Frequently asked questions
Kidney transplant surgery is a procedure where a kidney is transplanted from a donor to a recipient suffering from kidney failure. Kidney failure can result in life threatening complications and the survival rate for the sufferer is very less. In such situations, the only options left for these patients are dialysis or kidney transplant.
Kidney transplant surgery has become common, because of its high rate of success. The kidneys for transplant can come from a deceased donor or a living donor. For getting a deceased donor’s kidney, one has to get entry into an organ recipient list. Then they will need to wait for their turn to come. In a living donor kidney transplant, a close family member can volunteer to donate one of their kidneys. Non-family members can also become a donor if they are found compatible. The awareness about the procedure among the general population has resulted in an increase in the number of healthy donors.
Kidney transplants are necessary for those suffering from end stage renal disease. These people require periodic dialysis to clear the toxins from the body. Long term dialysis has its own share of complications which forces the patient to go for a kidney transplant. More importantly, a kidney transplant improves the quality of life and long-term survival rate significantly.
Some conditions that cause end stage renal disease are-
-- Pyelonephritis or recurrent urinary infections
--Polycystic kidney disease
--Conditions causing prolonged obstruction of urinary tract
--Type 1 and Type 2 diabetes
--High blood pressure
People suffering from any of the above diseases are potential candidates for kidney transplant. Certain people suffering from end stage kidney disease, however, cannot undergo a transplant surgery due to a variety of reasons. Some of them are:
--Chronic or recurrent infections
--Cancers that have spread to other organs
--Severe heart or respiratory problems
--Certain liver diseases
--Current tobacco, alcohol or drug abuse problems
A kidney transplant does not last a lifetime. In fact, for younger patients, they may require two or more transplants during their lifetime. On an average, the lifespan of a kidney donated by a deceased donor is 12 years and 15 years for the one donated by a living donor.
To ensure optimal functioning of the transplanted kidney, one has to follow certain guidelines in a strict manner. Some of them are:
· Stop smoking if you do
· Maintain a healthy diet
· Keep your body weight within prescribed limits
· Moderate-intensity exercises should be done for about twenty minutes per day.
· Drink alcohol only in moderation, if you do drink.
· Say no to recreational drugs
· Medicines for other illnesses should be taken with caution. Always inform the doctor about the condition.
· Since immuno-suppressants reduce the immunity, care must be taken to avoid infections
· Avoid dehydration. Drink the recommended amounts of fluids
· Symptoms of infection like fever, headache, muscle pain, diarrhoea, vomiting should be taken seriously.
· Other body conditions if any, like diabetes, high blood pressure, thyroid problems etc. should be kept under control.
All these are small adjustments in life, but the benefit is a healthy kidney and a healthy life.
The preliminary step is the identification of the donor. The recipient is subjected to a lot of health tests to confirm their ability to undergo a major surgery. Various tests are done on the recipient and donor to identify various compatibility factors between them.
Some of the mandatory tests are:
· Blood type testing- To identify the blood group
· Tissue typing – This is to identify the compatibility of human leukocytes antigens, the tissue markers found in cells and are almost exclusive to an individual. If the donor and recipient markers are the same, the transplant is called a perfect match kidney transplant. Siblings are the perfect matches most of the time.
· Cross match testing -This test is carried out two different times, to find out if the recipient reacts to the donor’s kidney.
· Serological evaluation- To identify the presence of viruses like HIV, CMV etc.
Once these tests are done and a compatible donor is found, both the donor and recipient are sent for counselling. All aspects of the surgery are discussed in detail during the session and the consent of both parties are obtained. Once this is over, the date of the transplant surgery is fixed.
Kidney transplant procedure:
A kidney transplant procedure is done under general anaesthesia. The procedure may last between three to four hours. Once the patient is sedated the surgery is started. There are three stages of the surgery.
First stage- The donor kidney is placed in the abdomen through an incision in the lower abdomen. The recipient kidneys will not be removed unless there is a chance of it causing problems like pain, infection etc.
Second stage- The adjacent blood vessels are attached to the blood vessels of the donated kidney. This provides blood supply to the transplanted kidney to get it to start functioning.
Third stage- The ureters of the donated kidney are attached to the urinary bladder of the recipient. This enables the flow of urine from the transplanted kidney to the bladder. A stent may be placed in the ureters to retain its patency. The stent is removed after a few weeks through a minor surgery called cystoscopy.
Once all these stages are completed successfully, the incision in the abdomen is closed by suturing and stapling. The patient is then shifted to the recovery room for close observation.
Risks in kidney transplant:
The rate of serious complications after kidney transplant has come down drastically in recent years. Still, the procedure has its share of risks and complications. Apart from the usual risks of surgery like bleeding, infection, blood clots etc. there are some major risks involved as well.
