Do you know few things related to Kidney transplant? A question answered

Feb 16, 2010

Organ transplant is one of the most advanced forms of modern medical service and enormously improved the survival rate of otherwise hopeless lots of patients.

Reader's question :

I have an urgent question mainly to you - posting in this forum so that others also may share their views.

One of my relative from Pecharthal, Tripura has been suffering from Kidney ailments for last 3 years. He was first diagnosed in mid 2007 with a Creatinine reading of 2.9. They treated him under Baba Ramdeb's medication and yoga for last 2.5 years - recently the creatinine level shot up to 4.5. Now they are worried and lost trust on Yoga and medication.

Now the questions are :

1. Can they go for a direct Kidney Transplant now? I understand, before transplant patient undergoes dialysis as long as things are kept under control. But they want to do Kidney Transplant directly.

2. I understand, only family members can donate a Kidney. Any other pre-conditions?

3. Best place for performing the transplant and approximate cost?

4. Any possibilities of getting a discount anywhere -- if yes the procedure. He is a teacher in primary school.

I know I am throwing plethora of questions -- do not even know the relevance - pls let me know if any other aspects we need to consider here. Would be
really great if I can get some info -- I understand how busy you are.

-Srikumar

Doctor's answer :

Dear Srikumar,

Thank you for this rather important question of high educative value.

Organ transplant is one of the most advanced forms of modern medical service and enormously improved the survival rate of otherwise hopeless lots of patients. In pre-organ transplant era, a patient with an irreversible damage of any organ had no other option other than counting his days and that is very painful.

The earliest successful organ transplant was “Skin “ for burn patients.

The Transplant of Kidney was the next organ done with consistent success and the most widely done transplant these days.

Other Organs which are transplanted with wide success rate are Liver, and Heart.

Kidney Transplant

I will describe all the important aspects of a Kidney transplant through answering few questions which will automatically answer the questions raised.

Who needs a Kidney transplant?

Any patient with a kidney disease may not necessarily require or will require a Kidney Transplant. The chronic kidney ailment normally will be reflected with 1) increased Urea and Creatinine level 2) Intractable hypertension 3) Uncontrolled serum Potassium level 4) Reduced GFR (glomerula filtration Rate) < 30 coupled with gradually reduces general health conditions.

A patient of chronic renal disease with a serum creatinine level up 7 will normally be required medical treatment ( medications) by good nephrologists and should remain in constant watch. Haemo dialysis will require in much selected group of few out of them.

A patients with a serum Creatinine level > 7 will require haemodyalysis once or twice a week as per need to bring the level below 7. Such patients will continue to do well and expected to be managed as such. They may not require a transplant.

How ever if the need for dialysis become more frequent twice a week on a regular basis, to maintain a serum creatinine below 7 or 8 // or the GFR become below 10—an indication of a trans plant is made
In other word A patient should earn a transplant by virtue of being completely Dialysis Dependant.
A patient with a creatinine increased from 2.9 to 4.5 in 3years is a patient of CRF and deserve only a medical treatment . He does not earn a transplant

Why not do a transplant directly?

Organ Transplant for all purposes is guided by strict regulation under a specific Clause.

The reasons being the presence of large scale business driven scandals. Presently the Transplant is controlled by an empowered body called Transplant committee present in every state and major transplant centers. Headed by doctors/lawyers /lawmakers.

Everything related to Transplant is defined in law and implemented by this committee like 1) Donors definition/type 2) Recipients definition etc

Any organ transplant is a hazardous surgery even in the best of the centers and hands
Certain Mortality ( death) 5-10% is always there. Long morbidity is a rule
Maintaining a transplant involves costly medication like Azathioprine/steroids/other immuno suppressants etc. long years, even life long, and many has very dangerous side effects.

There is at least 5-10% rejection of graft in case of identical wel matched donation. It is unto 20 % in less or unmatched donations.

So until body function goes well - No Transplant
No Transplant in anticipation of a complete Renal Failure at a later date.
Wait for optimum time.
Beware of unethical touts roaming around.

Who can donate?

1. Blood relative ----Siblings –brother/sister/parents children. They carry at least 50 % of the characters.
The best one where HLA tissue typing matches and blood group is similar. Success rate—90-95%. Wife is included in this group on compassionate ground. Uncle Aunts are not included in this.

