- What is kidney transplant?
- Who needs a kidney transplant?
- Who can be a kidney donor?
- Kidney transplant vs Dialysis for life
- What is pre-emptive kidney transplant?
- Who makes up your kidney transplant care team?
1. What is Kidney Transplant?
Kidneys are essential for sustaining life. Individuals who end up with very little or almost no kidney function, either due to an incurable disease, birth defect or extensive injury, require a solution to regain/assist with their kidney function. Kidney Transplant is one of the methods to do so.
This involves a surgical procedure of “transferring” a healthy, matched kidney from a willing donor to “implant” it in the belly of the patient requiring the organ. Hence the name, Transplant.
Here, the donor kidney is securely removed with parts of its urine outflow pipe (Ureter) & blood vessels. Transplant surgeons attach this entire “work-station” to the kidney recipient’s urinary bladder and important blood vessels within the patient’s belly at the lower corner.
In most patients who get a kidney transplant, their native, unwell kidneys remain in their original location. These kidneys shrivel and completely lose their function with time, while the donor kidney placed in the lower part of their belly takes over.
However, in some cases such as polycystic kidney disease, widespread kidney damage due to stones or blood clots or infection, the damaged native kidneys could be a cause for discomfort or outright harm to the surrounding organs. So, such unwell kidneys require surgical removal while receiving the donor kidney.
When your medical team uses the phrases “decline in Kidney Function” & “Kidney failure” in the context of deciding whether you require a Kidney transplant/Dialysis, it refers to the overall functioning capacity of:
◾Both your kidneys (as in most humans)
◾ Your only kidney if you happen to be born with one kidney
◾ The surviving kidney if you had to have one of your kidneys removed surgically for a medical reason/extensive injury
2. Who needs a Kidney Transplant?
Patients who require a Kidney Transplant suffer from loss of kidney function due to:
◾Conditions that cause Chronic Kidney Disease and subsequent kidney failure (End Stage Renal Disease)
◾Acute, extensive kidney damage from prolonged kidney stones that may block the urine outflow pipes on both sides and cause further damage due to back-pressure (Hydronephrosis)
◾Widespread, irreparable damage of both kidneys or a solitary kidney due to injury/trauma
Patients who qualify for receiving a kidney transplant are termed “Transplant Candidates”. And those who receive a Kidney from a donor are technically termed “Transplant Recipients”.
3. Who can be a Kidney Donor?
Anyone who has two intact, properly functioning kidneys, is reasonably healthy and is willing to give the “gift of life” to an individual with kidney failure can volunteer to donate one of their kidneys.
There are two kinds of organ donation:
Most people are born with 2 healthy kidneys, but one normally functioning kidney is enough for leading a normal life.
This enables willing persons to donate one of their kidneys to a patient with kidney failure, and continue with a normal life. Such organ donation is called Living Donation.
For this, potential Kidney Donors will need to take necessary tests at their nearest authorized transplant centre. This is to see if they are fit to donate their kidney and undergo surgery.
Depending on the country of residence and local laws, the hospital itself can register willing & healthy living donors.
DECEASED (after death) DONATION
Should an individual want to pledge their organs for donation after death, they will be termed “Deceased Donors”.
To opt for deceased donation, individuals should contact the relevant government-approved authority in their respective nations to get an Organ Donor Card made. It is also advisable for such persons to inform their family and close friends of their intent to avoid confusion at a later stage.
◾ Almost all countries view organ donation as an altruistic act. There is NO money exchange involved in return for the organ. At best, the patient party may cover the medical and logistical costs of the Living Donor.
◾ In countries like the UK and Singapore, there may be legal provisions that allow for re-imbursement of a part of the patient’s monthly salary / earnings (provided the donor is employed/self-employed). If you are a valid organ donor in any of these countries, your medical team should be able to provide more guidance on this matter.
◾ Some countries such as India have extremely strict laws governing living organ donation to check organ trafficking. In such cases, living organ donation is legally possible ONLY IF the organ donors intend to help a near relative, preferably a blood relative (parents, children, siblings, first cousins).
In each case, the patient & the donor need to present themselves together before first class magistrates of their area to obtain “legal approvals”. These involve intense scrutiny and heavy paperwork, before the life-saving surgery can actually take place.
Any unsatisfactory paperwork or attempt to commit fraud can not only jeopardize the patient’s prospects to get the surgery but can also invite prosecution for the alleged defaulter.
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4. Kidney Transplant vs Dialysis for life
Let’s provide a brief background before getting to the actual answer.
