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Kidney Transplant Kidney Transplants

About Kidney Transplant

Kidney Transplant India

We have got two kidneys. They are bean-shaped organs located on each side of our vertebral column below the diaphragm in the back of the upper part of the abdomen. They maintain our health by removing waste products, excess water, and salt (sodium and potassium). They also keep blood pressure, bone health, and hemoglobin. When the kidney is not able to perform these functions efficiently, we call it kidney failure. When the kidney stops functioning completely, we call it end-stage kidney failure (> 90-95% of kidney function is lost). There is a threat to life. Kidney failure can be of 2 types. 1) Acute kidney failure (Temporary failure), which is potentially recoverable. 2) chronic kidney failure (permanent kidney failure), where there is permanent, irreversible damage to the kidney.

We are fortunate that artificial kidney is available to do kidney function i:e, dialysis adding many years to life. When the kidney fails permanently – end-stage kidney disease, diseased kidney function can be replaced surgically by a healthy kidney. It is called a kidney transplant. Kidney transplant is the preferred treatment because it is associated with better quality of life, longer survival, fewer dietary restrictions, lower cost, and almost full capacity to work compared to lifelong dialysis.

Causes of End-stage kidney failure (Permeant irreversible damage to the kidney)

Common causes include:

For patients suffering from end-stage kidney disease to keep alive, we have options like:

Hemodialysis This is like an artificial kidney. It does almost all excretory functions of the kidney, like removal of waste products, excess of salt, water, potassium, and phosphorus. It helps to control acid balance and blood pressure. Blood is pumped from the body by vascular access through a dialyzer filter (artificial kidney) by machine and then returned to the body. Hemodialysis can be done at the center or at home.

Peritoneal dialysis Here, our peritoneal membrane in our abdomen, which covers our organs act as a filtering membrane. Fluid is pumped into the abdomen (peritoneal) via a catheter; fluid is exchanged every 4-6 hours daily. This is slow dialysis. There is no stress on heart or blood pressure fluctuations, and there is slow removal of toxins and water like our normal kidneys. This is a home-based therapy.

A Kidney transplant Is the treatment of choice for end-stage kidney disease. It does all functions of a kidney with better quality of life, longer life span at a lesser cost overall. One healthy kidney from a donor is removed surgically and inserted into the patient (recipient). A transplanted kidney does the job of a failed kidney. One kidney is sufficient to maintain life and to live a long healthy life.

Types of kidney transplant

Living donor Kidney comes from usually a family member like father, mother, brother, sister, or wife preferably. If a related donor is not available unrelated may be considered, but there should not be a commercial deal between the donor and recipient.

Braindead donor If a living donor is not available, one can register through a hospital with a zonal coordination center for a deceased donor transplant (Braindead/ cadaver transplant). A transplant will be performed when a kidney becomes available. The main problem is the long waiting list which maybe takes 3-5 years to get a kidney depending on the frequency of donations.

While waiting for a transplant, living donor, or deceased donor, you have to remain relatively healthy and free from infection.

  • Rs 6 Lakh

    Costs

    Rs 6 Lakh

  • 10 Days

    Stay at Hospital

    10 Days

  • Back to work

    Back to work

    4 Weeks

Pre Transplant Evaluation:

Once it is decided to go for a kidney transplant before undergoing this procedure, you may need to be evaluated to determine (1) whether you are fit to undergo a transplant and its technical feasibility (2) there are no active infection and other comorbidities like advance age, advance cardiac disease, a liver disease which will affect your long-term survival after transplant. It may need correction prior to kidney transplant, or a combined organ transplant may be considered.

Detailed history, physical examination is done to find out what is your native kidney disease, what are the chances it can recur in a transplanted kidney. Your heart will be evaluated by a cardiologist for any heart disease which may need correction before transplant. Pulmonologist will evaluate your lung function whether its adequate for giving anesthesia, and there is no active lung disease like pulmonary tuberculosis or other chest infections.

The urologist will evaluate whether your bladder is adequate capacity, there is no obstruction to urinary flow, and there are no kidney stones, also evaluate blood vessel caliber, flow and are not calcified so that anastomosis is possible. The urologist will also investigate whether your original kidneys need to be removed or not.

The gynaecologist will evaluate women recipients between age 21 to 65 years of age for cervical cancer by Papanicolaou (Pap) smear. Women, more than 40 years should have mammography to screen for breast cancer.

Psychological assessment will be done by a psychiatrist to identify any social, financial, circumstances behavioural issues that may influence adherence after transplant. The psychologist also assesses fitness to give informed consent.

Dental, dermatology, ENT evaluation to rule out septic foci if present eradicated before transplant.

Laboratory evaluation

Donor evaluation:

If a donor is available, preferably an 18 to 65 years of age pre-emptive transplant before going on to long-term dialysis may be considered. Pre-emptive transplant is cost-saving and has better outcomes. You as a donor will be evaluated, and short and long-term risks will be discussed as per the donor's health profile.

ABO compatibility will be tested nowadays because of advances in technology, and immunosuppression medication transplants can be done across the ABO barrier. The cost will be higher, and the risk will also be higher.

There is also an option of paired or swap kidney transplant.

compatibility and cross-match testing will be done to assess your immunological risk and is mandatory by HOTA (Human Organ and Tissue transplant Act.)

Medical evaluation:

The purpose of medical evaluation of a donor is to determine that you are in good health, don’t have any renal problems, diabetes, hypertension, psychologically sound, no disease that can be transmitted to the recipient. It will be confirmed that you don’t have long term or short-term risk for removing one kidney. You will undergo the following investigations as a donor.

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Lab tests

Once a donor is evaluated, and the recipient is fit and prepared-made medically fit by treating nephrologist, there will be a meeting between recipient, donor, relatives, surgical and medical team. Anesthesia team will again re-examine all documents and explain in detail the plan. The transplant coordinator will help to prepare legal documents to apply for permission as per HOTA to the local,/ state level/, central level authorization committee.

Once a donor is evaluated, and the recipient is fit and prepared-made medically fit by treating nephrologist, there will be a meeting between recipient, donor, relatives, surgical and medical team. Anesthesia team will again re-examine all documents and explain in detail the plan. The transplant coordinator will help to prepare legal documents to apply for permission as per HOTA to the local,/ state level/, central level authorization committee.

The recipient, donor, and relatives will have to attend committee meetings. All your documents will be reviewed and assessed that there is no commercial interest in transplant and there is no money transaction, sale/buying of kidney between the recipient and donor. Committee will approve/disapprove the surgery and donation. Once the committee has approved, you will be posted for kidney transplant surgery.

Living on dialysis

Patients whose kidney has failed will need to dialysis for their entire life until they get a kidney transplant. Life expectancy on dialysis may vary depending on the other medical conditions and how well the patients follow their treatment plan. The average life expectancy of a patient on dialysis is 5-10 years; however, many patients have lived quite well on dialysis for 20-30 years. One of the reasons for the short survival is that most patients with kidney failure are relatively older. The benefit of transplants is much better in younger patients, and a living donor kidney transplant is more beneficial than a deceased donor transplant.

Kidney transplant operation process

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