What should I do if the surgeon is preparing to operate on the wrong kidney during a renal surgery?

Immediate Intervention is Required When Operating on the Wrong Kidney

You should immediately tell the surgeon that the diseased kidney is the left one, not the right one they are preparing to operate on. This is a critical patient safety issue that requires immediate intervention to prevent wrong-site surgery.

Patient Safety Protocol for Wrong-Site Surgery Prevention

When you identify a potential wrong-site surgery situation:

1. Speak up immediately - Patient safety must take priority over hierarchy in the operating room
2. Be clear and specific - State "I notice we're preparing to operate on the right kidney, but according to the patient's history, the diseased kidney is the left one"
3. Request verification - Ask for confirmation through imaging review or medical records
4. Maintain professional tone - Focus on patient safety rather than assigning blame

Evidence Supporting Immediate Intervention

The ethical framework for living kidney donation emphasizes that patient autonomy and safety are paramount considerations 1. Operating on the wrong kidney would constitute a serious medical error with significant consequences:

• Removal of a healthy kidney while leaving the diseased kidney in place
• Need for additional surgery to address the diseased kidney
• Increased risk of chronic kidney disease and potential need for dialysis 2, 3
• Significant morbidity and mortality risk 4, 5

Importance of Surgical Site Verification

Proper surgical site verification is a critical safety measure in renal surgery. The KDOQI guidelines emphasize that the decision regarding which kidney to operate on should focus on the needs of the patient 1. Operating on the wrong kidney contradicts this principle and places the patient at unnecessary risk.

Potential Consequences of Inaction

Failing to speak up when you notice a potential wrong-site surgery could lead to:

• Irreversible harm to the patient
• Unnecessary loss of a healthy kidney
• Increased risk of acute kidney injury, which is associated with:
  • Higher in-hospital mortality
  • Decreased long-term survival
  • Progression to chronic kidney disease 5
• Legal and ethical liability for all operating room personnel

Common Pitfalls to Avoid

• Fear of hierarchy - Don't let concerns about status prevent you from speaking up about patient safety
• Assuming someone else will notice - Take personal responsibility for patient safety
• Delayed intervention - The further a procedure progresses, the more difficult it becomes to correct an error
• Unclear communication - Be specific about your concern rather than hinting at a problem

Conclusion

In this situation, the only appropriate action is to immediately inform the surgeon that they are preparing to operate on the wrong kidney. This intervention is supported by ethical guidelines and clinical evidence prioritizing patient safety above all other considerations in surgical settings.