by George Taniwaki

Yesterday, I had three meetings as part of my presurgical consult. My second meeting was with the living donor transplant coordinator, Kami Sneddon. She provides me with written instructions for two rituals I must perform over the next day prior to checking in for my kidney donation surgery. Then she walks me through the instructions. At the end of our meeting she thanks me for being a donor and says she will visit me after my surgery.

Day before surgery

5:30 am Eat light breakfast
6:00 am Start fast, no solid food or milk after this point
noon Drink 10oz (300ml) magnesium citrate and water
8:00 pm to midnight Drink 2 quarts (2 liter) water
10:00 pm Take shower using Dyna-Hex-4 and scrub brush
midnight No liquids after this point

Day of surgery

4:30 am Wake up, remember no food or water
4:45 am Take shower using Dyna-Hex-4 and scrub brush; afterwards do not use any body or hair grooming products
5:15 am Drive to the hospital, you must have a companion

Presurgical bowel cleansing

The first ritual is to ensure my digestive tract is empty before I undergo anesthesia. Today (the day before surgery), I have a light breakfast at 5:30 am. After that, I cannot have any solid food or milk until after my surgery. I can only drink clear liquids that have no caffeine. Water, apple juice, and fruit-flavored soft drinks are fine. No coffee, tea, colas, or orange juice. I didn’t ask about broths, but I won’t have any of that either.

I go to work in the morning, but come home at noon. That’s when I take my dose of magnesium citrate solution, a laxative. It is a non-prescription item that can be bought over-the-counter at any drug store. However, for convenience, Ms. Sneddon gave me a prescription that I filled at the hospital pharmacy.


Swan Citroma. Photo by George Taniwaki

The pharmacist provided me with a 10oz (300ml) bottle of Swan Citroma (mmm, lemon-flavored). It’s priced at $6.50 plus tax, but the transplant center covered the charge. She told me that I should drink the whole bottle, about half at once, the other half a few hours later, and drink additional liquid if I’m thirsty. She also says the Citroma will go down easier if I refrigerate it and add a dash of salt if I’m not on a sodium restricted diet.

To remove the last bit of liquid in my bowel, I should have nothing to drink between midnight until after my surgery. To prevent dehydration though, I should drink two quarts (2 liter) of clear liquid between 8 pm and midnight.

Presurgical scrub

The second ritual I need to perform is to ensure my body (actually, the skin on my abdomen) is sterile. For this, Ms. Sneddon provided me with a bottle of Dyna-Hex 4, a bactericidal liquid soap containing chlorhexidine gluconate 4% solution.


Dyna-Hex 4 antiseptic soap. Photo by George Taniwaki

I am instructed to shower the night before surgery using a liberal amount of this soap and scrub my body using a brush (actually, I used a fresh washcloth) from my neck down to my knees for at least 10 minutes. I should repeat this scrubbing and showering the following morning before coming to the hospital for my surgery.

Using antiseptic soap will reduce the chance of bacteria and loose flakes of skin entering my body and causing an internal infection. Ms. Sneddon also tells me that I should not shave or use any grooming products the morning I come in for surgery since these can also enter my body and either irritate or infect me.

For more information on becoming a kidney donor, see my Kidney donor guide.

[Update: Added table describing the rituals to be performed the day before surgery.]