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Kidneys are the two bean-shaped organs, each about the size of a fist, located on either side of the spine at the bottom of the rib cage. Human beings have two Kidneys, which are responsible for several functions. The most important function is removing waste products and balancing fluid levels in the body. Other functions include regulating Blood Pressure, the production of the hormone ‘erythropoietin’ which controls the making of red blood cells, converting Vitamin D from sunlight for stronger and healthier bones.  

A kidney Transplant or Renal Transplant is the transfer of a healthy Kidney from one person into the body of a person who has little or no Kidney function. 

The loss of Kidney function, known as end-stage chronic kidney disease or Kidney failure, is the most common reason for needing a Kidney Transplant. Transplant improves the quality of life along with increasing the life expectancy of the patient. Post a Kidney Transplant, the patient can discontinue Dialysis, resume normal diet and fluid intake

There are many advantages of having a Kidney Transplant as compared to maintenance on Hemodialysis: 

• Eliminates the need for Dialysis and help patients enjoy a life filled with fewer restrictions (for instance greater freedom to travel), more energy and, productivity 
• Increased life expectancy and better quality of life 
• More effective and less costly than Dialysis 

Before moving forward with patient evaluation and surgery, the financial counselors and coordinators review the patient’s insurance policy carefully and advise them in case of any concerns. Many insurance companies now include transplant benefits. The finance team at the hospital help patients to understand the rules in detail. Sometimes Medicare and private insurance plans cover much of the cost of a Kidney Transplant.

Not all patients are suitable to have a transplant. The team at our Partner hospitals discusses the transplant procedure in detail with the patient during hospital visits. One needs to go through several screening levels to help ascertain the suitability criteria for a transplant. The selection criteria for Kidney Transplant recipients include the following: 

• Existing or impending end-stage renal disease 
• Free of malignancies 
• Free of active infection 
• Intact or correctable urological abnormalities 
• No active abuse of alcohol, drugs or, smoking 
• Heart and Lung status consistent with being able to tolerate the surgery and consistent with a predicted good, long-term outcome 
• Ability to follow transplant protocols and medication regimens 
• An acceptable body weights 

Every potential candidate is considered on an individual basis. Several radiological, blood, and urine tests are done and evaluated by the Urologist and Nephrologist.

There are two ways in which a Kidney can be donated. The person giving the Kidney is called the Donor. The person receiving the Kidney is called the Recipient. 

Living Donors: Everyone is born with two Kidneys. Some choose to donate one of their Kidneys to a family member or a friend. This is called Living Kidney Donation. A person can live a long and healthy life with just one Kidney because the remaining Kidney quickly takes over the work that both Kidneys were doing previously. Additionally, long-term studies have not shown any decreased Kidney function in Living Donors. However, donors should have a close medical follow-up with their primary care doctor at least once a year for a Blood Pressure Check and Kidney Function Tests. Living Donors may belong to one of the following transplant categories: 

• Related Transplant - siblings, parents, spouse or, children over 18 years of age 
• Swap Transplant 
• Unrelated Transplant - only in exceptional cases under the recommendation of the state authorization committee 

Deceased Donors: A Deceased Kidney Donor, previously called a Cadaveric Donor, donates the Kidney post his / her death. A seniority list of all registered patients awaiting Cadaver Transplant is drawn up as per the NOTTO guidelines and then allocated accordingly.

Living Donor Kidney Transplant has many benefits, some of them are highlighted below: 

• Higher success rates 
• Shorter waiting time 
• Flexibility to schedule - living donation allows patients to schedule a surgery time that is convenient for both the patient and the donor 
• Avoidance of Dialysis  and early referral may allow for transplant before initiation of Dialysis therapy, referred to as “Pre-emptive Transplant” 

 One can be a Living Donor if he /she matches the following criteria: 

• Age between 18 and 65 years 
• Normal renal function with two Kidneys 
• Free of active infections 
• Free of malignancies for at least 2 years (medical history is evaluated individually) with exception of primary brain solid tumors in which Kidneys can be taken anytime for donation 
• No history of diabetes 
• No active/untreated substance abuse 
• Excellent physical and mental health condition 

Living Donors who are not a compatible blood type may still be able to donate by doing a “donor swap” with another incompatible pair. A second alternative is ABO Incompatible Transplant - treatment of the recipient before the transplant that would allow his or her body to accept the incompatible blood type. In addition to blood type, tissue typing (white blood cell/lymphocyte or HLA type) is tested and examined for compatibility. HLA type is inherited, and this is the reason, related Living to Living   Donors may be more likely to be compatible. An HLA compatibility test is done before every transplant. 

DTPA Renal Scan and CT Angiography of donors are undertaken and Kidney with Lesser GFR (Function) and complex vascular anatomy are considered for donation. The Donor Nephrectomy operation can be open or Laparoscopic depending upon anatomy complexness and previous history of surgery. Right-sided Donor Nephrectomy is usually done by open method for technical reasons like want of IVC Cuff Endo staplers. 

