what is a kidney transplant?

Kidneys are the two bean-shaped organs that are located on each side of the spine just under the rib cage which regulates the filtering and removal of waste, minerals, and fluid from the blood by producing urine. The functioning of these organs is very essential for our whole body system.

When a condition arises where our kidneys lose the ability to filter, the level of harmful fluids and wastes in our body increases. They get accumulated which can increase blood pressure which can even lead to kidney failure which is the end stage result of kidney disease. This occurs when kidneys have lost their 90% ability to function properly.

When this condition occurs, it becomes necessary to transplant the diseased kidney with a healthy one. A surgical procedure through which a healthy kidney is placed in your body that takes over the work of your failed kidney is called a Kidney transplant.

During the transplant surgery, the kidney from the donor is placed in your lower abdomen. The blood vessels of the new organ are then attached to the lower part of your abdomen which is just above one of your legs. After connecting the vessels, the ureter (new Kidney’s urine tube) is connected to your urinary bladder.

Dr Rajesh Goel the best nephrologist in Delhi explains well about the process and complications associated with the process. He offers the best kidney transplants in India with very less complications and ensures proper treatment and cure to each one of his patients.

Why is Kidney Transplantation required? 

Kidney failure or the loss of kidney function is the most common reason for needing a kidney transplant. Patients with end-stage chronic kidney disease might also require kidney transplantation. Using a blood-filtering procedure known as dialysis, it is now possible to partially replicate the functions of the kidney. Kidney transplantation procedure involves placing a healthy kidney from a deceased or living donor to a patient whose kidneys are no longer functioning properly permanently. A kidney transplant can help patients feel better as well as lead a normal life for years. Besides, it can also effectively treat chronic kidney diseases.

End-Stage kidney disease can result in a build-up of waste products and different toxins in the blood that might lead to coma or death. Renal replacement therapy is often recommended for the treatment of end-stage kidney disease. Renal replacement therapy is performed in the form of kidney transplantation or dialysis. 

Patients suffering from kidney failure or end-stage kidney disease may benefit from getting kidney transplantation instead of living on dialysis. Kidney transplantation helps avoid side effects of dialysis and offers an overall better quality of life. As compared to patients continuing dialysis, patients who have had a kidney transplant performed have fewer dietary restrictions.

Not only do people who get kidney transplants usually live longer, but also tend to have fewer long-term health problems. Moreover, they also get a better quality of life and more energy. Choosing the Best nephrologist in India can increase the chances of living a healthy life. Dr. Rajesh Goel is the Best Nephrologist in Delhi who has performed several successful kidney transplants. To prevent rejection of the new organ by the body’s immune system, the patient should take proper follow-up care and the required immunosuppressant medications after the procedure. People who receive a successful kidney transplant tend to live longer compared to those who stay on dialysis.

Donor Identification 

Kidney Transplant Requirements for a Live Donor

The specialists at a Medical Center or a Hospital can help you understand the requirements for a live donor kidney transplantation. The requirements for becoming a live donor include the following:

  • Be in good psychological and health condition
  • Be over age 18 
  • Have normal kidney function
  • Have a compatible blood type
  • Be willing to commit to the surgery, pre-donation evaluation process, as well as the burden of recovery

Many factors are taken into consideration when matching organs from deceased donors to patients on the waiting list. These usually include the following:

  • Blood type
  • The patient’s waiting time
  • The severity of the medical condition of the patient
  • Whether the patient is available
  • Body size
  • Distance between the hospital of the patient and the donor’s hospital 
  • Whether the patient has no current infection

However, you cannot be a live donor if you:

  • Have chronic kidney problems
  • Have diabetes, heart disease, or cancer
  • Are under age 18
  • Have any conditions such as pregnancy, being underweight, that can jeopardize your overall health by kidney donation                                                                                       

Testing Involved in the Process of Evaluating a Living Donor

The following processes are carried out to determine if someone can be a donor or not. The testing procedure involves:

Physical examination and medical history review: An extensive review of all systems such as previous surgeries, illnesses, and past family medical history is performed. Before performing any invasive tests, any abnormalities found are investigated further.

To determine the insurance or financial coverage for the donation and the testing process, a financial consultation is required. The recipient’s insurance will pay for surgery and testing expenses if the donation is to a family member or friend.

