Transplant over Dialysis.
The Better Option?
Kidney transplant is a better option, here’s why:
The recipient's life expectancy increases as compared patients on dialysis6
Patients have lower dietary restrictions4
They feel more energetic and positive, and their overall quality of life improves6
It is cost-effective in the long-term7
Two types of organ donation7
Living donor organ donation
As per law, an individual who is alive and decides to donate a kidney (or another organ) to a blood relative or emotionally-related person like a spouse, who needs a transplant
A living donor transplant has many advantages over a deceased donor kidney transplant-the most important being a significantly higher success rate8
Cadaveric organ donation
A person can donate multiple organs and tissues after death (brainstem or cardiac death). Their organs continue to live in another person's body, giving them a new chance at life.
Deceased donation is only possible if the family or the next of kin gives consent. It helps if the donor has signed an organ donor card and/or has informed the family about the decision beforehand8
How to go about organ donation?
To be eligible to donate your organ, the main provisions under the THO Act *
and the newly passed Gazette by the Government of India include:9
For living donation:
Relatives who can be living donors include mother, father, brothers, sisters, son, daughter and spouse. A recent Gazette also added grandparents to the list of relatives who can be living donors. These first relatives must have valid proof of their relationship with the recipient either by genetic testing or legal documents. If there are no first relatives, the donor and recipient must seek special permission from a government-appointed authorisation committee and appear for an interview with the authorities to explain their motive for donation, which may be purely out of affection or altruism.10, 11
Brain death and its declaration:
To be declared brain dead, there are two criteria/certifications required from doctors, 6 hours apart. Two of these have to be doctors nominated by the appropriate government authority, with one of the two being an expert in neurology.11
Regulation of transplant activities:
This can be achieved by forming an Authorization Committee (AC) and Appropriate Authority (AA) in each state and union territory.
*THOA: The Human Organ Act, 2014
But despite all these benefits, only, 12000 (fewer than 4% of the overall ESRD patients) kidney transplants happen in India. Some of the reasons for such a low number of transplants are a lack of awareness, taboos and misconceptions around it. Fewer people come forth to pledge their organs and only a fraction of them actually end up donating.15
Challenges associated with transplantation
Gifting an organ to another individual is one of the most noble things you can do, as it will not just transform lives but will also save lives.
There are quite a few challenges and myths associated with organ donation and transplantation though. Let's look at some of these.
Lack of awareness
Lack of awareness about organ donation has always been a significant barrier in India. Whether it is socioeconomic factors, language barriers, or education status, they are hindrances that affect organ donation and renal transplant.
Sociocultural factors
In several cultures worldwide, the dead are revered, and autopsies or cadaveric transplants are not preferred. While India has laws and policies to avoid the exploitation of organ donors, sociocultural factors prevent many people from signing up to become donors after death.
Lack of essential medical infrastructure & staff
To perform kidney transplant procedures, primary, secondary, and tertiary hospitals must have the required infrastructure and trained staff, which is not the case in most healthcare establishments in India.
Frequently asked questions about kidney transplantation
Who can donate?
A living donor can be a blood-related family member or emotionally-related person like a spouse, provided he/she is at least 18 years of age and has a good overall physical and mental health10,11.
What is the screening process for potential donors?12
a. Blood and Immunological compatibility with the recipient
b. Risk behaviours that may have exposed them to certain diseases
c. Past medical history
d. Relevant travel history
What is the process of kidney transplantation?
In living donations, surgeons typically remove a kidney of the donor using a minimally invasive laparoscopic procedure13, *
*all kidney retrieval is not done by lap method. There are many done by open method also.
Will the kidney transplant impact the donor’s or recipient’s life expectancy?
Living donation does not change life expectancy, and does not appear to increase the risk of kidney failure. In fact, people who have donated a kidney outlive the average person14
As for the recipient, they live longer than those who stay on dialysis. A living donor kidney functions, on average, 12 to 20 years, and a deceased donor kidney from 8 to 12 years.16, 17
How long will it take for both, the donor and the recipient, to recover and resume work?22, 23
Most donors only spend 1-4 nights in the hospital and can return to work in 2-3 weeks. The risk of complications from a donation is low, but as with any major surgery, there are risks involved. As for the recipients, they should be back home from the hospital within a week, post surgery. Most of them can return to work eight weeks or more after their transplant.
What precautions must be followed by the donor and the recipient post-surgery?18-21
Post surgery, donors as well as recipients are advised to:
a. Avoid driving for at least two weeks
b. Females should avoid pregnancy for at least 2 years
c. Avoid lifting heavy things for six weeks
d. Follow a healthy low-salt, low- fat diet
e. Drink plenty of water
f. Limit alcohol and caffeine intake
References:
1. https://pubmed.ncbi.nlm.nih.gov/35529086/
2. https://www.kidney.org/atoz/content/about-chronic-kidney-disease
3. https://www.organindia.org/kidney-diseases
5. https://www.kidney.org/atoz/content/dialysisinfo
6. https://www.nhs.uk/conditions/kidney-disease/treatment/
7. https://pubmed.ncbi.nlm.nih.gov/35232772/
8. https://www.organindia.org/overviews/know-organ-donation/
9. Thurlow JS, et al. Global Epidemiology of End-Stage Kidney Disease and Disparities in Kidney Replacement Therapy.
Am J Nephrol. 2021;52(2):98-107.
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779960/
11. https://notto.mohfw.gov.in/faqs.htm
12. https://www.kidney.org/transplantation/livingdonors/who-can-be-living-kidney-donor
13. https://www.kidney.org/transplantation/livingdonors/general-information-living-donation
14. https://www.kidney.org/transplantation/livingdonors/what-expect-after-donation
15. Data on file.
16. Benefits and Risks of Kidney Transplants. Available at: https://www.lahey.org/lhmc/department/transplantation/live-donor-kidney-transplant/pros-cons/.
As accessed on: 20/07/2023.
17. The Benefits of Kidney Transplant versus Dialysis. Available at: https://www.bidmc.org/centers-and-departments/transplant-institute/kidney-transplant#:~:text=On%20the%20other%20hand%2C%20patients,from%208%20to%2012%20years.
As accessed on: 21/08/2023.
18. Kidney Donation. Available at: https://my.clevelandclinic.org/health/articles/7457-kidney-donation.
As accessed on: 14/07/2023.
19. Living healthy after a transplant. Available at: https://www.kidneyfund.org/kidney-donation-and-transplant/life-after-transplant-rejection-prevention-and-healthy-tips/living-healthy-after-transplant.
As accessed on: 14/07/2023.
20. How To Live Healthy After A Kidney Transplant. Available at: https://www.medanta.org/patient-education-blog/how-to-live-healthy-after-a-kidney-transplant/.
As accessed on: 21/08/2023.
21. Post-transplant care. Available at: https://www.organindia.org/post-transplant-care-2/.
As accessed on: 21/08/2023
22. Larson DB, Jacobs C, Berglund D, Wiseman J, Garvey C, Gillingham K, Ibrahim HN, Matas AJ. Return to normal activities and work after living donor laparoscopic nephrectomy. Clin Transplant. 2017 Jan;31(1).
23. What to Expect After Donation. Available at: https://www.kidney.org/transplantation/livingdonors/what-expect-after-donation.
As accessed on: 28/07/2023.
Issued in public interest by : Sanofi healthcare India Pvt. Ltd.
MAT-IN-2301931-1.0-8/2023