Kidneys are fist-sized, bean-shaped organs located on either side of the spine which are indispensable for the proper functioning of the human body. They perform the critical function of regulating the body’s salt, potassium and acid levels, and expelling the wastes and excess fluids from the body in the form of urine.
Kidney Transplantation is a treatment of last resort, opted for when the existing kidneys are incapable of functioning properly. It is a surgery which involves placing a healthy kidney from a living or deceased donor in the recipient’s body. The artery and vein from the donor kidney is connected to those of the recipient, and the ureter of the donor kidney is connected to the recipient’s bladder to enable the flow of urine. The new kidney may or may not start working immediately after the transplant. In the latter case, dialysis is needed to carry out the kidney’s functions in the interim period, till the new kidney starts working normally. According to Dr. H Sudarshan Ballal, Chairman and Nephrologist at Manipal Hospital, in order to be eligible for donating a kidney, the donor should have been healthy enough with no major complications such as diabetes. Kidney transplants have a high success rate and so is the most recommended treatment prescribed for kidney diseases, provided of course, there is a match between the donor and the recipient.
Kidneys can be donated by either a living or a deceased donor. The living donor might be a blood relative or a complete stranger. Dr. Ballal opines that the kidneys from a living donor is more durable, starts functioning sooner in the recipient’s body and results in fewer complications post-surgery. If the donor is deceased, the recipient will be placed on a waiting list. In the interim period, regular check-ups and dialysis will need to be carried out to prevent the worsening of the condition.
Once it is determined that kidney transplantation must be carried out, there is a series of steps that are followed:
Some medical tests such as blood tests, heart tests, breathing tests and, in some cases, even urine tests are carried out to ascertain the compatibility of the blood and tissue types, check for the presence of viruses such as HIV, and determine the condition of the heart and lungs and to screen for drugs.
The transplant coordinator is the patient’s point of contact and educates him/her about the process and the precautions to be taken before and after the treatment.
The surgeon discusses the feasibility, benefits, potential risks and complications of the transplant and performs the actual procedure of placing the kidney in the body.
A nephrologist or a kidney doctor performs the physical examination of the patient and oversees his/her condition after the surgery.
A social worker helps the recipient follow a treatment plan and provides social support to the person such as helping out with finding employment, accommodation etc.
A dietician ensures that the patient receives adequate nutrition before and after the transplant.
Usually, a person who has just undergone kidney transplantation will need to stay in the hospital for several days to ensure complete recovery from the surgery. Since our body’s immune system is programmed to attack and destroy any foreign body, the patient must take immunosuppressants to tone down the effects of the immune system and facilitate gradual acceptance of the new kidney by the host body. The patient also needs to be aware of the medicines to be taken and the dietary restrictions to be followed after the surgery for the required time period. The immunosuppressants may have certain side effects such as weight gain, weakened immune system, cataracts, diabetes etc. and constant monitoring is required to monitor the kidney function and medical condition of the individual.
There are also certain risks that need to be factored in post-surgery. Due to the intake of immunosuppressants, there is an increased risk of infection as the immune system becomes slightly less effective. The anti-rejection drugs may increase the risk of cancer such as skin cancer and cervical cancer. In some cases, the new kidney might start working after some delay, ranging from a couple of days to a few weeks. In such scenarios, dialysis is needed to keep the body going till the time the new kidney starts functioning normally. There are also chances of recurrence of kidney diseases. Due to the medications being taken by the recipient, there might be incidences of stress and psychological and social problems among the receiver and his/her family members.
Notwithstanding the risks involved, Dr. Sudarshan Ballal says that kidney transplantation is often the best option for kidney diseases. Some of the benefits include a longer and better quality of life as compared to those who rely on dialysis as this is a permanent solution to the problem. The short-term and long-term advantages far outweigh the risks involved. Therefore, transplantation is and must be the most preferred option, provided there is a certain degree of match, for any serious complications related to the kidneys.
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