To ensure you and your kidney are healthy, your doctor will do some tests before you can donate. The Best nephrologist in Delhi can offer you reliable services and the Best kidney transplant in Delhi. Usually, the first thing the doctors do is check your blood. This is important in a directed donation where it is necessary to make sure your kidney is a match for the individual who will receive it.

Crossmatch test: Doctors will mix the recipient’s blood sample with the sample of your blood to see how they react. This will verify if they have antibodies that will cause their organ to attack your kidney

Blood type test: This makes sure the recipient’s blood type and your blood type are a good match.

Kidney Transplant Requirements while identifying a deceased donor

Many factors are taken into consideration when matching organs from deceased donors to patients on the waiting list. These usually include the following:

  • Blood type
  • The patient’s waiting time
  • The severity of the medical condition of the patient
  • Whether the patient is available
  • Body size
  • Distance between the hospital of the patient and the donor’s hospital 
  • Whether the patient has no current infection

However, you cannot be a kidney donor if you:

  • Have chronic kidney problems
  • Have diabetes, heart disease, or cancer
  • Are under age 18
  • Have any conditions such as pregnancy, being underweight, that can jeopardize your overall health by kidney donation                                                                                       

How a Kidney Transplant is done?

A kidney transplant is done by replacing the non-functioning kidney of the patient with a healthy kidney from the donor. The kidney can be either from a deceased donor or a living donor. Shortlisted healthy donors for kidney transplantation can survive well on one kidney. It is a well-developed and safe procedure that has more than an 80% of success rate. A process called ‘Cross-Matching’ is done to match the kidneys of the patient and the donor. 

Kidney Transplantation- Procedure 

A kidney transplant procedure usually lasts from two to four hours. The kidney will be placed in your pelvis rather than the usual kidney location in the back during the operation (Your kidney will not be removed). The vein that removes blood from the kidney and the artery that carries blood to the kidney is surgically connected to two blood vessels in the pelvis. The tube that carries urine from the kidney to the bladder, the ureter, is transplanted by making an incision in the bladder.

The patient will remain in the recovery room for a few hours after the operation and then return to the Kidney Transplant Unit. When the procedure is over the surgeon will inform your family. After 12 to 24 hours of the surgery, you will be encouraged to get out of bed and walk as much as you can. Further, the nurses will explain to you the side effects, will instruct you in taking your medications, and discuss making lifestyle changes.

However, a cadaver kidney transplant will sometimes be temporarily slow in functioning. This is due to a condition called acute tubular necrosis (ATN) and a “sleepy” kidney. A patient might need to undergo dialysis a few times after the surgery. A “sleepy” kidney will usually start to work in two to four weeks.

To prevent rejection of the transplanted organ, most transplant recipients must take medication such as immunosuppressants. An increased risk for cancer, skin cancer, and lymphoma are some side effects of these anti-rejection drugs. A patient will be closely monitored for these conditions.

After the Operation

The patient will be taken to the specialist high dependency transplant ward for the first 5 to 7 days after the kidney transplantation surgery. Apart from that, you will have several tubes connected to you when you wake up after the operation. You will have some drips in your arm or neck and a tube in your bladder called a catheter for supplying you with fluids. Besides, you will have oxygen supplied to you by a mask. The catheter in your bladder will be staying in place for up to five days. Most people will be sitting in a chair or out of bed and will be allowed to gradually start eating the day after the operation on day two. Sometimes a stent, which is a small plastic tube, will be left near your bladder for around 3-4 weeks. The stent will be removed through the bladder at a later date using a small procedure. 

The procedure for removing this small plastic tube involves a small camera being inserted via the urethra into the bladder. The bladder will be small which means you will probably have to urinate very often if you have been on dialysis for a long time. The length of your stay in the hospital will depend on how quickly your new kidney begins to work and your health. After the kidney transplant, most patients spend between 7 and 14 days in the hospital. You might need dialysis after your transplant since it is not unusual for your kidney not to work straight away. It may take 2 or 3 weeks for the newly transplanted kidney to work fully. The Best nephrologist in India will monitor many factors such as your creatinine level and drug (immunosuppression) levels each day, and offer you the Best kidney transplant in India

Your new kidney will be working better if your creatinine level is lower. The doctors might recommend a kidney biopsy if your creatinine does not come down as low as your doctors would like. The procedure of kidney biopsy involves putting a needle into the kidney to take out a small piece of tissue. These tissues are necessary to examine exactly what is going on in the kidney. 

