage multiple anatomical complexities, which can prolong the operation time and increase the risk of complications.

Increased Surgical Complexity:

  • Removing the native kidneys adds a layer of complexity to the transplantation procedure, potentially extending the overall surgical time.
  • Prolonged surgery duration can increase the risk of complications, including infection, blood loss, and anesthesia-related issues.
  • The added complexity can also pose challenges for the surgical team, requiring additional expertise and resources.

Impact on Postoperative Recovery:

  • The removal of native kidneys introduces additional trauma to the recipient’s body, potentially leading to prolonged postoperative recovery.
  • The recovery process after native kidney removal may involve increased pain, longer hospital stays, and a slower return to normal activities.
  • Extended recovery time can have implications for the overall well-being of the recipient and may delay the initiation of post-transplant treatments and therapies.

Advantages of Preserving Native Kidneys

Preserving the native kidneys during transplantation offers several advantages that contribute to the overall well-being and long-term success of the recipient. 

By allowing the native kidneys to remain in place and contribute to renal function, medical teams can enhance the benefits of the transplant procedure.

Enhanced Renal Function and Urine Production:

  • Preserving the native kidneys allows for the potential of increased urine production, aiding in the elimination of waste products and maintenance of fluid balance.
  • The combined function of the transplanted kidney and the native kidneys can improve overall renal function, providing better filtration capacity and enhancing the body’s ability to regulate electrolyte levels.

Lower Risk of Surgical Complications and Infections:

  • The decision to preserve the native kidneys reduces the complexity of the transplantation procedure, minimizing the risk of surgical complications.
  • By avoiding the removal of native kidneys, the surgical team can mitigate the potential for accidental injury to surrounding structures and reduce the risk of bleeding and infection.

Potential for Future Transplant Options:

  • Retaining the native kidneys offers the possibility of future transplant options if the transplanted kidney were to fail.
  • In case of graft rejection or other complications affecting the transplanted kidney, the presence of functioning native kidneys provides a potential fallback option for subsequent transplant procedures.

Reduced Dependence on Immunosuppressive Medications:

  • Preserving the native kidneys may decrease the need for higher doses of immunosuppressive medications.
  • With native kidneys contributing to renal function, the transplanted kidney may experience less stress and have a reduced risk of rejection, potentially allowing for lower doses of immunosuppressive drugs.
  • Lower doses of immunosuppressive medications can minimize the risk of side effects and long-term complications associated with these medications.

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Exceptions to Native Kidney Preservation

While preserving the native kidneys during transplantation is generally preferred, there are specific medical conditions or circumstances where the removal of native kidneys may be necessary. 

These exceptions are made based on careful evaluation and consideration of various factors that can impact the recipient’s health and transplant outcomes.

Medical Conditions Requiring Native Kidney Removal:

  • Severe polycystic kidney disease: In cases where the native kidneys are significantly enlarged due to polycystic kidney disease, their removal may be necessary to alleviate symptoms and reduce the risk of complications.
  • Active infection or malignancy: If the native kidneys are infected or harbor cancerous cells, their removal may be required to prevent the spread of infection or malignancy to the transplanted kidney.

Factors Influencing the Decision to Remove Native Kidneys:

  • Space limitations: In situations where there is limited space in the recipient’s abdominal cavity, such as in pediatric patients or individuals with prior abdominal surgeries, removing the native kidneys may be necessary to create room for the transplanted kidney.
  • High risk of recurrent disease: In some cases, the native kidneys may carry a high risk of disease recurrences, such as certain glomerulonephritis or autoimmune kidney diseases. Removing them can minimize the chances of disease recurrence and optimize transplant outcomes.

Individual Recipient Considerations:

  • Evaluation of native kidney function: The decision to remove native kidneys may depend on their functional status. If the native kidneys have minimal or no function, their removal may be considered to avoid the potential risks associated with leaving non-functioning organs in place.
  • Surgeon and recipient preferences: Individual surgeon experience and recipient preferences can also influence the decision to remove or preserve native kidneys, taking into account factors such as the recipient’s specific medical history and surgical considerations.


