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What is Kidney Transplantation? Kidney transplantation involves taking of a healthy kidney from a healthy person (donor) and putting it surgically in the body of other person (recipient) whose kidneys have failed completely. Transplanted kidney can work in new environment (in recipient body) for a long time. Kidney failure patient can expect near normal life with successful transplantation. Quality of life is far better with successful transplant than with life on long term dialysis. Only word of caution is that even transplant patient needs close medical follow up initially and has to take life long medicine to prevent rejection of transplanted kidney. Who is eligible for Transplantation? Generally patients who are in the age group of 5 to 65 years and who are free of other serious illness are good candidates for transplantation. Individual cases can be decided by the Nephrologist. What are the sources of kidneys? There are two sources:
Live Donors Living related donor are accepted only if they are WILLING, healthy and has compatible blood group and good tissue matching. (It is not absolutely essential to have compatible blood group as now a days we can do renal transplantation even when 'ABO' Blood group is not matching). Who is eligible to donate the kidney? Only family members with very sound health, matching blood group and good tissue type can act a donor. It is our principle not to save one life at the cost of other and so donor is thoroughly evaluated and is accepted only if all his/her reports are normal. Male can act as a kidney donor for female patient and female can act as a donor for male member. Tissue matching is done from blood examination only - 10 ML of blood is collected from the patient and the donor for this. Also cross matching is done and it should be negative before the donor is accepted. Siblings (brothers & sisters) are likely to have either 100% match, 50 % match or 0% match. Parents have 50% match with children. Distant relatives may have 50 % match. Cadaveric Donors Cadaveric donors from a person who has just died from non kidney related causes, such as car accidents. Advantages of a live related donor over cadaveric donors:
What is blood grouping? An Austrian doctor Kall Land Stainer discovered that blood of average human could be classified under one of the four groups namely, A, B, 0 & AB. These groups are based on certain protein molecules in the blood.
From the following table one can find who is eligible to donate the blood and one who can donate the blood to recipient is also eligible to donate the kidney.
Life with one kidney Kidneys have great reserve capacity and that only two third of one kidney are needed to maintain the blood absolutely pure and to perform all the functions demanded of the kidneys. This means that a person can manage very well with one kidney and therefore any living person can donate one kidney to someone else and live normal life on the remaining one (Please refer views of kidney donors from the booklet "LIFE WITH ONE KIDNEY" published by this charitable trust). The HAZARDS of donating a kidney are two (RISK TO THE DONOR);
a) One is from the surgery itself. Removal of a kidney is a major operation under general anaesthesia and carries a risk of death ONE in THOUSAND.
As mentioned earlier, donor is fully evaluated - By physical examination, tests are conducted to see he/she has no diabetes, High blood pressure, Liver, Heart or kidney problems. He/she is accepted as a donor if all reports are normal. Post operating care for donor Donor is admitted to the hospital one day before surgery and has to stay for seven to ten days in the hospital. He has to undergo major surgical procedure. All we can say that risk to the donor is minimal (may be less than 0.5%) only. He/she may have pain for few days and is advised not to do any heavy work for three months after the surgery. Once this time period is over, they can resume normal work and has no restriction of any kind. Donor should be above 18 years and less than 65 years of age. What is tissue typing?
Each one of us has some chemicals on the surface of the cells of our body, which are called HLA (Human Leucocyte Associated) antigens. The closer the match of antigens between patient and donor the better the chance of a successful transplant. We inherit four of these from each parent, and thus have eight in all, and the combinations constitute our distinctive tissue type. Within the family parents and children match each other in half their HLA antigens. Among brothers/sisters 25% chance of a full match. 50% chance of a half match and 25% chance of No match.
An individual represented as AC would have 25% chance of a brother or sister also having inherited AC, and 50% chance of sharing either A or C with a sibling (AD and BC each). The individual BD would not match his/her brother or sister AC at all. Even with identical donor recipient pairs there is a tendency to reject the kidney because there must be other antigens of which medical science is yet unaware. However, the greater the member of shared HLA antigens, the less the tendency to rejection. The only people who do not reject transplants at all are identical twins. Since they are in every respect identical, they accept each others tissues as their own. In transplantation certain medicines are used to surpress the rejection reaction. Unfortunately, the same reaction is responsible for the defence of the body against infecting bacteria, fungi, viruses and parasites, so the immunosuppressed patient is prone to develop infections. The closer the tissue (HLA) matching the less is the dose of immunosuppressive needed and thus the less the risk of infection and of loss of life. At present the rate of success is 90 to 95% for full matching (all four HLA matching) 70 to 75% with 50% match and 30% for NO match at all. Cross Match
Just prior to the transplant blood is taken from donor and recipient & mixed to ensure no reaction, i.e. negative cross match.
 
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