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Kidney Donation

Kidney Transplantation

This entry is part 4 of 6 in the series Dr Lisa

Kidney Transplantation

Kidney_TransplantationKidney Transplantation was started in 1902. Emery Ullman was the first person who performed this procedure on an animal. After that, various surgeons tried to apply the technology to humans, but the experiments couldn’t be completed successfully. Dr. Yuri Crow was the first surgeon who transplanted human kidney transplanted to another person from a dead donor but did so unsuccessfully. In 1954 he made his first successful attempt of kidney transplant surgery from a living donor to a patient. Since then, a new era of kidney transplantation has started and a lot of kidney transplants have since been performed all over the world. Special drugs have been developed that help a new kidney survive in the donor’s body and they are getting better all the time.
Why do we need Kidney Transplantation
Kidney transplant is the best treatment option for patients with end stage renal disease (in which complete renal shut down has occurred). Only renal replacement therapy in form of dialysis or kidney transplant can extend the life of these patients in the long term.
The organ is taken most of the time from a live person, usually a relative. A donor is not compatible if he/she has different blood group, very different age/weight and presence of the serious diseases. The patient should not be too old. Also very young children do not tend to have such operations.
Where can we carry out Such Operations
Different countries have their own centers where they can carry out these operations. Depending on the expertise and the quality of care provided, the success rate is different in different regions of the world. People usually turn to different countries with good surgical outcomes, best medical facilities and lower cost. Among them, the most popular countries are United States, Israel, Germany and even Pakistan because of the reasonable cost.
So kidney transplant in Germany costs about 110 thousand Euros.
Kidney from a Donor before Surgery
In the world there is an acute shortage of both the donors and the organs. Demand is more than the supply of organs. Not everyone can give his kidney without compromising his own health. The donors with other health issues can develop complications after donation.
After removing the kidney it is best to use it on the same day. In the longer term and for transport of the kidney, it is stored in a special solution at a temperature of 6 degrees. Its viability is for three days.
Few Medical Aspects
The new kidney is transplanted without removing the old diseased kidney. Right kidney is transplanted on the left side, and vice versa.
Once an organ has been secured for you – either from a living or deceased donor – you must begin preparing for surgery.
You should not eat or drink immediately prior to surgery unless cleared to do so by your Transplant Coordinator.
It is very important that you are healthy for your surgery. If you have a cold, flu or any other type of infection or sickness, your transplant surgery may need to be postponed. Once you arrive at the hospital, you will have a chest x-ray, electrocardiogram, urinalysis, and blood work done to assess your current health.
An anesthesiologist will discuss your anesthesia care with you. You may be asked to shower with a medicated soap. You will receive antibiotics intravenously (IV) just before you go to the operating room.
While you are being prepared for surgery, a team of surgeons are working to remove the organ from the donor. In most instances, the organ is found to be suitable and the transplant proceeds as scheduled. On average a kidney transplant takes approximately 8-12 hours.
On rare occasions the surgeon may find something that makes the organ unsuitable for transplant. In this case your operation will be postponed. While we understand this can be disappointing, it is critical that we obtain the best organ possible for you to avoid complications.
The transplant surgeon will notify your family when the procedure is completed. They may be able to see you for a few minutes immediately following the surgery.
The new kidney is not always easily accepted by the body. The doctors monitor the response of the body towards newly transplanted kidney. A patient takes powerful drugs to avoid failure of the new kidney. The kidney is gradually accepted by the body, but the risk of rejection of this kidney is always present.
The prognosis of renal transplant surgery is getting better gradually. Sometimes very serious consequences require a more rigorous treatment.
The patient is discharged after kidney transplantation after telling adequate restrictions and making sure that patient is compliant in every aspect. The doctors may restrict the amount of fat consumed (about 25%), carbohydrates (50%) and other substances. Patient is often discharged with a diet chart usually having several dietary options taking into account the patient’s dietary needs and restrictions.
This is a big question. The cost of Kidney Transplantation, including preliminary testing, the surgery itself and post-operative recovery costs vary country to country and depend on the hospital and level of care provided. These costs start to add up, even before transplant. The estimated cost of renal transplant in USA is around $262,900. Other countries like Singapore, UK, India and Pakistan have different costs. There are some centers which provide these services free of charge e.g. in Pakistan a center named Sindh Institute of Urology and Transplantation (SIUT) performed about 60,910 kidney transplant surgeries last year without any charge and the medicines after surgery are also provided free of cost for lifetime period.
Why the Original Diseased Kidney is not usually removed during kidney transplant?
In most cases, the diseased kidneys are not removed. There are three conditions that might require your diseased kidneys to be removed:
•    Repeated infection that could spread to the transplanted kidney
•    Uncontrollable hypertension caused by your original kidneys
•    Backup of urine into your kidneys (a condition called reflux)
This is because removal of kidney carries additional risk of bleeding and may complicate the renal transplant surgery. And also the diseased kidney may have some residual function left. If the surgeon remove the original kidney and you reject the new kidney as well, the prognosis becomes grave because you can’t live without a kidney.

Dr Lisa