Living Donor Nephrectomy (Laparoscopic)
5054750300— Open donor nephrectomy50548wRVU: 24.73 — Laparoscopic donor nephrectomy with autotransplantation
Living kidney donor: [related / unrelated / paired exchange]
Same
Laparoscopic [hand-assisted] left [/ right] donor nephrectomy
[Attending name], MD
[Fellow/Resident name]
General endotracheal
Patient is a [related / unrelated] living kidney donor for recipient [initials / MRN]. Donor evaluation complete: ABO compatible, cross-match negative, GFR [X] mL/min, split function [X%] left / [X%] right. Left kidney selected for donation [/ right selected due to anatomy]. No donor comorbidities precluding donation. Risks including bleeding, ureteral injury, conversion to open, hernia, and long-term single-kidney function discussed at length. Independent donor advocate involved. Consent obtained.
Left kidney with single renal artery and single renal vein. [Accessory lower pole artery identified and managed.] Ureter [adequate length to pelvis]. Kidney [appeared healthy, pink, and well-perfused].
The patient was positioned in the right lateral decubitus position with the left side up, kidney rest elevated. The left flank was prepped and draped in sterile fashion.
A [12-mm / 5-mm] port was placed at the umbilicus using [optical trocar / Veress needle / Hassan technique] with CO2 insufflation to 15 mmHg. Additional [3 / 4] ports placed in the left flank under direct vision. [A hand-port was placed at a [7 cm] left lower quadrant incision.]
The left colon was mobilized along the white line of Toldt. The spleen and pancreatic tail were mobilized medially. The renal hilum was dissected. The gonadal vein was ligated and divided. The adrenal vein was [preserved / ligated and divided]. The ureter was dissected to the level of the iliac vessels with a generous periureteral tissue pedicle. The renal vein and artery were each dissected free circumferentially and prepared for division.
The ureter was clipped and divided distally. IV heparin administered. The renal artery was clipped [x2 proximal clips] and divided with [locking clips / endovascular stapler]. The renal vein was clipped [x2] and divided with [locking clips / endovascular stapler]. The kidney was removed through the [hand-port / Pfannenstiel / lower quadrant] extraction site in a laparoscopic bag.
Kidney passed to back-table team; [immediate perfusion with cold preservation solution, excellent perfusion of parenchyma]. Total warm ischemia time: [X] minutes.
Hemostasis confirmed. Fascial port sites [12 mm and extraction site] closed with figure-of-eight [0-Vicryl]. Skin closed. Patient tolerated the procedure well.
None
Left kidney passed to back-table for transplantation
Minimal
None
Patient extubated in OR. Taken to PACU. Discharged POD 2-3.
Epic SmartPhrase Version
PREOPERATIVE DIAGNOSIS: Living kidney donor: [related / unrelated / paired exchange]
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Laparoscopic [hand-assisted] left [/ right] donor nephrectomy
ATTENDING SURGEON: ***, MD/DO
FIRST ASSISTANT: ***
ANESTHESIA: General endotracheal
INDICATIONS: The patient is a .PTAGE-year-old .PTSEX who is a [related / unrelated] living donor for recipient [initials]. Donor evaluation complete; ABO compatible; cross-match negative; GFR *** mL/min; [left / right] kidney selected. Independent donor advocate involved. Risks including bleeding, ureteral injury, open conversion, and long-term single-kidney status discussed. Informed consent obtained.
FINDINGS: [Left / right] kidney with [single / double] renal artery and single renal vein. [Accessory lower pole artery identified and managed.] Adequate ureteral length. Kidney appeared healthy and well-perfused.
DESCRIPTION OF PROCEDURE:
Patient right lateral decubitus. Left flank prepped. Umbilical 12-mm port placed; CO2 to 15 mmHg; additional ports under direct vision. [Hand-port placed at LLQ.] Left colon mobilized along Toldt; spleen and pancreatic tail reflected medially. Renal hilum dissected; gonadal vein ligated and divided; adrenal vein [preserved / divided]. Ureter dissected to iliac vessels with periureteral pedicle. Ureter clipped and divided. IV heparin given. Renal artery clipped x2 and divided; renal vein clipped x2 and divided. Kidney extracted via [hand-port / Pfannenstiel / LLQ] in endo-bag; warm ischemia time *** minutes. Immediate back-table perfusion confirmed. Hemostasis confirmed. Fascia closed at 12-mm and extraction sites. Skin closed. Patient tolerated the procedure well.
ESTIMATED BLOOD LOSS: Minimal
SPECIMENS: Left kidney to back-table for transplantation
COMPLICATIONS: None
DRAINS: None
DISPOSITION: Patient to PACU. Anticipated discharge POD 2-3.
Signed: .ME, .MYDEGREE
.TODAYVariants
Right donor nephrectomy
Right renal vein is shorter, requiring more careful dissection and sometimes an IVC patch. Document vein length and whether extension with donor iliac vein was needed. Right side selected when anatomy favors it (multiple left arteries, right dominance).
Open donor nephrectomy
CPT 50300. Flank incision or midline. Increasingly rare; reserved for difficult anatomy or failed laparoscopic approach. Document conversion rationale if open after laparoscopic attempt.
Charting Tips
- Document warm ischemia time as a specific number in minutes, not 'minimal.' This number travels with the kidney and cannot be reconstructed after the fact.
- Document vascular anatomy in detail: number of renal arteries, artery and vein length achieved, and how any accessory vessels were managed. The transplant surgeon plans bench reconstruction from your note.
- State that the ureter was mobilized with its periureteral fat pedicle intact and document the length achieved. Ureteral ischemia is the leading cause of urologic complications after transplant.
- Document the donor's urine output at case conclusion and whether the remaining kidney appeared to compensate. This is the intraoperative record of single-kidney function.
- Document heparin dose, time given, and time from heparin to clamp. This is a donor safety record, not a transplant logistics note.
- Any intraoperative deviation — capsular tear, bleeding, accessory vessel injury — must be documented completely. This is elective surgery on a healthy person. There is no acceptable undocumented complication.
Billing Tips
- Bill 50547 for laparoscopic donor nephrectomy (hand-assisted or pure laparoscopic, 20.06 wRVU, 90-day global). Bill 50300 for open donor nephrectomy (18.41 wRVU). The laparoscopic approach does not require a modifier, as 50547 is the specific laparoscopic code.
- The donor's surgical care is billed separately from the recipient's transplant. Two separate surgeons (or the same surgeon on two separate claims) bill for the donor operation and the recipient implantation. Both are covered under the recipient's insurance as part of organ procurement.
- Hand-assisted laparoscopic donor nephrectomy (HALDN) uses the same code as pure laparoscopic (50547). Document hand-port use in the operative note but code selection does not change.
- Donor follow-up within 90 days (wound check, blood pressure monitoring, renal function labs) is included in the 90-day global. Donor evaluation, workup, and preoperative visits are separately billed and typically covered under the recipient's insurance through the transplant center.
- If a complication requires reoperation on the donor (e.g., bleeding requiring open conversion and exploration), bill 50323 (back-table preparation) is not appropriate. Document and code the specific reoperation using the appropriate open exploratory code with modifier -78.