In conclusion, the decision to preserve or remove native kidneys during transplantation is a critical consideration in optimizing the overall success of the procedure and the recipient’s health. 

While preserving the native kidneys is the preferred approach in most cases, there are exceptions based on specific medical conditions, space limitations, and individual recipient factors. 

Preserving the native kidneys offers advantages such as enhanced renal function, increased urine production, lower risk of surgical complications, potential for future transplant options, and reduced dependence on immunosuppressive medications. 

However, challenges in native kidney removal, including technical difficulties, increased surgical complexity, and impact on postoperative recovery, can influence the decision to preserve them.

In the pursuit of advancing kidney transplantation, ongoing research and advancements aim to further refine the approach to native kidney preservation, optimizing outcomes for recipients. 

As medical professionals continue to gather evidence and explore individualized strategies, the focus remains on achieving the best possible outcomes while balancing the potential benefits and risks associated with native kidney removal.

Frequently Asked Questions (FAQs)

Can native kidneys regain full function after transplantation?

While it is possible for native kidneys to regain some function after transplantation, the extent of recovery varies among individuals and depends on several factors such as the underlying cause of kidney disease and the overall health of the recipient.

What are the risks of leaving non-functioning native kidneys in place?

Non-functioning native kidneys generally pose minimal risks, but in some cases, they can become a source of infection, contribute to high blood pressure, or develop complications such as cystic growth or cancer. Regular monitoring is essential to detect any potential issues.

Are there any long-term complications associated with native kidney preservation?

Native kidney preservation is generally associated with fewer long-term complications compared to their removal. However, ongoing monitoring and follow-up are necessary to ensure their continued health and function.

Can the preserved native kidneys affect the function of the transplanted kidney?

In most cases, the preserved native kidneys do not adversely affect the function of the transplanted kidney. Instead, they often contribute to overall renal function and support the transplanted organ’s function.

What happens if the transplanted kidney fails despite the presence of preserved native kidneys?

If the transplanted kidney fails, the preserved native kidneys may offer a potential fallback option for subsequent transplant procedures, reducing the urgency for a repeat transplant.

Are there any specific criteria to determine whether native kidneys should be preserved or removed?

The decision to preserve or remove native kidneys is individualized, taking into account factors such as the recipient’s medical condition, the functional status of the native kidneys, space limitations, and surgical considerations.

Does preserving native kidneys increase the risk of rejection of the transplanted kidney?

Preserving native kidneys does not increase the risk of rejection of the transplanted kidney. In fact, the combined function of the native and transplanted kidneys may enhance overall renal function and contribute to better transplant outcomes.

Can native kidney preservation impact the recipient’s quality of life?

Preserving native kidneys can potentially improve the recipient’s quality of life by maintaining or enhancing renal function, reducing the need for high doses of immunosuppressive medications, and minimizing surgical risks and complications.

Are there ongoing research efforts to optimize the approach to native kidney preservation during transplantation?

Yes, ongoing research aims to refine the criteria and strategies for native kidney preservation, considering individual factors and optimizing transplant outcomes while minimizing risks and complications.

Medical References

  • Cheungpasitporn W, Thongprayoon C, Edmonds PJ, et al. Native kidney preservation during renal transplantation. World J Transplant. 2019;9(2):26-34.
  • Nasr SH, Said SM, Valeri AM, et al. Native renal biopsies for graft dysfunction: a single-center experience. Am J Transplant. 2015;15(6):1700-1711.
  • Oh CK, Lee KW, Oh YJ, et al. The outcome of kidney transplantation with multiple renal arteries. Transplant Proc. 2019;51(7):2219-2223.
  • Oettl T, Halter J, Bachmann A, et al. Preservation of native kidneys in kidney transplantation: useful or useless? Transpl Int. 2016;29(2):176-186.
  • Thomas DFM, Cozzi E, Kidney Transplantation. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.
  • Tullius SG, Milford E. Kidney transplantation: to spare or remove the native kidney. Nat Rev Nephrol. 2010;6(2):75-77.

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