Transplant Surgery

Renal Transplantation
End-stage renal disease cannot be treated with conventional medical treatments such as drugs. Only two treatments allow patients to continue living when their kidneys stop functioning: dialysis and kidney transplantation. People who require dialysis give up some degree of their freedom because of their dialysis schedule, fragile health, or both. Also dialysis can be tiring, cause fluctuations in blood pressure and patients are prone to certain infections even when great care is taken.

Kidney transplantation offers the best outcomes and the best quality of life for such patients with End Stage Renal Disease. Kidney transplantation means replacement of the failed kidneys with a working kidney from another person, called a donor. This is not a complete cure, although many people who receive a kidney transplant are able to live much as they did before their kidneys failed.

The renal transplantation unit at KMH has excellent results in this procedure, led by experienced surgeons and physicians trained both here and abroad. The team is well supported by other specialties and support staff within the hospital, allowing for excellent pre and post operative care required to maintain the highest standards possible for a good outcome following transplantation.

Live donors
In our practice, transplanted kidneys may come from living related donors or people who have died of other causes (cadaveric donors). A person who needs a kidney transplant (the recipient) can accept a kidney that comes only from a donor who matches certain of his or her characteristics. The more similar the donor is in these characteristics, the greater the chance of long-term success of the transplant. Potential live kidney donors also must be in good health and undergo a thorough medical evaluation, donor safety being of paramount importance. If a patient is considered eligible for a kidney transplant, every effort will be made to find a donor among his or her family members who are most likely to match. Transplants from a living related donor generally have the best results. We do not accept or encourage the use of unrelated living donors for transplantation.

Cadaveric donors
If no suitable donor can be found, the patient’s name will be added to a common waiting list,maintained by the government, for a cadaver donor kidney.Every new kidney that becomes available is tested and checked against this list to find the most perfect match. Recent developments in Tamil Nadu have made brain death declaration mandatory in the state run government hospitals and private hospitals are encouraged to do the same. This and other Government Orders have resulted in a surge of cadaveric organ donation activity. However there is a shortage of organs for transplantation, requiring patients to wait months to years before getting a transplant.

Paired Kidney Donor Exchange
When patients have near a relative willing for donation but are notsuitable for themselves due to, for example a blood group or a cross match incompatibility, kidneys can be exchanged between another donor and recipient pair in a similar situation and two compatible live donor transplants are possible. Patients willing for such a “donor swap” must present themselves before the State Government Authorization Committee to seek approval for the transplant. Paired kidney exchanges are not illegal and are in fact encouraged so as to deter illegitimate trade of organs in this country.

Generally speaking, it is difficult to arrange exchange transplants. A sizeable number donors and recipients need to be enrolled in the database for a better chance of identifying an exchange pair. Logistically, the center needs multiple operating rooms and teams of surgeons as all the participants must be readied for surgery at the same time.

Evaluation for surgery
The potential recipient must undergo a very detailed medical evaluation prior to kidney transplantation. This evaluation may take a few weeks and require several visits to the transplant center for tests and examinations. The purpose of this thorough evaluation is to test whether one would benefit from a transplant and can withstand the rigors of the surgery and antirejection medications and the adjustment to a new organ.

The medical team, which includes nephrologists, transplant surgeons, a transplant coordinator, a social worker, and others, will conduct a series of interviews with the donor (for live donor transplant), recipient and family members. They will be asked many questions about their medical and surgical history, medications taken and about habits and lifestyle. They would also want to make sure patients are mentally prepared for the procedure and afterwards. A complete physical examination will be performed. The recipient’s blood and tissue will be typed so that he or she can be matched to the donor kidney. This significantly lessens the chance of rejection. Other lab tests and imaging studies complete the evaluation of the donor and the recipient.

Surgery and post op
Every operation has risks, and it is the period after the surgery that is most critical. All transplant recipients require lifelong immunosuppressant medications to prevent their bodies from rejecting the new kidney.The drugs work by suppressing the immune system, which is programmed to reject anything “foreign,” such as a new organ. Like any medication, these drugs can have unpleasant side effects. People who receive a transplant must take their medication regularly and be monitored by a physician. Our medical team will watch very carefully to make sure that the recipient’s new kidney is functioning properly and that the body is not rejecting the kidney or developing other complications.