Kidney Transplant in India

Kidney Transplantation:
Kidney transplantation is the transplant of a kidney into a patient with end-stage kidney disease. End-stage kidney failure is caused by diabetes, chronic Blood Pressure and Chronic glomerulonephritis. Kidney transplantation is also known as Renal Transplantation. Kidneys remove excess fluid and waste from your blood. When kidneys lose their filtering ability, dangerous levels of fluid and waste accumulate in your body — a condition known as kidney failure. A kidney transplant is remains the only option in such situation. Kidney transplants are one of the most common transplant operations. Only one donated kidney is needed to replace two failed kidneys.

Candidates for Kidney Transplantation:
Kidney transplantation is the preferred treatment for most patients with end stage renal disease (ESRD), regardless of the cause of their kidney failure. Any individual with ESRD is a potential transplant candidate. You do not have to be on dialysis to be evaluated for or receive a transplant.

Kidney transplant candidates must have adequate heart-lung function and can't have other medical conditions that severely limit life expectancy. You'll work closely with the transplant team to increase the benefit of and reduce the risk of transplant. Since transplant requires a lifelong commitment to taking medication and to having regular physician contact, patients also must understand and be willing to accept this responsibility.

Not a Candidate for Kidney Transplantation:
A kidney transplant may NOT be recommended if you have:

• Certain infections, such as TB or osteomyelitis
• Difficulty taking medications several times each day for the rest of your life
• Heart, lung, or liver disease
• Other life-threatening diseases
• History of cancer
• Infections such as hepatitis that are considered to be active
• Smoking, alcohol or drug abuse, or other risky lifestyle habits

Donors for Kidney Transplantation:
All donors are carefully screened to make sure there is a suitable match and to prevent any transmissible diseases or other complications. Kidneys for transplantation come from two sources:

• Living donors: Living donors are usually immediate family members or sometimes spouses.
• Deceased/ Cadaveric donors: Deceased donor kidneys usually come from people who have willed their kidneys before their death by signing organ donor cards.

Preparation for Kidney Transplantation:

• The patient has to follow diet advised by the transplant team.
• Patient should refrain from alcohol and smoking.
• The transplant team may recommend exercise program
• Transplant team may recommend an exercise program to keep patient’s weight in check.
• Certain medicines may be prescribed before the transplant.

Evaluation and Tests for Kidney Transplantation:
Once the patient is referred to the transplant centre, he will be thoroughly evaluated by a transplant team. Certain tests are advised before the kidney transplantation procedure:

• Tissue and blood typing
• Blood tests
• Skin tests
• Heart tests such as an EKG, echocardiogram, etc.

Kidney Transplantation Procedure:

• People receiving a kidney transplant are given general anesthesia before surgery. The surgeon makes a cut in the lower abdomen area.

• Surgeon places the new kidney inside the lower abdomen. The artery and vein of the new kidney are connected to the artery and vein in the pelvis. Ureter is then attached to the bladder. Patient’s own kidneys are left in place, unless they cause, high blood pressure, infections, or are too large for the body. The wound is then closed.

• Kidney transplant surgery takes about 3 hours. People with diabetes may also have a pancreas transplant done at the same time which usually adds another 3 hours to the surgery.

Types of Kidney Transplantation Surgery:
A nephrectomy is the surgical term for the removal of a kidney. A healthy kidney intended for donation is normally removed by one of two procedures.

• Laparoscopic Nephrectomy - A laparoscopic nephrectomy is performed under a general anaesthetic. Three or four small abdominal incisions are made in the abdomen to provide access for surgical instruments that are used to detach the kidney and to ligate the blood vessels. The intact kidney is enclosed in a bag and removed through an incision or it may be placed in an impermeable sack, morcellated and removed through one of the port sites.  Laparoscopic Nephrectomy provides patients with a safe and effective way to remove a diseased or cancerous kidney. Laparosopic nephrectomy is a minimally invasive technique, which provides patients with less discomfort and equivalent results when compared to the larger incision required with traditional open surgery.