An ultrasound machine is used to know if there is rejection developing in the kidney. Doctors use ultrasound to locate the kidney and then the skin in the area is numbed with a local anesthetic. You will be admitted to the hospital after a kidney biopsy if the rejection develops in the kidney. This is necessary to monitor you for potential complications. Although the risks associated with performing a kidney biopsy are small, some patients experience bleeding after the biopsy. You will be prescribed a high dose of steroids for between 3 and 5 days if you develop some rejection. 

Risks Involved 

According to Dr. Rajesh Goel, as in the case of any type of surgery, a Kidney transplant also has its risk factors. It has been observed that the rates of serious complications in transplants have fallen in the last few decades due to the advancement in modern medicine techniques.

As the best nephrologist in Delhi Dr. Rajesh Goel says, everyone can have a kidney transplant, but there are certain risk factors involved which makes you ineligible for the transplant.

Some reasons are

  • If you have a current and recurring infection that can’t be effectively treated
  • If you have cancer that has spread from its original location to other parts of the body
  • It might be unsafe if you are having server heart or any other serious health problems
  • If you possess any serious health condition then it wouldn’t get any better even after a kidney transplant.
  • If you fail to follow the treatment plan then it can harm your health.

Complications may also arise from the use of immunosuppressant medications which reduce the activity of your immune system. If the transplanted kidney shows some complication it can also be a risk factor.

The majority of the surgical complications occur in the first few months after the surgery, but chances are there for them to develop after many years too.

By the nature of occurrence, we can classify them into short-term complications and long-term complications.

Short term complications

Urinary tract infections along with cold, flu are some symptoms after kidney transplants.

On the higher side, serious infections like Pneumonia, and Cytomegalovirus can also occur which may require hospital care.

Another short-term complication is the blood clots that develop in the arteries which are connected to the donated kidney. The chances for this to occur is 1 in 100 kidney transplants.

For some cases, the blood clots may dissolve using medication but if the blood supply is blocked then it is advised to remove the donated kidney.

Another problem is called Arterial stenosis which causes the narrowing of the artery connected to the donated kidney. It can develop after months or even years after the transplant. The problem with these conditions according to the best nephrologist in India is that they can cause a rise in the patient’s blood pressure. At this time the narrowed artery has to be stretched to widen it and a stent (small metal tube) has to be placed inside the complaint artery to stop it from narrowing further.

The blocked ureter is also an issue in some patients after transplant. It can be blocked soon after the kidney transplant. It can also happen after months or even years and the main reason behind this is due to scar tissue. In some cases, Catheter can be used to drain and unblock the ureter or sometimes surgery would be necessary to remove the block.

Chances are there for urine leakage occurring after one month of the transplant surgery causing the building up of fluid in the tummy or leak through the incision of surgery. If such a condition occurs further surgery has to be done to repair it to the original condition

Long term complications

The complications arising from immunosuppressant which prevents your body’s immune system from attacking the new organ which can cause the new kidney to get rejected. The long-term use of this medication can result in various side effects like increased risk of infections, high BP, weight gain, pain in the abdomen, swollen gums, thinning of bones, mood swings, etc.

Diabetes is another complication that can arise from a Kidney transplant. After transplant some people tend to develop this condition as they are not feeling unwell, they consume a lot of food and gain weight which can lead to this condition. The frequent urge of urination, thirst, and tiredness are the symptoms included.

The next condition is high blood pressure which can increase the risk of developing serious conditions like heart disease, attacks and also cause strokes.

The long-term use of immunosuppressants can increase the risk of developing some types of cancer which include certain skin cancer including melanoma and non-melanoma. Chances are there to develop Lymphoma too which is cancer that has affected the lymphatic system.

Aftercare 

Renal transplantation is a surgical procedure needing extreme aftercare. The recovery from this transplantation depends on various factors which include the age of the patient, their overall health condition, the severity of their renal disease, dysfunction of the secondary organ, and also types of infection. The patient’s recovery includes moral support and encouragement from their family members. The patient also must have strong willpower and a positive attitude which aids them very much in their process of recovery.

