The kidney transplantation was done 40 years ago and since then a large number of renal transplants have been done. There have been remarkable improvements in the immunosuppressive agents. These are used to prevent the kidney from being rejected.

What are the different types of the kidney transplantations?

Living related kidney transplantations. Here the kidney donor is either the patients brother, sister, father or mother.

Living unrelated kidney transplantations. In this case the donor is either the patients spouse, friend or member of the community who donates for altroestic reasons.

Cadeveric donors. The kidney is obtained from a person who is brain dead. It is important to note that the heart is beating but the brain stem function does not exist.

Non–heart beating donors. In this the organ is retrieved after the heart is stopped beating. In most western countries cadeveric donation is the most predominant form of kidney transplantation. In lesser developed countries the predominant mode of kidney transplantations is from living related or unrelated donations.

What necessitated the passing of the Organ Donation Act in India?

The act was passed to curb the commercial purchase of kidneys. The situation was exploited by middlemen resulting in very little remuneration to the donor who was usually from a low socioeconomic status. In addition, there were instances when kidneys were removed from patients without their knowledge. The act also defined the criteria for brain death in order to encourage cadaveric donation.

What is the importance of the blood group in kidney transplant?

Matching of the blood groups is an absolute pre–requisite for kidney transplantation. The following guidelines are used. However the following matches are also feasible.

Donor	Blood Group Donate to
A	A, AB
B	B, AB
AB	AB
O	A, B, AB, O

The Rh typing of the blood need not be the same. For e.g: from a mother who is B (+) ve to a patient daughter who is B (–) ve.

What is the concept of kidney “Matching” in kidney transplantation?

In addition to the blood group HLA matching is done. HLA (Human Leukocyte Antigens) are proteins present on white blood cells that are the products of closely linked genes on chromosomes no 6. There are more than 100 such identifiably proteins. They are divided into different classes A, B, C and D and DR. For each of these subgroups the matching is done.

Can a kidney be transplanted if there is not a single match?

This situation does arise. It is called “Zero” match. Transplant surgeons weigh the merits of the necessity and make the decision.