• Open Nephrectomy - In a traditional, open nephrectomy, the kidney donor is administered general anesthesia and a 6–10 in (15.2–25.4 cm) incision through several layers of muscle is made on the side or front of the abdomen. The blood vessels connecting the kidney to the donor are cut and clamped, and the ureter is also cut between the bladder and kidney and clamped. Depending on the type of nephrectomy procedure being performed, the ureter, adrenal gland, and/or surrounding tissue may also be cut. The kidney is removed and the vessels and ureter are then tied off and the incision is sutured (sewn up). The surgical procedure can take up to three hours, depending on the type of nephrectomy being performed.

Follow Up Care Post Kidney Transplantation:
A successful kidney transplant requires close follow-up with your doctor and you must always take your medicine as directed. The period immediately following your transplant may be very stressful. Following are some of the important care to be taken after your kidney transplantation surgery;

• Before leaving the hospital, patient will be given instructions about  anti-rejection medication and its doses
• Patient will be taught about measuring blood pressure, temperature, and urine output at home.
• In the first few weeks after leaving the hospital, the transplant team will review the patient, undergo blood tests, and adjust medication doses. 
• You must keep follow-up appointments with your transplant team to monitor for signs of rejection.

• In the follow up appointments, the transplant team will conduct regular blood and urine tests to detect any signs of organ failure. One or more ultrasounds of the graft kidney may be done to see if there are structural abnormalities suggesting rejection.  
• An arteriogram or nuclear medicine scan may be needed to confirm that blood is flowing to the transplanted kidney.

Kidney Transplantation Rejection:
Unfortunately, when the immune system sees a newly transplanted organ as a foreign object that could be harmful to you, it attempts to rid your body of it. This is called as rejection. The immune system may reject the transplanted kidney. For this reason, patient must keep aware of warning signs and symptoms of rejection. Hypertension, Swelling or puffiness usually in the arms, legs, or face, decreased urine output, fever, abdominal pain, etc. The patient must contact the transplant team immediately if any of these symptoms develop. The anti rejection drugs taken after surgery help prevent rejection. This is called immunosuppressive therapy. These drugs weaken the immune system to allow your body to accept the transplanted organ. If the patient is taking immunosuppressant drugs he is regularly screened for infection, high blood pressure, diabetes, cancer, etc.

Advantages of Kidney Transplantation:
The outcome for kidney transplants surgery continues to improve with advances in immune-suppressing medications. Following are some of the advantages;

• Freedom from dialysis and freedom from the time commitment that it requires
• Increased energy
• No longer seeing themselves as chronically ill
• 3-year graft survival rate after transplantation is almost 80%. 
• The earlier you can detect rejection, the better the chance it can be reversed and the new kidney's function preserved
• Those who undergo Kidney transplant enjoy better quality of life after the procedure
• Those who receive a kidney from a living related donor do better than those who receive a kidney from a deceased donor

Disadvantages of Kidney Transplantation:
Problems breathing, Reactions to medications, wound infection, etc. are some of the disadvantages and side-effects associated with kidney transplantation.

Kidney Transplantation in India:
Kidney Transplantation in India is performed through cutting - edge clinical solutions, research, extraordinary patient care and infrastructure of world-class standards. This has addressed concerns of many patients and has helped them get rid of complex and most end stage kidney diseases.  Kidney transplant is a complex surgical exercise and need highly skilled consultants, ingenious technical staff and advanced technology working with perfect harmony, enormous dedication and team work. India offers a one stop solution for all those seeking critical procedures such as kidney transplantation.

Cost of Kidney Transplantation in India:
Kidney transplant cost in India allows people of every class and from every part of the world to avail the best medical care suited to their pocket. Everything from finding a donor and performing the surgery to the prolonged recovery period and lifelong medication, each factor adds to the cost, making kidney transplantation difficult to afford for some people.