The concept of organ transplantation as a therapy for replacement of non-functioning organs began in India, originated in mythological medicine in the twelfth century B.C. Lord Ganesh, is popular in this part of the world, revered as a God of wisdom and vanquisher of obstacles, is an example of the very first xenograft performed by Lord Shiva using an elephant's head. This Aryan legend in the Rig Veda has been followed by several similar examples in many other civilizations round the world involving use of limbs, heart and the spirit.
         Over 1 million people worldwide are alive on dialysis or with a functioning graft. Incidence of end-stage renal disease [ESRD] has doubled in the last 15 years. In the USA, 30 million people suffer from ESRD and by 2010 >600 000 patients will require renal replacement therapy.
         The currently reported incidence of chronic renal failure in India is based on extrapolated data from the US. As yet, no large-scale population studies are available. In India approximately one in thousand people are suffering from end-stage renal disease. Uncontrolled Diabetes mellitus and hypertension account for the largest percentage of cases (76.2%) for the ESRD. Even the simple pain killer medicine taken for long time without doctor's advice can lead to ESRD.
         A Kidney transplantation is a procedure performed to replace nonfunctioning kidneys with a healthy kidney from another person. Kidney transplantation is the best way to treat kidney failure or the ESRD. The benefits of a successful Kidney transplantation are many. Most people find they have increased stamina and energy and can return to a more near normal lifestyle. Those who were dependent upon the dialysis can enjoy new found freedom.
How do family and friends know when it is time to consider donation?
         When a patient loses 90 to 95 percent of his or her kidney function, they are considered to have End Stage Renal Disease (ESRD). At this point, life-saving treatment becomes necessary. Treatment options for patients with ESRD are dialysis (where an artificial kidney machine removes waste from the blood) or a kidney transplant from a living or deceased donor.
         Sometimes, a patient with 85 percent loss of kidney function will undergo a transplant which allows them to avoid having to go on dialysis. Kidney patients and their families will discuss the best course of treatment with their doctors.
Who can be a donor?
         Donors need to be between the ages of 18 and early 70s and can include parents, children, siblings, other relatives, and friends. An ideal donor should have a genuine interest in donating and a compatible blood type with the recipient.
         Donors should be in good general health. Typically, someone who has high blood pressure (both treated and untreated), cancer, diabetes, kidney disease, heart disease, liver disease, sickle cell disease, HIV or hepatitis will not qualify to be a donor. However, these diseases are not all absolute contraindications to donation. Every donor will be considered on an individual basis.
Do some donors have trouble making the decision to donate?
         The decision to donate can vary from person to person. Some people make the decision instantly with few worries or concerns. Other people go through some soul-searching and will talk with close friends or family before deciding whether or not to donate. It is normal for some people to be afraid of donating a kidney as well as to experience guilt about not wanting to be a donor.
         Individuals should not, under any circumstances, feel pressured to donate. The only "right" decision is the one that makes the donor feel comfortable. Potential donors are encouraged to speak with the living donor team if they have any questions or concerns about their decision.
What is the first step to becoming a living donor?
         If you are interested in being a living donor, you should contact the Living Donor Kidney Program to request a questionnaire. Once the questionnaire has been completed it will be reviewed by a nurse / doctor coordinator to determine if you may proceed with initial blood testing.
         Once your blood type, antigen match, and cross match are known, the living donor nurse / doctor coordinator will discuss the results and the donation process with you and answer any questions so that you can make an informed decision about proceeding with donation. This conversation is strictly confidential and is not shared with the recipient. If the donor decides to continue with donation, they must then complete a comprehensive evaluation.
What does the donor evaluation include?
         We encourage all donor evaluations to be completed at the Vinayaka Mission Hi-Tech Hospital, Salem. The work-up can often be completed in 1-2 days, though additional testing may be required in some cases.
         You will complete a medical history and receive a physical examination, which includes a blood pressure check, to ensure that you don't have any concerning health conditions.
         A series of laboratory and X-ray tests, as well as an ECG, will be completed to screen for kidney function, liver function, hepatitis, heart disease, lung disease and past exposure to viral illness. Urine testing will also be done to make sure that your kidneys function normally. In addition, results from your routine annual health maintenance tests (e.g., pap smear, mammogram, colonoscopy, etc), as well as any necessary medical clearance for pre-existing conditions, will need to be submitted to the living donor team for review. Other tests may be necessary depending on the results of these studies.
         A CT angiogram (a computerized tomography, or CTA) scan will also be completed. During this scan, contrast is injected into the blood stream through a vein in your arm. The contrast travels to the kidneys and urinary tract while the CTA scan and X-rays are done. These tests help the transplant staff to determine if your urinary tract, kidneys, and the blood vessels leading to the kidneys are normal. These procedures are done in the hospital on an outpatient basis. The scan takes about an hour and does not affect your ability to drive a car. The scan must be completed at the Vinayaka Mission Hi-Tech Hospital, Salem to ensure quality of radiographic 3D construction of the kidney vessels.
