The kidney can come from one of the two donors
- A non–living donor (cadaver)
- A living donor (usually a close blood relative)
Registration kidney transplantation
Along with your name, address, other details should be entered in the transplant register. In case of cadaver (brain dead) donor the call could be made at any time, including at night.
- Diet and Fluids
The majority of dialysis patients follow strict dietary and fluid restrictions. Over indulgence of either could make you unfit for surgery.
Make sure that you are taking all your medications to combat the effects of kidney failure like blood pressure tablets, calcigard etc. This will keep you as physically fit as possible for treatment.
When you arrive at the Kidney Unit you will be seen and examined by the doctor. The doctor or the nurse will take several blood samples, including blood for the Cross Match Test. A series of tests will be carried out to make sure you are fit for the surgery, including a chest X–ray and a ECG.
A kidney transplant operation usually takes about 3 hours on a average. After the operation you will be usually shifted to a recovery room for observation for about half an hour. Then you are nursed in a cubicle in Intensive Care. An hourly output of your urine will normally be emptied via a tube called a ‘catheter’ into a bag.
After Kidney Transplant
In a majority of the Living Related kidney operations, the kidney will start functioning immediately after the operation. However, in case of the kidney coming from a dead donor, it sometimes will initially work sluggishly and may even take weeks to resume working normally.
After the operation you will have to take the prescribed tablets FOR THE REST OF YOUR LIFE. It has some side effects but they are rarely serious and they disappear within 3 to 6 months as the drug dose is reduced to maintenance level.
Many transplant patients experience rejection episodes at some stage, particularly in the first 4 weeks. Scans and ultrasound tests or biopsy on the kidney usually is able to diagnose the rejection or the malfunction of the kidney.
During the time you are in the hospital, you will spend time learning about the routines you must follow when you go home from the hospital.
It is the normal body response to a foreign organ. It is also part of the body's ability to defend itself against infection. The kidney transplanted in your body is also treated as a foreign body. Our body has antibodies which attack a transplanted kidney and cause rejection. Many transplant patients experience rejection episodes particularly in the first 4 weeks. It should however be stressed that a rejection does not mean failure.
Due to reduced immunity, patients may suffer from infection. An infection that is not triggered can lead to rejection.
Cadaver donor transplant planning
When it has been decided that a living donor transplant is not possible for someone who wishes to have a kidney transplant, then the process of obtaining for a cadaver kidney begins. A cadaver kidney is a kidney that comes from someone who has recently died and whose family has consented to kidney donation.
When a cadaver transplant is planned, the recipient may need dialysis while waiting for the transplant. The waiting time can vary from months to year, depending on various factors.
Matching Cadaver Kidneys to Recipients
Each time a kidney becomes available, its tissue type and blood type are matched for the best possible recipient. The goal is to obtain the best possible match between kidneys and recipients regardless of location. Blood samples will be drawn. Sometimes a final crossmatch must be done between your blood which is drawn when you come to the hospital and a blood sample sent along with the kidney. This final crossmatch, which takes several hours, must show that there is compatibility between your blood cells and the donor's cells.
The recipient should not have had any recent problems, infections, or blood transfusions.
When you get to the hospital, you will have a physical examination, electrocardiogram, chest x–ray, blood studies, and dialysis if needed. The examination, x–rays, and electrocardiogram are to determine that you are medically fit for the transplant surgery. Dialysis may be carried out so that your body chemistries are in good balance. A physician will visit you and will ask you to sign consent forms for the operation, the anesthesia, and for blood transfusions which may be needed during surgery.
While you are in the hospital, the transplant surgeons and nephrologist will both be taking care of you.
Usually you will not know the name of the donor of a cadaver kidney. The family of the donor will not be told your name by anyone in the transplant program. These rules are strictly enforced to maintained the privacy of both the donor family and the transplant recipient.
Two teams of doctors are used, one for the donor surgery and one for the transplant surgery. The kidney is removed from the donor and transplanted immediately into the recipient. Each operation usually takes about 2 to 4 hours. After the operation, the donor is taken to the recovery room until he/she awakens from the anesthesia. The donor has to stay in the hospital for 5 to 6 days after the operation. The first few days after the surgery, the donor will experience pain in the incision. Pain medication will be provided for relief. As the healing process takes place over the next several weeks, the degree of pain will decrease.
A foley catheter, a tube into the bladder, will be in place for a short while to monitor the function of the remaining kidney. Urine draining through the catheter may be bloody. The folly catheter is removed the day following surgery. Upon awakening after the surgery, the donor will have an intravenous (IV) line until able to eat and drink an adequate amount of fluid. Routine post–operative care will include
- Turning in bed every 2 hours,
- Deep breathing and coughing to lessen the chance of lung complications from the anesthesia (such as pneumonia and collapsed lung),
- Sitting up and walking around the hospital room as soon as possible to lessen any problems with circulation (such as blood clots in the legs).
After about 5–6 days, the donor can be discharged from the hospital for further recuperation at home. A post–operative visit to the clinic is usually scheduled for 1 – 2 weeks after discharge. Three to four weeks after surgery, most donors will be able to return to light work and by six weeks, return to normal activities.
The possibility of risk or complications is rare, but include the possibility of wound infection or reaction to the anesthetic. Death due to complications is rare.
Some Final Advice
A transplant is a precious gift which will give you a new lease of life. Under no circumstances should one stop one's ANTI–REJECTION TABLETS. One is more prone to infections. It is advised not to take episodes of fever lightly. It must be reported immediately to one's kidney specialist.
One of the actively involved doctors in our support group project is a well known Nephrologist Dr. Abhay N. Sadre.
To help us build and maintain a comprehensive support group, we need your input and help.
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