Kidney transplant is said to be an effective treatment mode for people with stage 5 chronic kidney disease (CKD). It involves harvesting a healthy kidney from a matching (related or braindead) donor and transplanting it into a person battling CKD.
Both dialysis and kidney transplant offer what is known as kidney replacement therapy or KRT, says Dr Tanmay Pandya, director of nephrology and renal transplantations, Sarvodaya Hospitals, Faridabad, Haryana.
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Kidney transplantation is scientifically proven to be the best form of KRT, in terms of longevity, financial and social productivity of life in people, says Dr Manjusha Yadla, head of nephrology at Gandhi Medical College, Hyderabad.
“Also, a person undergoing dialysis is prone to being exposed to blood-borne infections like hepatitis B, hepatitis C and HIV,” adds Dr Upal Sengupta, a nephrologist at Fortis Hospitals, Kolkata.
This is why various tests are carried out before a kidney transplant.
Take the case of Celeste Reilly, 30, a childhood educator from Brisbane, Australia, who has a rare form of polycystic kidney disease. “I was on dialysis for over two years,” says Reilly. She underwent kidney transplant after her blood type matched with a deceased donor’s. Before transplant, she had to undergo many tests to screen for underlying conditions.
Also, Dr Pandya says, “People who know that they are going to require dialysis in future choose to undergo kidney transplantation before they reach the stage of dialysis, which is known as pre-emptive kidney transplant.”
How is a match for donor kidney found?
The two primary sources of donor kidneys are living donors and deceased or braindead donors, explains Dr Pandya, adding that the living donor and recipient must be close relatives — a grandparent, a parent, a spouse, a sibling, a child or a grandchild.
However, Dr Sankaran Sundar, director, Aster Institute of Renal Transplantation, Aster Whitefield, Bengaluru, says there is provision in law for unrelated donors to help their loved ones with a healthy kidney also. “It could be a friend, a close relative like a cousin, uncle, aunt, father-in-law, son-in-law, mother-in-law, mother-in-law,” he says. “In such cases, an approval has to be obtained by the organ donation authorisation committee at the government level. There must be no commercial transaction, and no sale of organ.”
Dr Pandya says the following checklist is adhered to for different types of kidney transplants:
1) Living-donor transplant
- The donor must be older than 18 and ideally younger than 65 years.
- The donor should be in good health and free of any chronic illnesses.
- Blood parameters are checked
- A person must pass screening tests before being approved as a donor.
2) Deceased/braindead donor/cadaveric kidney transplant
- Donor must have been declared brain dead following an accident or brain hemorrhage.
- The donor’s next of kin has to consent for organ donation after grief counselling. Then workup (evaluation) of donor kidney is done.
3) Kidney swap transplant or paired kidney transplant
In such cases, two families having a person with renal failure each have incompatible donors within the family, but exchange kidneys with a donor and recipient pair from the other family.
Screening tests done in the recipient
The screening tests depend on the age of the person. “In people above 60 years of age, their vulnerability to immunosuppressive drugs after the transplant puts them on a relatively cautious side of considering a transplant,” says Dr Yadla. “Some western countries consider [human leukocyte antigens or] HLA index (protein markers used to find matches for transplants) rather than age.”
In newborn children, the minimum weight must be considered, she adds.
Dr Yadla says that blood, radiological, immunological, microbiological investigations through blood test, urine test and X-rays are done to know the impact of CKD on other organs.
A kidney recipient also needs to undergo a series of other tests to ensure their other organs are intact.
In a living-donor transplant, the donor is a healthy volunteer who also goes through screening tests. “This is why strong clearances from each department are needed to understand the functioning of donor kidneys,” says Dr Yadla.
Waiting for a match
Those needing a cadaver-kidney transplant usually have to wait long periods before they get a match with a deceased donor, says Dr Yadla. “The waiting time in deceased-donor transplants is specific to an area’s rules of kidney transplantation,” she adds. “However, for a living-donor transplant, the waiting time depends on the time taken for the evaluation of donor kidney.”
Younger age groups are given more preference in the waitlist, while certain blood groups like AB might have to wait longer, according to Dr Yadla.
Not everybody can be a recipient
According to Dr Sengupta, not all CKD patients can undergo a kidney transplant. These include:
- People who are immunosuppressed due to another end-stage chronic illness like end-stage liver disease, heart disease (like coronary artery disease) or lung failure (like tuberculosis).
- Those who have an active malignancy or have recovered from cancer in last five years.
- People with peripheral vascular disease. Transplanted kidney should get attached to the blood vessels of the recipient, but these are damaged in people with peripheral vascular disease.
Plus, people on dialysis who have active hepatitis B & C infections are first evaluated by their nephrologist to see if they can go for a kidney transplant.
Transplants: The money angle
A kidney transplant can be expensive. While Reilly was lucky to receive financial relief from the Australian healthcare system, in India one can look for funding from area-specific private insurance schemes, government schemes and NGOs, says Dr Sengupta.
Takeaways
Dialysis and kidney transplant are both forms of kidney replacement therapy. However, experts consider kidney transplant as the best form of renal therapy since it offers the prospects of a better quality of life. Several tests such as a blood test and an echocardiogram have to be done before enlisting someone on the waitlist for kidney transplant.