Individuals interested in becoming Living Donors should first undergo medical screening. A person should only consider donation procedures he or she is in excellent health and genuinely wishes to donate without any outside pressure. The Donor has to undergo blood testing to ascertain his or her blood and HLA type (tissue typing) to determine compatibility with the recipient. The potential Living Donor has to undergo a detailed evaluation to enable the transplant team to decide his / her eligibility t donate. The evaluation includes a complete medical/surgical history and physical exam; blood tests, X-rays, and procedures to check for general overall health, Cancers, Heart and Lung diseases, and infections. CT Angiography, Psycho / Social Evaluation, and Gynecological examination should be undertaken amongst females. If any problem is detected with the routine evaluation, additional testing may be necessary. The transplant team may decide a potential Donor is unacceptable to donate at any time during the evaluation. 

The Donor’s hospital stay is normally for four to five days. The ability to return to normal activities and work varies, but generally, this is possible within four to six weeks. Many Donors find Living Kidney Donation to be extremely rewarding and meaningful. Many family members have come forward and stated that it has further strengthened their bond with their loved ones. Those who choose to donate are regarded as true heroes by the recipient and the recipient’s loved ones. The transplant team is committed to facilitating the Living Donation process as easily as possible for the Donor. 

During the transplant operation, the Kidney is placed into the lower part of the abdomen, on either the right or left side just above the hip bone. It is put in this spot because it is close to the bladder and gets the blood supply it needs. The incision for the surgery is usually about 4 to 6 inches long. The Kidney blood vessels are attached to branches of the patient’s iliac artery and vein. The Ureter is attached to the Bladder. In most instances, the recipient’s ow Kidneys are left in place. The surgery usually takes two to four hours. Family members can expect a five to six-hour wait from the time the patient is taken to surgery until the time he/she is shifted to the recovery room. After the surgery, the transplant surgeon meets the family members to apprise them about the patient’s condition. 

The patient has to undergo preoperative evaluation and testing before either a Living or Deceased Donor Kidney Transplant. After routine lab tests and Donor / Recipient cross-matching, the evaluation of the patient is done. If the final evaluation confirms an acceptable crossmatch with no further medical complications, then the transplant surgery is carried out as per schedule. After the surgery, the patient has to stay for about 7 to 8 days in the hospital. 

Donor Nephrectomy operation can be performed by Laparoscopy or Open Surgery technique. Pneumoperitoneum is established through either a closed technique with a Veress needle or an open technique. The patient is catheterized with 16 catheters after induction on and lateral position is made. Pneumoperitoneum was created using a Veress needle and then 3 to 4 ports are inserted. Laparoscopically Kidney is all-around along with its Ureter, recovery Renal Artery, or Arteries, and Vein or Veins are ligated and cut. Then, the Kidney along with Ureter is delivered outside the body by a small cosmetic incision. Following are the advantages of Laparoscopic Donor Nephrectomy: 

• Lesser post-operative pain 
• Shorter stay in the hospital 
• Faster recovery 

Open Nephrectomy operation is performed with the patient properly positioned and prepped; a 6-8 cm incision is made from the tip of the 10th rib to the edge of the rectus abdominis muscle. This rib is not resected; instead, the fascia and muscle layers are split in the line to minimize post-operative pain. The peritoneum is retracted medially with Deaver retractors to expose the retroperitoneal space and the Kidney. Dissection starts at the Ureter, which is separated from the retroperitoneal tissue. Thereafter, all around freed from all-around along with its Ureter, Renal Artery or Arteries, and Vein or Veins are ligated and cut. Then, the Kidney along with Ureter is delivered outside the body and layered closure of the wound is done. 

The post-operate will be monitored around the clock by a team of Intensive Care Specialists, Transplant Doctors, and Nurses. After surgery, the patient is sent from the operating room to the recovery room and is closely monitored from anesthesia, the pat specialized fitted to the specialized Organ Transplant ICU. During the surgery, the recipient patient has a catheter inserted in his / her bladder so that urine can be drained out and the output can be carefully measured and monitored. The catheter is usually taken out four to five days after surgery. At that point, the patient might feel the need to urinate frequently. Eventually, the bladder adjusts and the normal urination frequency returns within a few weeks. Activity: In most cases, the staff helps to get the patient up in a chair within 24 hours of surgery. The patient is also encouraged to do deep breathing and coughing exercises to prevent lung complications. Pain control: The Nurse provides the patient with pain medication and consequently monitors its effectiveness. Monitoring vital signs and fluids: The patient has an IV (intravenous) line placed in surgery so IV fluids and medicines can be administered to the patient. Frequent checks of the patient’s vital signs and measurements of fluid intake and output are done. Kidney Function Testing: The patient has to undergo frequent blood and urine tests to check the function of his / her transplanted Kidney. Nutrition: The patient has to get started on a liquid diet immediately after surgery. The diet of the patient has to be similar to a healthy heart diet. Double J (DJ) Stent Removal: A DJ stent (plastic tube) is put in the Ureter to keep it open to drain urine. It is removed about two weeks after the transplant during an outpatient procedure called Cystoscopy. 

After the/she is discharged, he/she is recommended a strict follow-up regimen within one or two days. The patient is given the day and time of the appointment before leaving the hospital. After receiving the new Kidney, the patient needs to attend the transplant clinic twice a week for the first month and thereafter once a week for the next two months, followed by monthly follow-up for the first year and then three months. These clinical appointments are important as the risk of transplant rejection or infection is highest during the first few months. The transplant team at the Hospital closely monitors the progress of the patient during this critical time. The nursing staff and clinical coordinators are responsible for teaching and imparting information about proper care and skills such as blood pressure monitoring, intake and output measurement, consumption of medications as per schedule.