Humans usually have two kidneys, one on each side of the upper abdominal region of the body. In addition to removing wastes and excess fluid from the body, kidneys also control the metabolism of electrolytes in the body, such as calcium, potassium, sodium and more. It regulates blood pressure by producing hormones that maintain the pressure. Although humans have two kidneys, the body is capable of surviving with only one functioning kidney.

When ever there is a renal failure, the kidneys are unable to clear the excess fluid and waste materials from the body and there will be accumulation of these in the body in varying degrees leading to tiredness, weakness, leg swelling, nausea, vomiting, reduced appetite, breathlessness etc. Ultimately a stage will come in which these will start affecting the body’s functioning leading to requirement of Renal Replacement Therapy.

What is a kidney transplant?

A kidney transplant is a surgery done to replace a diseased or dysfunctional kidney in a person with a healthy kidney from a living or deceased donor. It is done once both the kidneys have failed and there is no chance of a recovery in renal function (end stage kidney disease).

Is renal transplant really required? Can’t I go on living with dialysis?

Dialysis and renal transplantation are forms of renal replacement therapy. Haemodialysis is done twice or thrice a week (approx 4 hrs per session) which works out to 8-12 hrs per week. This is hardly a replacement to the real work that the kidneys do that is 24 hrs a day, 7 days a week, 365 days a year. Because of the same reason, in spite of the excellent quality dialysis facilities available, it is never a replacement for a real kidney. People tend to get weaker and other organ systems also start getting affected once years get over on dialysis. Patients typically live 10 to 15 years longer with a kidney transplant than if they stayed on dialysis.

The benefits of undergoing a renal transplant are:

• There is no longer a need for dialysis as long as kidney functions adequately.
• Blood pressure is often easier to manage, but may still require medication.
• Long-term follow-up care is less time-consuming than dialysis.
• Fluid and dietary restrictions are usually no longer necessary and if required are much less rigid.
• Patients may return to work.
• Improved quality of life with expected increase in lifespan.
• More cost effective than dialysis.

Where will I get a kidney from? Who all can donate?

There are basically 2 kinds of donation – live and cadaver.

A cadaveric donor is a healthy individual who has had brain death (as certified by the team according to the THOTA act) whose family has consented to donate his organs as a gesture of goodwill towards the goodness of humanity. In order to qualify for receiving the organ, the patient has to register himself with the KNOS through the hospital.

A live donor on the other hand is a healthy individual who is willing to donate one of his kidneys to the patient. It can be related or unrelated. Related means with within the immediate family and includes the spouse. A related transplant is always better because of better HLA match and reduced risks of rejection. However because of a number of reasons, predominantly medical, families might not be having a donor. In such cases, an unrelated donor may be looked for.

The recipient/family need to identify a healthy individual who is willing to donate a kidney out of compassion and emotional attachment. He/she needs to be evaluated by the transplant team as per the protocols and needs be certified fit for donation.

Note: The hospital, concerned doctors or any other staff of the hospital do not have any responsibility or have not authorised or appointed any individual/organisation in identifying or convincing anybody for organ donation. The Hospital’s liability is limited only to screen a willing donor as per the existing legal requirements and perform transplantation, if there is matching between donor and recipient and both are clinically fit.

Soliciting or offering kidney donation with any intention, other than that stated above, is punishable according to The Transplantation of Human Organs Act.

Following are the information and the instructions the donors should be aware of before making a decision about donating their kidney:

• The life expectancy of kidney donor appears to be similar to that of non-donors
• Risks of major complications: The risks of donation are similar to those present in any major surgery, such as bleeding and infection
• Risk of death: Death resulting from kidney donation is extremely rare and is estimated to be 0.03 percent
• The short-term risks of undergoing donor nephrectomy (removal of the kidney) are very low and in general < 1.0 percent
• The donor will have some pain and discomfort for a few days initially after surgery. Donor will have a scar of the surgery (few small ones in laparoscopic surgery)
• Donor is recommended not to do heavy exercises for 2 months after surgery.
• Studies following living kidney donors for 20 years or more seem to demonstrate long term safety of the procedure and in general, do not significantly increase the incidence of kidney disease or hypertension
• Introduction of laparoscopic or endoscopically assisted kidney removing technique has been a major progress in organ donation. This helps the donors in the form of less post-operative pain, minimal surgical scarring, quicker return to full activities and work (approximately within 4 weeks), shorter hospital stay and
• magnified view of kidney vessels for the surgeons during nephrectomy
• Lifestyle after kidney donation: After kidney donation, the donor can lead an active, normal life with only one kidney. Numerous studies have shown that one kidney is sufficient to keep the body healthy. After recovering from surgery, a donor can work, drive, exercise and participate in sports, though contact sports are not recommended. A donor can continue in all types of occupations. Being a donor does not affect a person’s ability to have a child.
• Most living donors have a feeling of great satisfaction with the donation experience because they have helped to improve another person’s quality of life and survival

What are the disadvantages of transplantation?

• Risks involved from general anaesthesia as with any major operation.
• Addition of immunosuppressive medication (and possible side effects) to current medicines. You need to be careful in the early transplant period and need to avoid contracting infections
• Despite the advances in medications and treatment and everything going well, there can still be rejection episodes (body trying to displace the grafted kidney) even in the best of centres. Rejection is treated with Injections, changes in medications and adjunct therapies like plasmapharesis. Also unless properly cared for and controlled, Diabetes can affect the graft and also the native disease.
• Need for continued care by a kidney specialist – the periodicity will increase as the years go by.
• Transplantation is a treatment not a cure.
• It is important to remember that your kidney function and response to the medications must be medically managed for a healthy, long-term outcome.

I am a diabetic with diabetic kidney disease on dialysis. Is it safe for me to undergo renal transplantation?

Diabetes is the commonest cause of renal failure nowadays and so Diabetic Kidney Disease with ESKD is the commonest reason for renal transplantation. Renal transplantation is indeed safe for Diabetics however they need to be screened for cardiovascular diseases prior to transplantation (Coronary Angiogram may be needed). Also after transplantation, the sugars need to be well controlled. Uncontrolled sugars can affect the graft in the long run.

Dr Sooraj Y. S

Consultant – Nephrology, Toxicology & Renal Transplantation, Renai Medicity