After the surgery donors wake up immediately with a mild feeling of drowsiness. They can get out of bed in a couple of days and are made to walk in 2 to 3 days. As they recover the intravenous lines and catheters are removed. They have to follow a liquid diet first which can be replaced with a normal diet in a couple of days and can be discharged in a week. Depending on their pain threshold painkillers are given along with vitamin tablets and make sure they follow up with the treating doctors at regular intervals to keep them healthy.

Patients or recipients are kept in the ventilator for the whole night after the procedure, and it is removed only when they are completely awake. The first 24 to 48 hours are very critical for them so their conditions and renal functions are monitored very frequently. They are closely watched and checked for any sort of bleeding, infection, or any other complications.

The intravenous lines drain, and catheters are removed in a time of 3 to 4 days as they recover and are given a liquid diet followed by a normal diet in the following two to 5 days. They can be helped out of the bed in a couple of days later and can slowly participate in mild physiotherapy programs and also start walking in 4 to 5 days. They have to actively do incentive spirometry to prevent lung collapse and any sort of infection to the lungs. At the time of discharge, they are given anti-rejection medicines along with some emergency and necessary medications as required according to their conditions.

After discharge patients have to undergo continuous tests every 5 to 7 days, so they have to make sure that they stay very close to the hospital to avoid long journeys which can cause them severe discomforts while recovery.

The house in which the patient is going to stay has to be thoroughly disinfected so that they can’t cause any sort of infections to them. After shifting the patient can slowly try walking rather than using a wheelchair. The number of visitors must be strictly restricted to reduce the chances of infection. No person with any kind of illness should visit the patient. Also, the patient has to stay away from animals and birds too and also are advised to wear a mask for the first two to three months after transplant and also avoid crowded public places.

Personal hygiene and wound care is the next important part to be taken care of. Frequent handwashing must be practiced not only by the patient but also by the family members before having food and also makes sure to use handwashing antiseptic lotions after using the bathroom.  Proper oral hygiene has to be maintained by brushing regularly and rinsing the mouth after every time they have food.

After the surgery, there are chances that the patient may have lost their appetite. It may get better slowly, and they have to ensure that they follow a high protein diet which helps the healing faster.

The food to be prepared has to be completely hygienic. The utensils must be thoroughly washed, filtered or boiled water is to be used for cooking. Increase the fluid intake and have frequent small meals throughout the day. The diet has to be a well-balanced low-fat high protein diet.

They must completely avoid outside/ junk food, deep-fried oily foods, raw eggs, red meat, cold meat, and even overripe fruits.

Next is the exercise part which has to be followed at a slow but steady pace while recovery. It is 

Common that the patient may experience tiredness and small abdominal discomforts at the site of the operation for the first few weeks. Mild exercise should be done and if symptoms are getting severe you can consult your doctor and make necessary changes. Deep breathing exercise has to be performed to increase the lungs to expand and can help in coughing out the sputum. Perform limb exercise which helps to strengthen the patient’s limb muscles which helps in increasing blood circulation. Ensure that you get proper and adequate rest and sleep during this time. In the initial months of transplant, you are advised not to lift any sort of heavyweights or perform any abdominal exercise. After three months the patient can resume normal activities in weight training and abs exercise and even swimming which helps them in strengthening the muscles and flatten their tummy.

FAQ

If you are someone who needs to experience the best kidney transplant in India, then he or she has to understand that a kidney donor doesn’t need to be living; the person can be deceased also. Every human being is blessed with two kidneys, but a body can work perfectly just with a single kidney; a member from your family who has two perfectly functioning kidneys can donate one to you. Also, if someone matches your requirement regarding a kidney then he or she can donate.
You will undoubtedly find that people from different countries are travelling to India just to get their kidneys transplanted. Now you could be thinking why this is happening, then let me tell you that availability of the hospitals that specializes in kidney transplant is situated in India; also the expense involved is quite affordable.
If you are someone who is going to experience the best kidney transplant in India, then you should know that the insurance policy owned by you is functional only if you are getting operated on in a hospital that is associated with the health insurance providing firm. The health insurance you have enrolled for promises you to offer the best kidney transplant in India; however, any expenditure apart from the operation cost will be incurred from the patient’s side. Once you are going to experience the best kidney transplant in India, then you should check or ask any of your family members to ensure the coverage offered to you by the health insurance you have opted for.

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