After cooling the removal of the kidneys is completed. The ureters are divided at the pelvic brim. Care is taken in mobilising the ureters so that they are not skeletonised. It is convenient to take the gonadal vessels with the ureter to avoid damage to the urter.
The kidneys are usually retrieved enbloc with aorta and IVC. The site of transection of the aorta distally should allow for the inclusion of any abberaant renal vessels. At the top end the aorta should be divided above any renal vessels, it is usualy to divide the aorta above the superior mesenteric artery.
The inferior vena cava is divided at the level of the transection of the distal abdominal aorta. The top end of the cava has been divided already when the liver was removed.
The kidneys are taken complete with the vessels, ureters , peri-nephric fascia and adjacent fat. The adrenal glands are taken with the kidneys as they are closely adherent.
The en-bloc resection of both kidneys and other tissues are removed from the donor and brought to a back-table. On the back table the kidneys are separated and each renal artery is perfused with university of Wisconsanin solution again to flush out any remaining blood.
The left renal vein is divided from the inferior vena cava, taking a small patch of the IVC. The aorta is then bisected longitudinally and the presence of polar arteries ascertained. All the renal arteries from the same side should be kept on a common patch.
The kidneys are placed in ice cold preservation solution, packed in double sterile plastic bags and transported to the transplant centre on crushed ice. The side of the kidney is marked on the transport bag.