Living with One Kidney (Kidney Transplantation)

Two functional kidneys are health assists that most people don’t realize they have. Donating one could mean giving a new lease of life to a patient. The treatment for End Stage Renal Disease (ESRD) is either dialysis or transplantation.

Transplantation is definitely the preferred option in the treatment of ESRD, as the overall quality of life and longevity is better after a kidney transplant. Even the overall cost works out to be cheaper after a transplant, in the long run.

The process of transferring a functioning kidney from a person (donor) to another person whose kidneys are irreversibly damaged (recipient) is called renal transplantation.

In our country, about 5,000-5,000renal transplants are done annually, and in most of the cases, the donor is a living person.

Kidney Transplantation:

Living vs. Cadaveric kidney Transplant

When the donor is a living person, it is called live renal transplantation. When the kidneys are taken from a dead person (certified brain dead by doctors in ICU), the process is called cadaveric renal transplantation.

The outcome of live donor kidney transplantation is better as it is a planned surgery, with the donor being properly matched and worked up for surgery.

Further, the donor kidney is retrieved in the same hospital as the recipient, during transportation of organs between the donor and recipient hospitals.

The longer the delay in transplanting the kidneys, the worse the outcome. Generally, the kidneys are unfit for transplantation after 24 hour of retrieval.

Kidney Transplantation

Who Can Donate?

• Should have two kidneys with normal functions – no protein leak in the urine and no severe infections in the genitourinary tract.

• No diabetes, poorly controlled hypertension, significant heart or lung disease, multiple kidney stones, cancer or any congenital disease involving the kidneys.

• No viral infections – HbsAg, HIV, HCV.

• Should have a negative lymphocyte cross match with the recipient.

• Should have a compatible blood group with the recipient. Please note the Rh factor is not considered in patients of renal transplantation. Moreover, transplantation across blood groups is possible now but the cost is much higher and is done in only few select centers.

• Should be between 18-60 years. However, donor above 25 years of age is preferred, so that the donor is more mature and able to give an informed consent.

• Should be mentally fit and willing to donate the kidney. Donation should be altruistic.

Donor Nephrectomy:

Surgical removal of kidney for transplantation into the recipient is called donor nephrectomy. There are two types:

Open Donor Nephrectomy:

• The traditional approach, in which a loin incision is given and the area exposed by retracting the ribs. This type of surgery allows and adequate exposure of the kidneys, proper mobilization and ligation of the blood vessels and the ureters, resulting in good kidney function in the post-operative period.

• However, the post-operative recovery time is more, pain medication requirement is more and the time to resume normal work is delayed as compared to laparoscopic donor Nephrectomy.

Laparoscopic Donor Nephrectomy:

• The operative time for lap donor Nephrectomies is less as compared to the open procedure, making it a more preferred option. Donor can be discharged very early in the post-up period and returns back to almost normal schedule by about three weeks.

• However, laparoscopic donor nephrectomy needs a higher degree of skill on the part of the surgeon.

• There is no doubt that laparoscopic live donor nephrectomy has reduced the fear amongst donors and has encouraged the process of voluntary kidney donation.

Also Read: Foods and Diet for Chronic Kidney Disease

Risk Factors:

• Generally Donor Nephrectomy is a safe procedure. Mortality is estimated to be around 0.02 per cent and obese patients are the ones mainly at risk.

• Both open donor Nephrectomies and lap-donor Nephrectomies have similar complication rates, as far as the major complications are concerned.

• Slightly higher risk of hypertension in the donors as compared to age matched general population.

Do’s and Don’ts for Donors:

• Which kidney is preferred for kidney donation? Left kidney is preferred.

• What should I not do, and for how long? Do not lift heavy weights and no strenuous exercises for the first three months.

• When should I start light exercises? Light exercises, particularly walking, can be started after two weeks of surgery when stitches have been removed.

• Can I climb stairs? Yes you can, do it gently after you are discharged from hospital.

• When can I go back to work? Light work, like that in an office, can be started after 3 weeks. Consult your doctor.

• Can I have normal conjugal life? Yes, you can, after the initial period of rest and after discussing with your doctor.

• Can I father a child? Yes, there is no problem for males as sperm production is absolutely normal.

• Can I conceive and bear children? Yes, women can bear children normally after the rest period specified by the doctor.

SOURCE: B-Positive Health Magazine

Leave a Reply

Your email address will not be published. Required fields are marked *