What Do I Need To Know About Kidney Transplantation?

ARE your kidneys OK? Millions of people around the world suffer from kidney diseases, and these patients will eventually need a form of kidney replacement therapy. Hemodialysis, peritoneal dialysis, and kidney transplantation save lives but with great costs, which are major issues in Western countries because they account for a significant proportion of healthcare expenditure. In Nigeria, due to the poor economy, 70% of the patients with end stage kidney failure are able to remain on hemodialysis for less than one month, 10% between three and six months, 5% between seven and 12 months, and only 1% remained on dialysis for more than 12 months. Simply put, majority simply die! Kidney transplantation is only recently available in the country, but still alien and highly unaffordable to most Nigerians. Sadly and surprisingly, the National Health Insurance Scheme does not include care of kidney disease patients!

Today, I shall discuss what you need to know about kidney transplantation. Happy reading! Kidney transplantation is the transfer of a normal kidney from the abdomen of a giver (‘Donor’) to the body of the person with a terminal kidney failure (‘Recipient’), usually within the lower part of the abdomen known as the ‘pelvis’. It is the least expensive (in the long run), and most effective treatment for end-stage kidney failure. It gives the patient freedom from dialysis, and it increases survival rate. It provides the best quality of life, adequate blood formation and bone strengthening of the recipient, without jeopardising the life of the ‘Donor’.

People who donate kidneys are able to live a normal life with one kidney.There are two types of kidney transplants: transplant from a living donor, and transplant from a person who died suddenly (“cadaveric donor” and “non-living donor”). The procedure is medically referred to as ‘isograft,’ if the transfer is between identical twins, while it is called an ‘allograft’, if it is between two related or unrelated individuals who are not genetically identical. It is not all patients with end-stage kidney failure that are eligible for the procedure; the specialist doctor will determine such eligible individual. The procedure can, and is currently been carried out successfully in three Federal University Teaching Hospitals in Nigeria and a private hospital in Lagos. There is a shortage of donors worldwide, and illegal ‘paid organ donation’ is common in some developing countries of the world.

Living related / unrelated donor
Living donor transplants tend to last longer than any other type of transplantation. This is usually because the organ is a better genetic match and because the transplant can be planned at the best time for both the donor and the recipient. In a living donor transplant, a kidney from a donor, usually a blood relative is transplanted into the recipient. A live related donor kidney comes from the patient’s blood relation such as a parent, brother, sister, or an adult child. In such a case, there is a far less chance of failure of the procedure (‘rejection’) and the recipient will not have to take as much medicine(s) after the procedure.

A living unrelated donor comes from someone who is not related to the person, like a spouse or a friend. The donor must be willing to give his or her kidney for love and affection without pressure from anyone. Potential donors must come forward on their own accord. However, this is a big decision for most people. Potential donors are usually carefully tested before they can donate a kidney. This is to determine if they are healthy enough to donate a kidney, and to see if the transplant is likely to work.

Transplantation involving a non-living donor
A non-living ‘cadaveric’ donor kidney is one that comes from a person who has just died. The person must have given permission before death or the family of this person must give permission to take the kidney(s), and possibly other organs, to be donated to someone who needs a transplant.

What is involved in transplant surgery?
Compatibility test is the most important factor in determining whether the donor will accept or reject a donated kidney. To make sure that the recipient’s body has the best chance of accepting the new kidney, several tests are usually performed. In any type of transplant, the blood group of the donor must be compatible with the blood group of the recipient. If the donor’s blood group is compatible with the recipient’s, a second blood test called tissue typing is done. This test will determine if the donor and recipient have the genetic similarities to ensure the greatest chance of a successful transplant.

Before any transplant, some of the recipient’s blood and some of the donor’s blood are mixed together. This is called a cross match and is done to make sure there are no substances that may cause the donor’s body to reject the transplanted kidney.

(To be continued)