Background:
In 2006, a survey was conducted among US surgeons; showing significant hemorrhagic complications of vascular management (VM) during live donor nephrectomies (LDN). Clips were associated with the greatest risk and has led to the contraindication of the use of hemostatic clips in the US. In the current study, we assessed which VM methods are used and considered most safe, and the incidence of complications.

Material and Methods:
The US survey was sent to 598 European Society for Organ Transplantation members, who profiled their profession as “surgeon” and selected “kidney” as organ type.

Result:
Of 598 surveys, 41% were returned; 156 surgeons perform LDN and constitute the study group. In venous and arterial VM, the GIA and TA stapler are most used; in terms of safety, 66% considered the GIA stapler safest for venous control, and 63% the TA stapler for arterial control. However, other closing techniques are used. Of 121 mishaps, 55.5% involved venous control and 45.5% arterial. Failure of clips occurred in at least 58 cases, while stapler malfunction occurred at least 40 times. One death from hemorrhage was reported, related to clip dysfunction.

Conclusion:
A variety of LDN and VM techniques are extant within Europe where approximately 6500 LDN procedures are performed annually. Strikingly, many surgeons do not use the VM method that they consider most safe, and persist in applying clips to the renal artery, which are known to cause donor death from sudden massive hemorrhage. Control of major vessels in LDN must employ transfixion-techniques for optimal donor safety.