Kidney Transplant is a surgical procedure to place a healthy kidney from a donor into a person whose kidneys no longer function adequately.

The main function of kidneys is to filter and remove excess wastes material and metabolites, minerals and fluid from the blood by the production of urine in nephrons.

When kidneys lose this filtering ability, harmful fluid and waste accumulate in, that raises blood pressure and results in end-stage renal diseases.

Common causes are:

1. Diabetes
2. Polycystic kidney disease
3. Uncontrolled high blood pressure
4. Chronic glomerulonephritis

People with end-stage renal disease need to have wastes removed via a machine called dialysis or a kidney transplant surgery to stay alive.

Types are:-

1. Deceased-donor kidney transplant
2. Living-donor kidney transplant
3. Pre-emptive kidney transplant

A kidney transplant is preferred for kidney failure as a kidney transplant can treat chronic kidney disease with glomerular filtration rate (GFR, which is a measure of kidney function) less than or equal to 20 ml/min.
Kidney transplant promises following benefits over dialysis,

• Better quality of life
• Lower risk of death
• Fewer dietary restrictions
• Lower treatment and maintenance cost

Under the following conditions, one is not eligible for receiving kidney donation,

1. Advanced age
2. Severe heart disease
3. Active or recently treated cancer
4. Poorly controlled mental illness
5. Dementia
6. Alcohol or drug abuse

Kidney transplant surgery carries the following risks,

1. Blood clots
2. Bleeding
3. Leaking from or blockage of the ureter
4. Infections
5. Rejection of the donated kidney
6. An infection or cancer that can be transmitted with the donated kidney
7. Death, heart attack and stroke

Kidney transplants are very successful. Over 94 per cent of transplants are working an year later however one needs to consult a nephrologist to assess their medical condition and suitability for undergoing this procedure.

Medical tests used by a nephrologist to assess your health before a transplant can include,

1. A physical examination
2. Blood tests
3. X-rays of the heart and lungs
4. Ultrasounds and other imaging of the heart.
5. A surgical review of arteries, veins and bladder
6. Periodic tests of anti bodies.

When preparing for kidney transplant, maximizing your general health and fitness will make you suitable for a transplant and aids your recovery.

You should also consider maintenance of your:

1. Recommended dietary and fluid restrictions
2. Schedule for dialysis
3. Obesity increases the risk of complications during surgery

During surgery, the new kidney is placed in position. If the patient has large kidneys, one may be removed to make space for the transplant. Usually kidneys are not removed.

The operation usually takes about two to three hours. The new kidney is connected to urinary bladder so urine can flow and a catheter is placed inside the bladder for up to five days.

The catheter and other tubes are removed after about four days.

You will be in hospital for about a week, depending on how quickly you can recover from the surgery.
Blood tests and scans will be taken regularly.

The tests will start daily and then reduce to weekly after around three to six months, according to how long it takes for the kidney to work properly.

You will be prescribed medications by your nephrologist. These stop your body from rejecting the kidney, but these medications can sometime make you prone to serious illnesses.

Before you decide to have a transplant, it is important to understand risks involved. So talk to your nephrologist about any complications involved.

In comparison to dialysis, kidney transplant recipients:

• Live longer,
• Have better health,
• Have less restriction on diet and water,
• Have more time and energy,
• Have better quality recipient

In comparison to a deceased donor kidney transplant, live donor kidney transplant:

• Has less rejection,
• Has a higher success rate,
• Eliminates the long dialysis waiting time.

A live donor must be:

1.  Biologically related to the recipient.
2.  At least 21 years of age; donors older than 65 years can be considered on a case by case basis
3.  Free from the following conditions:

• a. Cancer
• b. Diabetes
• c. Heart disease
• d. Hepatitis B or C
• e. HIV infection or AIDS
• f. Kidney disease

The operation involves removal of the kidney from the donor and then transplanting it in the recipient.

Step 1: Removal of the kidney from the donor.

• i. Open surgery, through a loin incision; or
• ii. Laparoscopic surgery (‘key hole’ surgery), where a camera and tiny instruments are inserted into the abdomen through very small cuts (0.5 to 1.5 cm). These are used to separate the kidneys after which the kidney is removed through a second incision of about 5-7cm at the lower abdomen. As the second incision does not involve cutting muscles at all, this method results in faster recovery for the donor.

Step 2: Transplant

• An incision is made in the front lower quadrant of abdomen of the recipient. The new kidney is placed and the incision is closed. The recipient’s own kidneys aren’t usually removed.
• The donor is usually discharged within three days after surgery; while the recipient can be discharged within 7 to 10 days.

The cost of Kidney transplant surgery varies across different cities and hospitals in India- 

Yes, from recent decade, patients from abroad come to India for transplant surgeries due to following
reasons,

• Top and Qualified Doctors: India has top and qualified doctors, specialists.
• Low Cost: For international patients, these treatments are relatively inexpensive making it affordable.
• Visa: The government of India is also encouraging the medical tourism by providing M-VISA to foreigners which is why it is quite easy to get a medical visa.
• Medical Tourism Facilitation: The ISO certified companies provides medical treatment or procedure packages & services along with arrangement of hotel, food, visa & transportation.

With the advent of better immunosuppressive agents to stop early rejection, there has been a shift from using high-dose steroids to prevent graft rejection.

Minimally invasive methods for managing transplant surgery complications have been possible due to the advances made in the field of urology.

As per the Indian law and amendments to it in 2011, there has been there is a provision of “required request” available to the intensive care doctors to ask for organ donation in the event of brain death, making kidney transplant more feasible.