Organ Transplantation

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When Your Kidneys Fail ?

Healthy kidneys clean your blood by removing excess fluid, minerals, and wastes. They also make hormones that keep your bones strong and your blood healthy. When your kidneys fail, harmful wastes build up in your body, your blood pressure may rise, and your body may retain excess fluid and not make enough red blood cells. When this happens, you need treatment to replace the work of your failed kidneys.

Kidney Transplantation

When your health care provider makes the diagnosis of end-stage renal disease, he or she will discuss your treatment options. Whether kidney transplantation is an option for you depends on your specific situation. If your health care provider thinks you may be eligible for a transplant, you will learn about the pros and cons of this treatment. If you are a potential candidate, you will undergo a thorough medical evaluation. In the meantime, you will be treated with dialysis.

Kidney transplantation is replacement of nonworking kidneys with a healthy kidney from another person (the donor). The healthy kidney (the "graft") takes over the functions of your nonworking kidneys. You can live normally with only one kidney as long as it functions properly.

The transplantation itself is a surgical operation. The surgeon places the new kidney in your abdomen and attaches it to the artery that supplied blood to one of your kidneys and to the vein that carries blood away from the kidney. The kidney is also attached to the ureter, which carries urine from the kidney to the bladder. Your own kidneys are usually left in place unless they are causing you problems, such as infection.

Are You Eligible For A Transplant?

Before you can receive a kidney transplant, you must undergo a very detailed medical evaluation.

  • This evaluation may take weeks or months and require several visits to the transplant center for tests and examinations.
  • The purpose of this thorough evaluation is to test whether you would benefit from a transplant and can withstand the rigors of the surgery and antirejection medications and the adjustment to a new organ.

Your medical team, which includes a nephrologist, a transplant surgeon, a transplant coordinator, a social worker, and others, will conduct a series of interviews with you and your family members.

  • You will be asked many questions about your medical and surgical history, the medications you take and have taken in the past, and your habits and lifestyle.
  • It will seem like they ask every imaginable question at least twice! It is important that they know every detail about you that could bear on a future transplant.
  • They also want to make sure you are mentally prepared for following the necessary medication regimen.

You will also have a complete physical examination. Lab tests and imaging studies complete the evaluation.

  • Your blood and tissue will be typed so that you can be matched to a donor kidney. This significantly lessens the chance of rejection.
  • You will have blood and urine tests to monitor your creatinine level, other organ functions, and electrolyte levels.
  • You will have x-rays, ultrasounds, CT/MRI scans, and other imaging tests as needed to make sure your other organs are healthy and functioning.

Any of the following conditions significantly increase your chance of rejecting the new kidney and may make you ineligible for transplant:

  • Active cancer
  • HIV infection
  • Serious heart or lung disease
  • Positive results for hepatitis C
  • Severe infection

How Transplantation Works ?

Kidney transplantation is a procedure that places a healthy kidney from another person into your body. This one new kidney takes over the work of your two failed kidneys.

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A surgeon places the new kidney inside your lower abdomen and connects the artery and vein of the new kidney to your artery and vein. Your blood flows through the new kidney, which makes urine, just like your own kidneys did when they were healthy. Unless they are causing infection or high blood pressure, your own kidneys are left in place.

Post Transplant Care

Your body’s immune system is designed to keep you healthy by sensing “foreign invaders,” such as bacteria, and rejecting them. But your immune system will also sense that your new kidney is foreign. To keep your body from rejecting it, you’ll have to take drugs that turn off, or suppress, your immune response. You may have to take two or more of these immunosuppressant medicines, as well as medications to treat other health problems. Your health care team will help you learn what each pill is for and when to take it. Be sure that you understand the instructions for taking your medicines before you leave the hospital.

If you’ve been on hemodialysis, you’ll find that your posttransplant diet is much less restrictive. You can drink more fluids and eat many of the fruits and vegetables you were previously told to avoid. You may even need to gain a little weight, but be careful not to gain weight too quickly and avoid salty foods that can lead to high blood pressure

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

  1. High blood pressure (Due to Original Kidneys), that cannot be controlled by the use of medications.
  2. Infected kidneys, with recurring urinary tract infection.
  3. Large polycystic kidneys.

What Are The Advantages Of Transplantation Over Dialysis ?

1. There is no dependence on the machine thrice a week for the rest of one's life.

2. There are hardly any restrictions in the diet and fluid intake after a successful transplant.

3. 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.

4. 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.

5. 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.)

6. 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.

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