- What is kidney transplantation?
Kidney (renal) transplantation is a surgical procedure in which healthy kidney from a person (donor) is removed and placed in a patient (recipient) with irreversible advanced kidney disease (end stage renal disease; ESRD).
- What are the types of kidney transplantation?
Kidney transplantation is classified into deceased donor transplantation or living donor transplantation depending on the source of the donor organ.
- Can I undergo living unrelated donor transplantation?
Living unrelated donor transplantation is not permitted by law; it is also unethical as it is associated with paid donation.
- Who are the patients for whom transplantation cannot be done?
Patients with kidney disease that invariably recurs and damages the transplanted kidney (graft), recently diagnosed cancer, positive cross match (see below) and active infection cannot undergo transplantation.
- Who can be a voluntary kidney donor for living donor transplantation?
Parents, children, siblings, grandparents and spouse can be voluntary kidney donors if their age is between 18 to 60 years (upper age limit can be relaxed in demanding situations).
Blood group of the donor should be compatible (well suited) with that of the recipient.
The donor should be free from long standing ailments that can affect kidneys in the course of the illness (diabetes mellitus, hypertension etc.) and should have two healthy normal functioning kidneys. They should not have infection with blood borne viruses (Hepatitis B, Hepatitis C and Human Immunodeficiency Virus infection) and they should be psychologically stable to make a decision on kidney donation without coercion.
- What are the tests done for the donor?
Apart from the evaluation for the above mentioned issues, tests will be done to make sure that there are no illnesses affecting other major organs. Assessment of individual kidney function by radioisotope renogram (a scanning test done following intravenous injection of radioisotope), tissue typing (blood collected from the donor and the recipient are tested for the degree of tissue level compatibility) and computed tomography (CT) angiography (contrast material is injected intravenously to see clearly the blood supply of the kidneys; location and branching of kidney blood vessels will help in surgical plan) are the other tests required for donor evaluation.
- What are the risks involved in kidney donation?
There is no increased risk of death or kidney disease in living donors in the long run. The donor is advised to have annual medical checkup to ensure proper care of single functioning kidney.
- What tests should be done for the recipient?
Apart from psychological evaluation and tissue typing, the recipient should undergo evaluation for a) the cause of the kidney disease if it is possible (to assess the possibility for recurrence of the disease in the graft and the timing of transplantation), b) lower urinary tract to rule out abnormal urinary outflow (they should be taken care before transplantation as they can predispose to post transplant urinary tract infection), c) blood borne viruses – if positive for viruses, they should undergo treatment for these viruses before transplantation and d) heart disease with coronary angiogram especially in patients who have diabetes mellitus and prior heart disease.
- How much time will it take to complete donor and recipient evaluation?
Approximately two weeks.
- What are the administrative procedures associated with living donor transplantation?
The donor should sign an affidavit stating that kidney donation is voluntary and not by force (to be attested by notary public). You should get an approval letter for undergoing transplantation from The Authorization Committee of Organ Transplantation, Karnataka. Our Hospital front office in charge will guide you in getting all these procedures done. If you are not a native of Karnataka, you should get No Objection Certificate from your native state Committee before submission of papers to the local Committee.
- What should I do to get the approval letter from the Authorization Committee of Organ Transplantation?
You should submit copies of all investigation reports along with a request form for kidney transplantation to The Authorization Committee of Organ Transplantation once all the tests are completed. The Committee will issue approval letter after verification of the documents (especially proof of relationship and residence) in two to three weeks’ time from the date of submission.
- What are the procedures after approval from the Committee?
Date will be fixed for kidney transplantation if you do not have any active infection or other problem. Final tissue cross match will be done using donor’s and recipient’s blood 2 days prior to scheduled date of transplantation to make sure that there are no preformed factors in the recipient’s blood that can damage the graft. If the cross match is negative, you will be admitted that day evening and the donor, the next day noon. Immunosuppressive medications will be started and a session of hemodialysis will be done the day before transplantation.
- What will be done during renal transplantation?
The recipient will undergo central vein catheter insertion (to monitor central venous pressure), urinary catheter insertion (to monitor urine output) and catheter insertion into the back (for injecting pain relieving agents) prior to surgery in the Operating Room (OR). The donor will undergo urinary catheter insertion (to monitor urine output) and catheter insertion into the back (for injecting pain relieving agents) at the same time.
The kidney will be removed from the donor under anesthesia and brought to the recipient table. By that time, space will be created in the abdomen of the recipient in the area above the thigh to keep the new kidney. Then the donor kidney will be connected to the recipient blood vessels.
- When will the transplanted kidney start working?
In almost all patients (95%), the graft will start its function immediately as evidenced by brisk urine output and progressive decline in serum creatinine (a blood marker for kidney function). Immediate function of the graft does not mean that everything will be all right thereafter. Kidney function may decline any time in the post transplant period (immediate and late) and that is why, constant and regular monitoring of kidney function using blood and urine tests is needed.
- What will you do if the graft does not function immediately?
The cause for defective graft function will be analyzed by blood, urine and ultrasound tests and appropriate corrective action will be taken to improve graft function. In that process, additional procedures like graft exploration in OR and graft biopsy may be required and you may continue to require dialysis till there is improvement in graft function.
There is a rare possibility (1%) that the graft may not function at all (because of complications in the blood vessels or severe rejection) and you will have to continue dialysis till you undergo transplantation again. Such grafts may require removal in OR to avoid serious life threatening complications like rupture of blood vessels or the graft itself.
- Will I require dialysis again after kidney transplantation?
But for the above mentioned situations, dialysis will not be required post transplantation.
- When will the catheters be removed?
The catheters will be removed in three to four days’ time for the donor and in a week’s time for the recipient (if there is no complication in the postoperative period).
- When will the donor and I be discharged after surgery?
The donor will be discharged on fifth day and you, on seventh or eighth day (if there is no major complication in the postoperative period).
- Will you remove my diseased kidneys?
The diseased kidneys will be removed only if they are seriously infected or the cause of severe hypertension or massive bleeding.