There has been an increase in the average life expectancy of Indians, due to better healthcare, and a decrease in child mortality. However, the increase in life expectancy has also caused an upsurge in the prevalence of lifestyle diseases like obesity, diabetes, and hypertension.
These lifestyle diseases have contributed to an increase in chronic kidney problems. Chronic kidney disease in India is prevalent in approximately 800 per million people. Many of them with kidney disease or kidney failure require a kidney transplant to live normal, healthy lives. Read on to learn more about kidney disease and kidney transplants.
A kidney transplant is a surgery done to replace a diseased or dysfunctional kidney in a person with a healthy kidney from a living or deceased donor.When a kidney is used from a deceased donor, the procedure is called a cadaveric renal transplant. The kidneys perform the task of waste removal from your body. They filter waste from your blood and expel it from the body through urine. Kidneys also play an important role in the maintenance of the body’s electrolyte and fluid balance. When the kidneys do not do their job, toxic waste builds up in the body and can make you really ill.
Humans have two kidneys, one on each side of the upper abdominal region of the body. The right kidney is located slightly lower than the left one so that there is space to accommodate the liver, which is situated immediately above the right kidney. They are each around 5 inches in length and approximately the size of a big fist. In addition to removing wastes and excess fluid from the body, kidneys also control the metabolism of electrolytes in the body, such as calcium, potassium, sodium, and more. It regulates blood pressure by producing hormones that maintain the pressure. Although humans have two kidneys, the body is capable of surviving with only one functioning kidney.
Kidney transplant, also called renal transplant, is performed to treat kidney failure in humans. When kidneys stop functioning,patients are put through the dialysis treatment. It is a process that filters waste from the blood mechanically, and performs the job that the kidneys are unable to.
The other treatment option for kidney failure is an organ transplant. In this procedure, a surgeon takes a donated kidney from a dead or live donor and places it in the body. After this, immune-suppressive medication is given to make sure that their own immune system does not treat the new kidney as a foreign object and attack it.
A kidney transplant may be the only option for people whose kidneys have completely stopped working. This is called end-stage renal disease (ESRD). If you have ESRD, you will need dialysis to survive, and a kidney transplant can remove your dependency on a dialysis machine for the rest of your life. Only one healthy kidney is required to replace two failed ones. This makes it possible for a living person to donate one of their kidneys to a patient with ESRD.
Kidney transplants are required for people who have kidney failure - that is, the kidneys have lost 90% of their ability to function. Various diseases and conditions can cause kidney failure. In India, nearly 60% chronic kidney disease and ESRD cases are attributed to complications from lifestyle diseases like diabetes and hypertension. The major reasons for kidney failure are:
A kidney transplant is a serious surgery, and as with any major surgery, there are several risks associated with this procedure. These risks include:
However, despite these risks, kidney transplantation may be the best treatment option for a person with chronic kidney disease or end-stage renal disease. After the procedure, one may have to take anti-rejection medication for the rest of your life. These medicines also come with several risks and side-effects, such as thinning of bones, high cholesterol, hypertension, hair loss or excessive hair growth on the body, weight gain, skin problems like acne, infection, and even increased risk of lymphoma and skin cancer.
A kidney transplant can be done if a suitable match is found from a live or a cadaveric donor. The kidney transplant procedure is done with the patient under general anaesthesia. The team of surgeons, nurses, and anaesthetists monitors the patient’s blood oxygen level, blood pressure, and heart rate continuously during the procedure. The actual renal transplant procedure is as follows:
After the surgery, the patient has to stay in the hospital for some time. They will also need several check-ups as they recover, and may have to take medications like immunosuppressants and antibiotics for the rest of their life.
A person with ESRD qualifies for a kidney transplant. However, there are some requirements and criteria that a person must meet to qualify:
The doctor will assess and evaluate in order to determine if a person will make a good candidate for a successful kidney transplant. People at advanced ages, who have mental illness, and people who are alcoholics or drug addicts will not make good candidates for a transplant.
Finding a kidney transplant donor is the toughest part of the kidney transplantation process. There are two types of donors:
Living donor: Since humans can lead healthy lives with just one kidney, a family member or friend can choose to donate one kidney . Familial donors are a better option as they may be a better match and the body is less likely to reject the new kidney. India’s live kidney transplant program is the second- largest in the world, just after the United States.
Cadaveric donor: The kidney of a healthy person who has died in an accident is transplanted into the patient. In India, not many people choose to register as organ donors in the event of an accidental death. As a result, the number of kidney transplants in India via cadaveric donations is quite low. To help with this, the government amended the law in 2011 and introduced a ‘required request’, making it mandatory for intensive care doctors to request the family members to donate the deceased person’s organs in case of a brain death.
Finding a Match: Finding a donor means finding someone whose kidney will be a good match for the patient’s body. This means the donor will have to be tested for matching blood type. Incompatible blood type donations are possible, but the patients need additional medical treatment before and after the transplant. Also, the likelihood of the new kidney being rejected by the patient’s body is much higher in such cases.
Once a donor is found who matches the blood type, they will be tested for tissue typing. This means they will be tested for HLA (Human Leukocyte Antigen) typing. This test matches genetic markers that will increase the possibility that the transplanted kidney will function efficiently in the patient’s body. A good tissue type match means that the body will not reject the new kidney.
The final step in the donor matching process is a ‘crossmatch’. In this process, a tiny bit of the patient’s blood is mixed with the donor’s blood sample in a lab. The lab technician checks for antibodies reaction against antigens present in the donor’s blood. If they don’t react, it is called a negative crossmatch, and this means that the patient’s body will not reject the new kidney. A positive crossmatch means the risk of rejection is higher, and the patient needs extra medical treatment pre and post-transplant.
Recovery after a kidney transplant requires several days of hospital stay to ensure that the new kidney is functioning well and that the patient’s body is not rejecting the transplanted kidney.They may have to stay for 1-2 weeks in the hospital, even if they feel well enough to be discharged.
The new kidney may begin working immediately or take a few weeks before it starts to function properly. Kidneys donated by family members start working faster than ones donated by unrelated or cadaveric donors. Patients go through pain around the incision site as they begin healing.
They will also be on immunosuppressant medicines to stop the body from rejecting the new kidney. Instructions are given on aftercare and medication routine, which is needed to be followed strictly. The doctor will advise the level of physical activity that the body can withstand while it is recovering.
The donor’s diet needs to change after a kidney transplant to remain healthy. Thedoctor will specify what kind of foods to eat or avoid. The recommended diet and nutrition instructions may include:
Once the patient has recovered, they need to make moderate exercise a part of daily routine to ensure they stay healthy and that the new kidney functions properly. Activities like walking, jogging, swimming etc. can become a part of their lifestyle after the transplant. However, the doctor must be consulted before starting exercises post-transplant.
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