Commonly, kidneys are only described as organs that help to clear-out toxic metabolic waste from blood & remove these via Urine. However, kidneys are sophisticated organs that perform a range of activities to balance and regulate all blood components with great precision. The carousel below shows some of these functions:
When Chronic Kidney Disease (CKD) hits, it causes all of the above kidney functions to get blunted over time and gradually progress to kidney failure (less than 15% of overall Kidney function).
It is only when kidney function falls below 10% that medicines alone do not suffice. Patients need to start Dialysis or if a donor is already available and willing, get a transplant, to continue to live.
Now, to answer the question, Dialysis can ONLY cover a segment of functions that Kidneys normally perform. It clears out blood wastes and can balance some of the minerals in your blood. But the efficiency of these tasks does not match up to native kidneys.
Further, Dialysis DOES NOT help with producing the blood-forming hormone, precise BP control, active Vitamin D production, stopping the loss of other important hormones (sleep & reproduction) from the body via urine, maintain blood pH (acidity/alkalinity) or even take care of your heart health. These present as an added set of side effects of Dialysis itself. You will need to continue with additional medication to help you with all of these body functions.
On the other hand:
Getting another native kidney via Transplant with proper matching, appropriate post-transplant medicines and responsible self-care means, adding the efficient organ “back to work” in its native state. All of the kidney functions should return seamlessly if the donor kidney adjusts properly within the patient’s body.
Yes, transplant comes with its side effects especially with the anti-rejection medicines or some possible complications. We will be rolling out separate guides on these segments subsequently. But the overall benefit profile & quality of life is a lot better with Kidney transplant as compared to Dialysis.
Hence, Dialysis is generally a good treatment to stabilize kidney failure patients till they find a matched donor or for patients who are too unstable for surgery or do not meet transplant fitness criteria.
For all other patients with kidney failure from CKD, a Kidney transplant is the best possible treatment for overall improvement in their quality of life.
5. What is pre-emptive Kidney Transplant?
The word “pre-emptive” means “initiating corrective steps in good time before an anticipated problem actually occurs”.
By that logic, Pre-emptive Kidney transplants should refer to transplants done much before kidneys completely shut down. That means, there should be no intervening Dialysis treatment involved.
When kidneys fail due to CKD, Dialysis and/or Kidney Transplant become necessary to continue to live longer.
◾Since kidney disease progresses silently, in usual practice, a huge segment of patients get their diagnosis at a fairly advanced stage.
◾In such a scenario, it becomes necessary to start such patients on Dialysis first, to stabilize them. They can then start to look for potential, willing kidney donors.
◾However, if fortunately, patients receive an early diagnosis, they are likely to have a time advantage to arrange for a matched kidney.
This could either be from a living donor or they could get on the transplant list to receive a kidney from a deceased donor when due.
In such cases, it is entirely possible in almost all countries with an active transplant programme, to choose to get a Kidney Transplant surgery when clinically indicated, without even starting Dialysis. This is Pre-emptive Kidney Transplant.
It is advisable for all patients with Chronic Kidney Disease to discuss this possibility with their medical teams. This is to gain a better insight of relevant local systems, rules and procedures on this matter.
Or if in doubt, simply Contact Us to find this answer for your country of residence. Team ATK will be happy to help.
6. Who all would take care of you during your Kidney Transplant journey?
Medical Care Team
◾Nephrologist (Doctors who focus on kidney patients)
◾Renal Nurse (Nurses specially trained to cater to kidney patients)
◾Renal Dietitian (for recipients only)
◾Dialysis care team (only for recipients who have been on Dialysis)
◾Anaesthesiologist / Intensivist
◾Clearance for surgery fitness: Cardiologist, Gynaecologist (for female recipients/donors)
◾Radiologist (for imaging tests like CT scans, Ultrasound scans)
◾Lab staff: Phlebotomist (draws your blood for blood tests)
◾Lab doctors: Pathologist, Microbiologist, Biochemist
◾Hospital administrative staff
◾Insurance liaison officer (depends on the country and the patient’s healthcare spending arrangement)
Legal team (Only in select nations)
To get necessary clearances from government-administered Transplant approval bodies
◾Civil Lawyer to get respective Donor & Recipient Affidavits made
◾Judicial magistrate to scrutinize all paperwork before granting Transplant Clearance
◾Doctor panel at Directorate of Medical Education or competent authority of the respective state/province.
So, these were some bare basic pointers about Kidney Transplant. We will be rolling out more detailed guidance on:
◾Post-transplant hospital experience
◾Post-discharge experience for Transplant patients & donors (diet, medication, complications, quality of life etc)
and a lot more BOTH for the Recipient & the Donor in subsequent articles under this category.
Do keep a tab of this space for a clear & practical take on these topics.
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