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Multi Organ Transplantation |
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Kidney Transplantation
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What is kidney transplantation?
A kidney transplant is a surgical procedure in which a
kidney is removed from one person (donor) and placed into the body of a person
suffering from renal failure (recipient), in which the transplanted kidney can
perform all the functions which the patient's own kidneys are not able to
perform. The transplanted kidney can perform all the functions which the patient's own kidneys are not able to perform.
Why is kidney transplantation necessary?
When a person has 'RENAL FAILURE', the kidneys do not properly filter harmful
waste products; as a result, excess wastes and chemicals start to accumulate in
the blood. When this happens, a dangerous accumulation of waste products can
occur, causing a condition known as uremia.
What are the options for treatment with irreversible
renal failure?
There are two options for treatment:
1. Dialysis, where the waste products from the blood are removed artificially.
2. Kidney transplantation
Any patient whose own kidneys have failed permanently is a potential candidate
for a kidney transplant. There are several factors in each individual case,
which determine whether a kidney transplant or lifelong dialysis is the better
form of treatment for that patient. These factors include age, availability of
family donors and the presence of antibodies in the patients (this increases
the risk of kidney failure after transplantation). The health factors which
increase the risk of the transplant operation are mainly heart disease, cancer
or infection.
What about the failed kidneys?
The removal of the kidneys (Nephrectomy) which are diseased
is usually not necessary prior to the time of transplant. The original kidneys
may have to be removed if they are producing damaging effects in the body, such
as in case of
- High blood pressure (due to
original kidneys), that cannot be controlled by the use of medications.
- Infected kidneys, with
recurring urinary tract infection.
- Large polycystic kidneys.
What are the advantages of transplantation
over dialysis?
- There is no dependence on the
machine thrice a week for the rest of one's life.
- There are hardly any
restrictions in the diet and fluid intake after a successful transplant.
- The physical sense of
well-being is so much better that one can go back to work in a style
similar to that before the illness.
- Usually the anemia (and feeling
of tiredness) seen in patients with renal failure is reversed after a
successful transplant, since the kidney is functioning to maintain normal
red cell production. For patients on dialysis, correction of anemia
requires life-long use of erythropoietin injections which are extremely
expensive.
- A woman may be able to
conceive a child after having a successful transplant. (Women on dialysis
usually do not ovulate and therefore are unable to become pregnant.)
- Men who may be having sexual
problems such as inability to maintain an erection may find this problem
eliminated once they receive a successful transplant.
Who are the potential kidney donors?
Kidneys are
obtained from 4 sources:
- Cadaver donors: A
cadaver kidney is removed from an individual who has been declared as
brain-dead from non-kidney related causes, such as an accident or a
stroke. Since a cadaver kidney is from a person not related to the
patient, the kidney has less possibility of close antigen matching and
thus less chances of success. Also, the recipient has to wait till a
suitable kidney is obtained. In our country, cadaver organs are not yet a
practically feasible alternative, though legislation for making removal of
organs from cadavers has been passed in Parliament.
- Living related
donors: Very close relatives-parents, siblings (brothers &
sisters), children, grandparents may donate a kidney to a near relative.
This is because a normal individual has two kidneys and can live safely in
good health with one kidney. Kidney donation does not alter the physical
capacity or life-style or longevity of life of such a donor.
- Emotionally related
recipient donor mother kidney donor: In the situation where
cadaver donor transplant is not available & living related donors are
found unfit, emotionally related kidney donors like spouse (husband/wife)
cousins, uncles, aunts, in-laws may donate a kidney and they are called
emotionally related kidney donors.
- Unrelated kidney
donors: When cadaver donors, living related donors, emotionally
related donors are not available or are found unfit, then unrelated donor
kidney transplantation can be considered. Patients should understand that
the chances of rejection are higher & costly medicines like Cyclosporin-A,
ATG, etc. have to be taken for better function of the transplanted kidney.
A kidney donor should have a compatible blood group, age above 18 years
and preferably below 60-65 years and should not have any major disease. In
the absence of the entire above potential kidney donors, the only option
for such patients is lifelong dialysis which is very expensive and which
may not be available to the patient where he is staying.
Special Note: Please read the Indian Govt. Laws on Human Organ Transplant
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