2. Unrelated distant relatives --- they need to be approved by the transplant committee. Success rate—up to 80 %.
3. Unrelated donor may be cleared on compassionate ground and with proof of close relationship
4. Cadaver—in case of patient with brain death .For such donor one has to register in the institution and wait for his turn and luck to get a cadaver donors.--- success 80 % The early the transplant taken the better is the result.

What are the factors affect the results and survival?

1) Recipients general condition—heart/liver function/Diabetes control status/etc
2) Type of donors ----Sibling with exact tissue match is the best.
3) Good tolerance of post transplant medications -- those cannot tolerate may end up with early rejection.

Where to get the surgery done?

1 ) It can be done at any place with a competent centre and personal at place.

Few places in Public sector with best results are PGIMER Chandigarh/ AIIMS Dehli.
In private there are countless of them in every city. Chandigarh has 4 private hospitals doing renal transplant.

What is the cost

PGI--- about 1-1.5 lac . But waiting period of about 3-6 months
Private ---3-4.5 lac
Medicines about RS 300-500/day for 10 years to life

For this particular case-of Srikumar’s relative--- NO TRANSPLANT NOW

Hope this gives a comprehensive idea about Renal Transplant. Should you require any thing more please feel free to ask

- Dr salil Saha

I had a practical experience

Thank you very much for such an informative article (wrote in replying to Srikumar's questions). I had a practical experience of assisting a patient from Kolkata whose family members stayed in my house. He got one kidney transplanted. The donor was his elder brother (such a nice gesture!!, I salute him). The operation was done under the leadership of Dr Shastri at Kamineni hospital at Hyderabad. They had lots of formalities to undergo including the legal part of it. However, the great news is: both are doing well even after four years of operation.

I'm sure we will regularly get similar types of information from you.

Regards.

Alternate treatment methodologies

Salilda, I remember what doctors told the patient ( I was there) in 2007 --they categorically told that this is non-curable (CKD) and in such cases the normal tendency is to fall for other alternate treaments - patient will fall for anyone who claims on TV or Newspaper that he can cure such disease 100% with his methods. Ayurveda and Yoga and also many quacks who administer "jori-buti-tabij-maduli- etc etc" ..probably faith play a bigger role--rationalism takes a back seat.

request you to pls enlighten us with your wisdom on this topic -- is Ayurveda and Yoga a good alternate medication? If yes -Is it proven with historical datapoint? If NO - how can we dissuade the patient family (few justifications) to fall prey to such things?

salil_spine's picture

Opinion is totally personal

Dear friend
I appreciate your feelings. Many a time’s rationality and scientific data base facts take a back seat .It happens when we run out of patience and funds. We look for unrealistically faster result and in cases not willing to accept an apparently unavoidable poor out come of a disease known for this. I really did not spend lots of time on things or items which did not need a relook.It are not healthy to comment on controversial tropics like the one you raised . My opinion should be taken as personal.
Most of them( Ayurvedic/Yoga etc ) has no much value or at the most have some aesthetic and placebo values. With the advent of new and much more dependable techniques of treatments in medical science, in the form of modern medicines, most olden method of treatments, jori-buti-tabij-maduli- etc have lost importance completely. But world is a wonderful place ,It has embraced every one in all ages , it has embraced Ram with Ravana ,It had Pandavas and Kauravas too , World had witnessed excess of every thing.
We can not blame the suffering patients always. While drowning you catch even the piece of straw expecting it to save you in spite of knowing that it’s not going to happen Every one try to practice things even if illegal and irrational for reasons best serves them. Only way to save our people from falling prey to them is though education, lots of public awareness programme and a high political focus on various health educational programme by using all available technology and media that we have. They need to be done on a continuous basis . Some day we will eradicate this darkness. Till that time what we can do is keep trying.
Doctor has rightly told that CKD is not curable. But with good treatment such patient still can go on living a quality life for many years.(I am unfortunately not a physician to provide you with more expertise)

With regards

Dr Salil Saha

Thanks Again Salilda

I could not browse the site yesterday. What you said makes a lot of sense and equipped with what you said - I will try to convince them and ask them to go back to proper medication.

Thanks Salil da, for such

Thanks Salil da, for such precise but simple narration. After going past with Srikumar's question, was wondering, there might be so much of medical nitty-gritty in your response but the reply was so generic. You perfectly managed those complexities and for Srikumar, the cloud of confusion is gone.

Thanks a Zillion Salilda

Amazing post Salilda. I got answer to all my queries and much more -- really amazing - not only from the info part but the english, flow of thoughts and level of details ..really great.