To treat kidney failure, a kidney transplant surgery is performed. In India, it is estimated that, on average, 2,20,000 people require a kidney transplant. But against this, only 7,500 kidney transplant surgery is performed. The mismatch between the demand for a kidney transplant and the actual surgery that took place is well established through this data.
The reason for this lower penetration of kidney transplants may be due to various factors including kidney transplant cost and low awareness among people.
In this article, you will learn about kidney transplant surgery in India:
About Kidney Transplant
In kidney transplant surgery, a healthy kidney from a deceased or living donor is placed into a person whose kidneys don’t function properly. When kidney’s lost their filtering ability, harmful levels of waste and fluids accumulate in the body. It will then give rise to blood pressure and can result in kidney failure. The end-stage renal disease occurs when the kidney’s lost nearly about 90% of the ability to function normally.
The Current Situation in India
More evidence suggests that kidney diseases in India are steadily rising owing to the rising burden of hypertension and diabetes. The incidence of end-stage renal disease (ESRD) is reported to be around 150-200 per million population.
At present, 90% of transplanted kidneys come from living donors, and only 10% come from deceased donors. Although the deceased donation rate has grown more than three times since 2012, there lies a wide gap between supply and demand.
To meet the increasing demand the government has adopted an expanded criteria donor list. This allows deceased kidney donation for donors more than 60 years of age and less than 6 years of age with normal parameters. And for donors from 51- 59 of age, two risk factors of hypertension, cerebrovascular death or serum creatinine>1.5mg/dl.
Who Requires Kidney Transplant Surgery?
A kidney transplant is required for people who have lost 90% of their kidney function. Various conditions and diseases can cause kidney failure. In India, up to 60% of ESRD and chronic kidney disease cases are attributed to lifestyle diseases. The major reasons for the failure of the kidney include:
- Type 2 diabetes: Here the body is unable to metabolize glucose properly, resulting in high blood sugar levels. Over a span of time, the excessive amount of sugar in blood vessels destroys millions of blood-filtering units present inside the kidney. This may eventually result in the failure of the kidney.
- High blood pressure: It is also called hypertension, and this is the second leading reason for kidney failure. Eventually, chronic high blood pressure can make the arteries around the kidneys narrow, hard or weak. The damaged blood vessels are unable to supply enough blood needed for the tissue of the kidney, depriving it of nutrients and oxygen.
- Polycystic kidney disease – This disease is caused due to genetic disorder. The clumps of fluid-filled sacs called cysts forms in the kidney, and it affects the kidney’s ability to filter blood.
- Glomerulonephritis –Little filters called glomeruli are contained in the kidney that filter wastes and excess fluid from the blood. The inflammation of these filters is glomerulonephritis. It can be a condition such as faulty immune responses, diabetes, viral and bacterial infection, vasculitis, and lupus.
Pre Transplant Evaluation
Once you decide to go for kidney transplant surgery, you may need to do some evaluation. It is to determine whether you are fit to undergo surgery and the technical feasibility and also about active infection. Detailed history and physical examination is made to find out your native kidney disease. The cardiologist will evaluate your heart for any heart disease which may need correction before transplant. The pulmonologist will evaluate the lung function to know whether it is adequate for giving anesthesia. The urologist will evaluate your bladder to know its capacity and also investigate whether your original kidneys can be removed.
Kidney Transplant Surgery
The kidney transplant surgery involves three main stages,
- A small cut is made carefully in the lower abdomen, through which the donated kidney is put into place. Your own kidney will be left where they are unless they are causing pain or infection.
- Nearby blood vessels are attached to the donated kidney’s blood vessels. This is to provide the donated kidney with the blood supply that needs to function properly.
- At last, the ureter (that carries urine from the kidney to the bladder) of the donated kidney is connected to your bladder.
A small stent (plastic tube) may be inserted into the ureter to ensure a good flow of urine initially. This will usually be removed 6 to 12 weeks later during a minor procedure known as cystoscopy. When the kidney is properly in place, the incision of the abdomen will be closed with surgical stitches, staples or surgical glue.
Kidney Transplant Post-Treatment Care
After the operation, you need to immediately begin treatment with medicines that will prevent your immune system from rejecting your new kidney. It may take a few days or weeks to perform properly. In this case, you will have to do dialysis.
Most people can leave the hospital within a week, but you need to attend frequent appointments at the transplant centre. It is to access the functioning of your kidney and check out how well the medicines are functioning. After kidney transplant surgery, you should return to normal activities and work within a few months, provided you make good progress.
Bottom Line
If you have end-stage renal failure or chronic kidney disease, a kidney transplant can eliminate the need for dialysis. Before deciding on treatment, make sure you discuss all your options with your healthcare provider.
