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 whom the transplanted kidney can perform all the functions which the patient's own kidneys are not able to perform.
Why is a 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.
Patients with irreversible renal failure have two options of 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 anaemia (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 anaemia 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:
1.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.
2. 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.
3.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.
4.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 all the 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.