Kidney Transplantation has become the most accepted mode of treatment for patients with terminal Chronic Kidney Disease (CKD) throughout the world as the quality of life and longevity is much better as compared to long term dialysis. Since the first successful human kidney transplantation between two identical twin donor recipient pair in USA in 1958 thousands of patients underwent this procedure with an excellent outcome. The programme was started at few centers across India in '70s and presently more than 4000 such operations are carried out every year in the country. Though more than 100,000 terminal kidney failure patient need kidney transplantation every year in India the number of transplant performed are very few. Besides the cost of such treatment lack of human organ for transplantation is the biggest hurdle to provide this treatment to every needy patient. Shortage of human organ for transplantation is a global problem and even in most developed countries where 80 percent of the organ transplanted are from cadaver donors, the average waiting period for a cadaver transplantation is about five years. In India more than 95 percent of the transplanted kidneys are from living donor and remaining from cadaver donors as awareness about organ donation after death is very low in general population. The government is also making effort to create awareness about organ donation and thus increase the number of cadaver donors in the country and in coming years we may start seeing the results.

In kidney transplantation, one kidney from another human being (whether living person or cadaver) is implanted into the patient's body by a sophisticated surgical technique. The new kidney works like patient's own kidney and most of the time they start producing urine immediately after transplantation. Within a reasonable period of time (normally less than a week) the Urea, Creatinine level return to normal and the patient experience a tremendous feeling of well being and start eating normal diet with virtually no food restriction. All patients are immediately put on immunosuppressive drugs to prevent rejection of the transplanted kidney. During first 48 - 72 hrs patient are kept under close observation and they are regularly monitored for blood pressure, temperature, pulse, urine output etc. and blood and other investigations are done at frequent intervals to monitor the progress. Normally the donor is discharged after 5-6 days of surgery and the recipient 10-12 days after surgery and they are monitored regularly on outpatient basis. During the operation some tubes are left in the operated area and they will be removed by the surgical team at an appropriate time. An urinary catheter is kept in the bladder for about a week to closely monitor the urine output.

• Discuss with the local Doctor/ Nephrologists regarding feasibility of a Kidney Transplant Operation in patients with CKD. Though age is not an important factor, underlying general health and cardiac (Heart) condition is quite important.
• If the patient is a fit candidate for kidney transplantation and have decided for the same start looking for a voluntary kidney donor within the family. As per the Human Organ Transplant Act only close family members/ first degree relatives (father, mother, brother, sister, son, daughter, husband and wife) can be a kidney donor. Have a meeting with the family members and try to find out a suitable/ voluntary donor of the same blood group. Please remember that patient with blood group AB can receive organ from donor with any blood group like AB, A, B or O (Universal recipient) whereas patient with O blood group can receive organ only from O donors. However, O group donor can donate organ to persons with any blood group (Universal donor). Check the blood group of the patient and the prospective donor and see that they are matching. If the donor is less than 18 yrs and more than 60yrs old he/she should not be considered for organ donation. However, upper age limit is flexible as per the health of the donor. He/she also should not be suffering from any chronic or serious disease like hypertension, diabetes, cancer, heart disease etc. The treating doctor would be in a position to guide properly regarding selection of the kidney donor. If there are several donors in the family who are willing to donate organ for the patient please let the doctor know about this so that he can select the best donors out of them. The doctor would also guide you in investigating the donor to assess his/her suitability for organ donation.
• If the patient is already put on dialysis, he/ she should remain under regular dialysis treatment by the time the donor is being investigated. The treating doctor would also assess the health condition of the patient and find out his/her suitability for undergoing a renal transplant operation. During this period the patient is fully investigated to rule out any underlying associated problem and if found would be treated to make the patient fit for the surgery. In diabetic patients it may be necessary to conduct a coronary angiogram test to rule out any coronary artery disease. If found positive the treating cardiologist would decide about the line of treatment. Some of them may need either coronary angioplasty/ stenting or coronary artery bypass surgery and in such event the transplant surgery may be delayed by few weeks to few months
• Though the doctor would never question the relationship between the donor and the patient as mentioned by the patient or the family, as per the law he has the responsibility to prove the same by medical means (by performing HLA typing/ DNA typing test). It is very important to co-operate with the medical team in this regard. As medically it may be difficult to prove the relationship between husband and wife, they should provide all documentary evidence as a proof for the same. It is always helpful to carry documentary proof of relationship between any donor and recipient including photo ID (passport copy, ration card, election card, PAN card, Driving license, marriage registration certificate, school/ college certificate etc) as a proof of relationship between the donor recipient pair.
• Normally patient is admitted at the hospital about 48 hours before the surgery and the donor is admitted about 24 hrs earlier. Immunosuppressive drugs (drugs to prevent rejection of the transplanted organ) are normally started 48 hrs before the surgery and they have to be continued indefinitely under medical supervision. The surgery for removal of kidney (Nephrectomy) and transplantation are both performed under general anesthesia and the duration of surgery varies from 3 - 6 hrs. In majority of the cases the transplanted kidney start functioning immediately, which is manifested by very good urine output. At times the transplanted kidney may take sometime to start functioning and during this time few sittings of hemodialysis may be necessary to tide over the crisis.
• It may take about 10 days to fully investigate the donor and the recipient before they are declared fit to undergo transplant surgery. The donor can leave the hospital within 5 days and the recipient between 10-15 days after the surgery. If the transplant is performed at a distant hospital, the donor can come back to his home town after about 15 days of surgery. However, the recipient need to stay at the transplant centre (outside the hospital) for about two months after the surgery and subsequently he can come back to the native place and remain under the follow-up of the local doctors.
• There are many surgical and medical complications which may develop in the post transplant period and the treating surgeon/ physician keep a close watch on them. It is very important to inform the doctor about any symptom you may develop in the post transplant period and most important being sudden drop in urine output, fever, swelling of the body, cough, and pain at the operated areas.
• The Human Organ Transplantation Act (HOTA) was enacted by the Indian parliament in 1994 to regulate the activities of organ transplantation in the country and subsequently the same bill has been accepted by most of the states with minor modifications by some. The main purpose of the act has been to stop unethical practice in organ transplantation and promote cadaver donor organ transplantation. Patients with first degree related donor (parents, siblings, children, spouse) can undergo the transplantation at any recognized hospital in the country directly, whereas patients with any other organ donor needs prior approval of the authorization committee formed by the state government. A patient undergoing the surgery at any other state outside the home state without the first degree related donor needs approval of the authorization committee of the home state as well the state committee where the surgery would be performed.