The current scenario of Kidney Transplants in India

What is a Kidney Transplant?

Kidney transplant is a procedure done though surgery to replace a diseased kidney with a healthy kidney from a live or deceased donor. The transplanted kidney takes over the work of two kidneys that failed so that the patient doesn’t need dialysis.

Kidneys are bean-shaped organs placed on either side of the spine just below the rib cage. The main function is to filter and remove excess waste, minerals and fluid from the blood by producing urine. Kidney transplant is done when the kidneys lose their ability to filter these wastes and thus leading to harmful levels of fluid and waste accumulating in the body. This could even raise blood pressure and ultimately result in kidney failure.

During the transplant surgery, a new kidney is placed in the lower abdomen and the artery and vein of the new kidney is connected to the body’s artery and vein. The new kidney starts making urine as soon as the blood starts flowing through it. But sometimes it might take a few weeks to start normally.

India’s position for Kidney Transplant in the world

The wait for a new and matching kidney can be very long sometimes. Generally, the transplanted kidneys come from either deceased donors or at times they could come from a family member.

About 2 Lakh patients In India are waiting for organ donation with a mere 15,000 donors available. The Ministry of Health’s calculation says that the annual requirement for kidneys could range between 2-3 Lakh with a mere 6,000 transplants occurring in reality.

The variance between the demand and supply of kidneys has to lead the government to push deceased donor or cadaver donations. The old statistics from the Indian Transplant Registry (a non-governmental initiative by the Indian Society of Organ Transplantation) says that out of the 21,395 kidneys transplanted in India between 1971 and 2015, only 783 were from a cadaver or deceased donors. This is also due to the lack of awareness and hesitation from the family members.

However, post-2012 there has been a significant increase in organ donations. The Live Kidney Transplant Programme in India has evolved in the past 50 years and is currently the second largest program in numbers after the USA.

The betterment of immunosuppressive drugs and induction agents stop early rejection events. Also, there have been various changes regarding the use of high dose steroids to prevent graft rejection which has resulted in lower incidences of post-operative complications in Transplant surgery. There have also been vast changes in the Transplant methods including minimally-invasive methods for managing surgery complications.

Since 2011 there has been a rule in the Indian Law and Amendments introducing a provision of “required request” for the Intensive Care doctors to ask for organ donation in the event of brain death. It also makes it mandatory to register it nationally and counsel relatives for organ donation. This has also helped in the improved rate of deceased donation in India.

The responsibility of carrying out organ donations lies with the hospitals. So, in respect of making a success of this Programme, the early identification, certification and maintenance of the potential donors in the Intensive Care Units is important. However, majority cases of Brain Injury death victims are brought in to the public hospitals. As these are not registered for the Programme, it often poses as a hurdle.

In India, the states doing relatively better in terms of transplantations and awareness are from the South region – Tamil Nadu, Pondicherry, Kerala and Andhra Pradesh. In the North region, however, Chandigarh has done well in terms of donors as per million people.

As of now, kidney transplant costs between Rs. 5 Lakh to Rs. 6 Lakh in private hospitals of the country. And post-treatment, the monthly cost is around Rs. 15,000 with the lifelong medicines costing around Rs. 10,000 per month.

The records in the Indian Transplant Registry reported that between 1971 and 2015, a total of 21,395 kidneys were transplanted in India, out of which a mere number of 783 kidneys belonged to deceased or cadaver donors. It is also due to the lack of knowledge of the process and apprehension among Indian families that leads to the decreasing number of deceased donors in the country.

The report also says that more than 2.5 Lakh people suffer from last-stage kidney diseases every year. In that 7 out of 10 patients go for dialysis and nearly 6 out of those 10 can’t continue due to heavy treatment fees. There are various dialysis centers available but they are majorly based in cities.

It is a fact that India is the diabetes capital of the world, and an increase in diabetes patients also leads to a proportionate increase in the number of Chronic Kidney Disease patients. As a majority of patients suffering from kidney disease come up at the end stage, dialysis and kidney transplant become the only option.

Post-transplant, one of the major challenges is to sensitize the patient about the importance of post-post-transplant care as any negligence can worsen the condition further and even be fatal.

The writer, Dr. Sudeep Singh Sachdev, is a Consultant Nephrology & Kidney Transplant at Narayana Superspeciality Hospital, Gurugram

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