         You will also meet with a transplant surgeon and complete a psychosocial evaluation with a psychologist.
         Once all results from the entire evaluation process are available, they will be reviewed by a multidisciplinary committee who decides whether you are able to safely proceed with the donation.
What is the health risks associated with being a donor?
         Your surgeon and nurse coordinator will discuss all health risks with you. The risks of donation are similar to those involved with any major surgery, such as bleeding and infection. Death resulting from kidney donation is extremely rare. Current research indicates that kidney donation does not change life expectancy or increase a person's risks of developing kidney disease or other health problems.
Will giving a kidney affect my lifestyle?
         A person can lead an active, normal life with only one kidney. Studies have shown that one kidney is sufficient to keep the body healthy. After recovering from surgery, a donor can work, drive, exercise and participate in sports, though contact sports are not recommended. A donor can continue in all types of occupations, including military duty. Also, being a donor does not impact a person's ability to have a child.
Will I have trouble keeping or getting insurance after the donation?
         A recent article that evaluated data on a donor's ability to obtain life, disability, or health insurance after surgery found that the majority of donors surveyed did not experience any problems. However, the article indicated that a small percentage of donors reported some difficulty with their insurability. All donors are encouraged to check with their insurance companies to verify their policy.
How do I prepare for surgery?
         Smokers must stop smoking at least one month prior to surgery and medications containing aspirin should not be taken for three days before the scheduled surgery. Women taking birth control pills are advised to stop taking them one month prior to surgery.
         A few days before the transplant, both you and your recipient will come to the hospital for pre-admission testing. You will meet with a nephrologist, transplant surgeon, anesthesiologist and a nurse practitioner in the hospital. You will be provided with specific instructions on how to prepare the night before surgery, such as not eating or drinking anything after midnight. The same day, you will have more lab work completed and will also meet with your nurse coordinator and social worker to review what to expect during your stay in the hospital and at discharge. You will also meet with the social worker earlier in the evaluation process who will help you to consider and prepare for emotional aspects of the donation experience.
What happens on the day of surgery?
         The staff starts an intravenous (IV) line where fluids are administered. You will meet with your transplant surgeon who will answer any remaining questions and will have you complete a consent form for the procedure.
         A patient escort will wheel you to the operating room when it is time for surgery. Shortly after arriving in the operating room, the anesthesiologist will give you sedation medicine through the IV. Once you are fast asleep, a breathing tube for general anesthesia is placed which connects to a breathing machine. This routine process assists patients with breathing during surgery. A urinary catheter is inserted into the bladder and then the surgery begins.
Following Surgery
What happens after the surgery?
         You will wake up in the recovery room feeling groggy and perhaps uncomfortable. A nurse closely monitors your vital signs and comfort level. Pain medicine will be given as requested. You will be wearing an oxygen mask and have a catheter draining urine from the bladder to a collecting bag in order to accurate measure the kidney's urine output. The catheter is usually left in overnight and removed at the bedside the next morning.
         You are encouraged to get out of bed as soon as possible - usually the night of surgery. Walking is expected the next day. It is common for donors to experience gas pain and bloating after surgery. Walking will help to expel the gas.
         You should be discharged from the hospital 4-5 days following the operation.
What should I expect during recovery at home?
         When you return home, your activities will be limited. You should not lift anything that weighs more that 20 lbs for the first four weeks. You may feel tired for the first week or two after the surgery and may need frequent naps. However, donors are encouraged to be active in between their periods of rest. Walking is considered excellent exercise during this time. You may also have some swelling around the incision area and should plan to wear loose, comfortable clothes.
         You will likely be able to return to work 2-3 weeks after the surgery, depending on the type of work. However some donors require a longer recovery period if their work requires heavy lifting or other physical demands.
What kind of follow-up is needed?
         You will have a post-operative appointment with your surgeon 1-2 weeks after the surgery. After donation, it is recommended that routine annual check-ups are completed with either your primary care physician or the transplant center.
What emotions do donors feel after the surgery?
         Most living donors say they feel great satisfaction with the donation experience because they have helped to improve another person's quality of life. Even in rare instances where the transplant is not successful, many donors say they feel positive about their decision because they did their very best to help a relative or friend. However, there is a small chance for donors to experience some negative or mixed feelings after the donation. These feelings have been more likely to occur in cases where the outcome of the surgery did not meet the expectations of the donor and/or recipient as well as in cases where the donor was unsure of his or her decision.