Renal Transplantation

Who a transplant is for

Transplantation is considered for people whose kidney function has fallen to the point where dialysis is needed or is approaching. Chronic kidney disease from diabetes, high blood pressure, glomerular disease and polycystic kidney disease accounts for most of it.

A transplant can be done before dialysis has started where a donor is available, and doing so generally leads to better outcomes than transplanting after years on dialysis. That is a strong argument for referral early rather than once dialysis is well established.

Where the kidney comes from

Living donor

A kidney donated by a healthy living person, in India most commonly a near relative or spouse. Living donor kidneys generally function sooner and last longer, and the operation can be scheduled rather than waited for. Donors are assessed thoroughly in their own right, and their long term safety governs whether donation proceeds.

Deceased donor

A kidney from someone who has died and whose family has consented to donation. Allocation runs through the official waiting list, so timing cannot be planned in advance.

The assessment before transplant

Both recipient and donor go through a detailed workup, and it is deliberately thorough because the aim is a transplant that lasts.

For the recipient this covers blood group and tissue matching, a crossmatch against the donor, screening for infection, cardiac and general fitness for surgery, and a urological assessment of the bladder and lower urinary tract. That last part is easy to overlook and matters a great deal, since a new kidney draining into a bladder that does not empty properly is a problem waiting to happen. For the donor it covers kidney function, anatomy of the blood vessels, and confirmation that living with one kidney is safe for them.

The operation

The new kidney is placed low in the abdomen, in the iliac fossa, rather than where the original kidneys sit. Its artery and vein are joined to the vessels supplying the leg, and its ureter is joined directly to the bladder, usually over a temporary stent.

The original kidneys are almost always left in place, since removing them adds risk without adding benefit in most cases. In good circumstances a living donor kidney starts producing urine on the operating table.

Recovery and life afterwards

The hospital stay after transplantation is usually one to two weeks, with close monitoring of kidney function, fluid balance and drug levels. The temporary stent is removed a few weeks later.

Immunosuppressant medication is taken from the day of the transplant and continues for as long as the kidney is working. Taking it exactly as prescribed is the single most important thing a transplant recipient does, since missed doses are a common route to rejection. These drugs also raise the risk of infection and, over years, of certain cancers, which is why follow up continues lifelong. Most recipients return to work, travel and normal daily life, and many describe the difference from dialysis as considerable.

Being realistic about it

A transplant is a treatment for kidney failure rather than a cure for it. Transplanted kidneys have a finite working life, and some people need dialysis again or a second transplant later.

Even so, for most suitable candidates it remains the best available option in both survival and quality of life. What can genuinely be promised is a thorough assessment, a clear explanation of the risks alongside the benefits, and honest answers about what is and is not likely in a particular situation.