The Department of Renal Transplant at Columbia Asia Hospitals offers both living donor and cadaveric transplant for those with end stage renal disease. The team of consultants is highly qualified and experienced, having trained in premier institutes across the globe.
The mission of the team is to provide state-of-the art services using evidence-based guidelines and international protocols, at an affordable cost. Transplantation along with comprehensive treatment for kidney diseases are being offered to patients under one roof.
Multi-disciplinary approach is the hallmark to manage successful renal transplantation. Apart from the acclaimed team of doctors, the hospital has the support of specially trained nurses, interventional radiologists, cardiologists, anesthesiologists, intensivists and others to manage the intricate care these patients require. A well-equipped, laboratory, radiology and imaging services and a contemporary transplant ICU complement the team.
What is Kidney Transplantation?
A kidney transplant is a surgical procedure in which a kidney is removed from one person (donor) and placed in the body of a person suffering from renal failure (recipient). The transplanted kidney can perform all the functions which the patient's own kidneys are not able to perform. The critical factor is: the patient and donor tissues should match. Donor kidney can be from a living donor or a cadaveric or brain dead donor.
Why is Kidney Transplantation Necessary?
When a person has 'RENAL FAILURE', the kidneys do not filter harmful waste products properly. As a result, excess wastes and chemicals begin to accumulate in the blood and can cause a condition called uremia. Patients with irreversible renal failure and end stage renal disease (ESRD) have two options of treatment:
- Dialysis, where the waste products from the blood are removed artificially by a machine
- Kidney transplantation, where a donor’s kidney is transplanted into the person suffering from renal failure.
- Chronic, uncontrolled high blood pressure
- Chronic glomerulonephritis, which is an inflammation and eventual scarring of the tiny filters within the kidney
- Polycystic kidney disease
If a person has the following:
- Active infections such as TB or bone infections, refractory to treatment
- Problems with taking medicines several times a day for the rest of one’s life
- Associated heart, lung or liver disease which is not treatable
- Other life threatening diseases
- Recent history of cancer, ongoing chemotherapy
- Infections such as hepatitis
- Untreatable psychiatric illnesses
Complications of surgery
Complications of anaesthesia though not common, may occur. Blood transfusion complications though rare may sometimes occur.
Complications of surgery itself, like:
- Infection of the wound and other systems in rare cases
- Hernia in the scar requiring major repair surgery
- Pneumothorax, a condition requiring insertion of a tube into the chest cavity.
- Acute allergy called anaphylaxis to antibiotics or painkillers leading to death in rare cases
- Any of the above complications may in rare cases, result in death.
To ensure continued well-being, the donor should attend mandatory follow-up as per the following schedule; a week after surgery, one month later, at six months, at one year and thereafter annually for life. The Transplantation of Human Organs Act 1994 specifies that it is the duty of the recipient to bring the kidney donor for mandatory follow-ups as advised.
Complications of surgery
Kidney transplantation is not without complications. Complications can not only affect the transplanted kidney (graft) but also the whole body in general.
Surgical complications involving the graft
- Wound infection
- Obstruction to flow of urine
- Fluid collection around the graft
- Clotting of blood vessels of the graft
- Urinary leak through the wound
Follow-up of the recipient after transplant
The recipient needs to come for follow-ups as per the following schedule; twice a week for 4 weeks, once a week for 3 months, once a fortnight for 6 months and once a month up to 2 years. Thereafter, once in 6 months for lifetime. These may be modified based on the patient needs by a nephrologist / transplant surgeon.
Medical complications involving the graft
- Hyper acute rejection: can occur in the operation theatre itself, in-spite of all mandated precautions
- Acute rejection: can occur from days to years after a successful transplant
- Chronic rejection: can occur several months to years after a successful transplant
Some of the above conditions may necessitate re-surgery once or several times to try to save the graft. Sometimes it may become necessary to do a graft biopsy or even to remove the graft to save the patient's life. The patient may then have to go back on dialysis and plan either a second transplant or a life on dialysis.
Complications involving the rest of the body, mainly due to medications prescribed post surgery like cyclosporine, azathioprine, steroids, ATG, ALG, rituximab and tacrolimus
- Infections like tuberculosis, pneumonia, brain infections, urinary infection, liver infections, etc. can occur. Some of these infections could be life threatening.
- Hypertension (high B.P.)
- Heart attack
- Cancer due to immunosuppressive drugs
- Loss of transplanted kidney due to BK virus infection
Salient Features Of The Transplantation Of Human Organs And Tissues Act,1994 And The Rules, 2014:
The transplantation of human organs and tissues in India is governed by the Transplantation of Human Organs and Tissues Act, 1994, (hereinafter referred to as “Act”) and the Transplantation of Human Organs and Tissues Rules 2014 (hereinafter referred to as “Rules”) framed thereunder and as amended from time to time.
- The definition of the term “near relative” means spouse, son, daughter, father, mother, brother, sister, grandfather, grandmother, grandson or granddaughter.
- Where any human organ, tissue or both is to be removed from the body of the person in the event of his brain stem death, such removal shall be approved by the board of medical experts in the manner prescribed by the Act and the Rules thereunder.
- An organ shall not be removed from the body of the donor before his death and transplanted into the recipient if they are not 'near relatives', unless they follow the procedures laid down under the Act and the Rules.
- All transplantation of human organs shall require prior approval from the Competent Authority / Hospital based Authorisation Committee / State Authorisation Committee. In the event of the donor and recipient being 'near relatives' and either of them is a foreign national, the approval of the State Authorisation Committee or Hospital based Authorisation Committee, (constituted as per the Act and Rules) is mandatory.
- The Act prescribes punishment for persons who are commercially dealing in human organs and also for removal of human organs without authority. There shall be no suit or other legal proceeding against any person for anything which is done in good faith in accordance with the provisions of the Act or corresponding Rules framed thereunder.
- The Hospital shall mandatorily have its Authorisation Committee duly constituted by the State Government, if such hospital is performing more than 25 transplants in a year.
- When the living donor is unrelated and if donor or recipient belongs to a State or Union territory, other than the State or Union territory where the transplantation is proposed to be undertaken, verification of residential status by Tehsildar or any other authorised officer for the purpose with a copy marked to the Appropriate Authority of the State or Union territory of domicile of donor or recipient for their information shall be required and in case of any doubt of organ trafficking, the Appropriate Authority of the State or Union territory of domicile or the Tehsildar or any other authorised officer shall inform police department for investigation and action as per the provisions of the Act.
- The documents for approval of transplantation would be processed by the Registered Medical Practitioner and administrative division of the Institution for transplantation while the approval will be granted by the competent authority / hospital based authorisation committee / State Authorisation Committee, as the case may be.
- The hospital performing kidney transplant will have to obtain and possess a valid license granted by the appropriate authority to perform such transplantations.
Transplant between unrelated donor and recipient
The Act and Rules permit transplantation between unrelated donor and recipient who do not fall under the category of near relative as defined under the Act. All other conditions as mentioned above shall remain the same as with a donation of an organ from a near relative.
This relates to transplantation of an organ received from a brain dead individual. Once brain death is established, the patient is kept on life support, till the decision to donate is taken. The statutory authority appointed by the government is informed. If the family is willing for the donation, informed consent will be obtained from the next of kin. The statutory authority appointed by the government shall confirm the patient's eligibility for the donation. Doctors approved by the statutory authority appointed by the government will perform a set of tests to certify brain stem death. The statutory authority appointed by the Government shall select the recipient based on the waiting list and tissue matching results.