The major risks are:
Acute transplant rejection - A battery of tests is usually done to assess the compatibility of the donor and the recipient. Immuno-suppressants are also administered prior to the surgery to prevent transplant rejection. Even then the recipient’s body, at times, rejects the donor kidney. This rejection that occurs soon after transplant is called acute transplant rejection. It affects almost one in three recipients.
Side effects of Immuno-suppressants- People with transplanted kidneys are put on immuno-suppressants for the rest of their life to prevent transplant rejection. They act by lowering the body's immune system which creates a lot of other complications. Increased risk of infections, diabetes, hypertension, bleeding problems, mood swings etc. are the major ones.
Primary non-function- A rare condition that happens when the transplanted kidney never starts working.
Acute tubular necrosis- Also called delayed graft function. In this condition, there is a delay in the functioning of the transplanted kidney.
Dehydration- The patients who undergo dialysis are advised to reduce fluid intake. At times this becomes a habit and the patient limits fluid intake even after the transplant. This leads to dehydration.
Urine leak- The ureters are stitched into the urinary bladder during transplant surgery. Urine leak happens when the stitches give way before healing. Corrective surgery may be necessary to set it right.
Organ rejection is how our body reacts to foreign objects or germs within our body. Our immune system is very powerful and is constantly working towards eliminating any unknown germs or objects within our body which are detected as threats.
When a new kidney is placed inside a body, the body’s immune system detects it as a threat and a foreign body and attacks it to destroy it. The immune system creates antibodies that try to kill the new kidney.
To allow the new organ to successfully function, medications must be given to ‘trick’ the body into accepting the organ.
Some of the most common symptoms of kidney transplant rejection are:
· Swelling/pain/tenderness around the kidney area
· Raised blood creatinine level
· High blood pressure
· Anxious/depressed mood
· Extreme fatigue
Other reasons why a kidney transplant can fail:
· Fluid collection – If fluid starts collecting around the kidney, it can cause pressure on the kidney and damage it. This should be treated immediately.
· Formation of clots – This can happen shortly after the surgery. Clots may form in the blood vessels leading to the kidney and stop the flow of blood to the kidney. If medications fail to dissolve the blood clot, then the kidney will need to be removed.
· Infections – It is common to develop infections such as urinary tract infections, colds etc. after the surgery, however serious infections can cause irreversible damage to the kidney if not detected and treated quickly.
· Urine Leakage – Sometimes there could be a leakage of urine from where the ureter joins the bladder. Urine may seep out and accumulate in the stomach or leak out through the incision. Further surgery might be required to rectify this issue.
· Non-abidance to rules – Kidney transplant patients will need to be on certain medications for the rest of their lives such as immune suppressants, which helps the recipient’s body to accept the new kidney. Missing out on these medications or stopping them can cause the body to attack the kidney and damage it.
Kidney transplant surgery is performed in all major hospitals in India. They are performed by extremely skilled and experienced surgeons who are widely respected in their field. These surgeons use the most modern equipment and practise the latest techniques in transplant surgery.
International patients looking for Kidney transplant in India should be aware of the fact that the donor should come along with the patient and the donor should be a close relative (ideally sibling, parent, spouse or children) of the patient.
The cost of kidney transplant in India is very less as compared to other countries. But one must note that the quality of treatment delivered in major hospitals in India are truly world class.
The cost of kidney transplant in India is typically between 15,000 to 20,000 USD.
Kidneys for transplants can be made available from two sources – a living donor and a deceased donor. A living kidney donation usually comes from a family member such as a parent, child, siblings or spouse. Sometimes a donor can also be a friend or a relative. There are also instances when recipients receive their kidneys from strangers. Even though it is beneficial for the donor and the recipient to have a genetic link, it is not necessary, thanks to modern-day anti-rejection medications.
A good living donor candidate should be someone who:
• Is healthy
• Is 18 years and older
• Has normal kidney function
• Is willing to become a donor and commit to the process
• Is of compatible blood type
• Is not suffering from health issues such as: high blood pressure, diabetes, cancer, kidney disease, heart disease or hepatitis.
Before being accepted as a kidney donor, the potential candidate will need to go through some tests and medical evaluations to make sure that they are healthy enough to donate. Some of these tests are:
• Blood tests
• Tissue tests
• Tests for HIV and Hepatitis
• Urine Tests
• Pap smears
• Antibody tests
• Cancer tests
• X-rays and EKG
• CT Scans
• Heart, lung, liver and kidney exams
• Mental health evaluation
Potential donors who smoke should ensure they let the doctors know about it. Smoking is considered as a risk to the potential donor which is why it is extremely important that the hospital know about it. Different hospitals have different policies regarding smoking. Some living donors may be asked to quit before donating and heavy smokers will be asked to see a pulmonary doctor.