Kidney Transplant Treatment Cost in India

The functions of kidneys are essential for maintaining life and most people have two kidneys from birth. These are located on either side of the spine posterior to the organs in the abdominal cavity under the rib cage. The functions of kidneys are

• Removal of waste products from the blood and made to pass as urine.
• With the release of several hormones blood pressure is regulated by kidney
• Hormone erythropoietin is released which stimulates the production of red blood cells.

In kidney transplant procedure, one or both kidneys are replaced by kidneys from a living or deceased donor. In very rare circumstances the patient can receive 2 kidneys from a deceased donor. The diseased kidneys are left after transplant in place and the new kidneys are placed in the front side of the body in the lower abdomen. Question is why are diseased kidneys not removed? If they are not severely infected or enlarged they are not removed since simply 3 kidneys are better than having only 1.

• The living donor: family members or direct blood relatives including children aged 18 or above may wish to donate their kidney to the patient. Or even a friend who is ready to become a donor and has undergone a match test for donations can qualify for the kidney transplant. In fact any healthy person can be a kidney donor safely. They need to have the knowledge and should be in a position to give consent.
• Deceased donor:  any person who has suffered a brain death can be eligible as a deceased donor. One can also choose to donate a kidney after death by undergoing some document related formalities. After the death of such a person, the kidneys are removed and preserved till a time a recipient has been selected.

Evaluation process for kidney transplantation: Irrespective of the fact whether the kidney shall be taken from living or dead donors, special blood tests are required to find out about the blood and tissue of the donor to map it with the right recipient for successful transplantation.

• Blood type testing: same blood group is required for donation of kidneys. However AB blood type is easiest to match and O type is very difficult to match.  AB type blood accepts from all other types while an O type only accepts from O.
• Tissue typing:  Tissue typing involves test of HLA in blood or human leukocyte antigens. These are like identifying markers on the cells that is very unique and is different from one individual to another. If the markers are the same for both donor and recipient, then chances of this being successful transplant increases and this works for many years without a problem.  Best matches of tissue typing are found with siblings. Even though perfect match may not be available, with majority mapping done transplantation is carried out.
  
• Cross match:  Human bodies have antibodies as a protection against infection. So during a transplant, the donor kidney can be treated as a foreign body and the patient’s inherent antibodies will try to destroy it making the transplant unsuccessful.  This is the reason why a cross match test has to be conducted where a sample of blood from donor will be mixed with the collected blood of the recipient. If the test results are positive then the recipient has to undergo special medication treatments to lower or suppress its reaction to the donor kidney. If it is negative then one can continue with the transplant.Usually cross match tests are performed several times before the procedure and the last will be conducted 48 hours before the transplant.
  
• Serology:  before transplantation testing is also done for viruses and other infection on the donor to prevent any disease transmittance during the transplantation from donor to recipient.
  

In the year 1994 the primary legislation for organ donation was first framed in India. It clearly outlines the transplantation, removal and storage of organs purely for therapeutic purposes and not for any illegal and commercial dealings.

The Act was kick started in few states and later other states were also included in India.  The amendment was finally notified in 2014 after being proposed and passed in 2011.

We at Medivenue assist patients to understand the law and establish their contacts with accredited and approved lists of healthcare providers in various parts of the country. We also help in the documentation procedure and filling up of requisite numbers of forms for the successful transplant procedure.

Renal failure is the condition when the kidneys stop working. If the condition of renal failure persists (chronic) then the end-stage renal disease is the outcome where toxic waste products of the body get accumulated and one may require dialysis or transplantation. Some of the reasons for end-stage renal diseases are:

•           Diabetes mellitus
•           Glomerulonephritis
•           High blood pressure
•           Polycystic kidney disease
•           Urinary tract having severe anatomical troubles

There are alternatives to treat the above without transplant but a kidney transplant is the closest treatment for continuing a normal life after suffering from failed kidneys.

•             Nausea
  
•           Vomiting
•           Appetite loss
•           Weakness and fatigue
•           Sleep apnea
•           Decreased mental ability
•           Changes in urination patterns
•           Uncontrollable high blood pressure
•           Itching
•           Swelling of feet and ankles
•           Fluid builds in the lining of the heart causing chest cramps
•           Breathe shortness for fluid build up in the lungs.
•           Cramps and muscle twitches

•           Cardiovascular diseases that cannot be corrected
•           Ongoing chemotherapy or history of metastatic cancer
•           Active type systemic infections
•           Current substance abuse
•           Uncontrollable psychiatric ailments
•           Significant cognitive impairment of the patient and no surrogate decision-maker

For a kidney transplant the patient will be diagnosed with the following:

•          Health history discussion with healthcare provider where patient’s health as well as family health shall be checked
•          Physical exam:  including height, weight, and blood pressure will be recorded and signs and symptoms of blood vessels supplying heart and brain will be conducted
•          Blood tests to analyze the amount of waste products like urea, creatinine amounts in the blood
•          Urine sample test:  to detect the presence of albumin quantity in the blood. Too much albumin indicates renal disease.
•          Imaging tests: to understand the shape and size of the kidneys for the detection of any abnormalities.
•          Biopsy: where some of the tissues from the kidney will be removed to study the nature of kidney disease and its extent.
•          Pulmonary evaluation and spirometry

These tests can be repeated overtime to help the doctor understand how the disease is advancing.

A kidney transplant procedure involves general anesthesia where the patient has no other senses during the entire operation.

The hand or arm starts with an intravenous line and additional catheters are used to monitor the heart and blood pressure or to take blood samples. You can put catheters in collarbone or groin, or even wrist.

Hair can be rubbed off from the surgical site and the patient's bladder has a urinary catheter inserted. The patient is now lying on his/her back on the surgical table.

A tube has now been put in the lungs through the mouth. It works during the treatment as a calming aid for the patient.

The anesthesiologist will have a close watch on the rate of heart, blood pressure, levels of blood oxygen and breathing all throughout the surgery.

A long incision will be made into the lower abdomen from one side by one of the kidney transplant surgeons. A visual inspection will be done by the team on the donor's kidney before introducing that in the body of the patient.

The donor's kidney is inserted into the uterus, with the technique of putting the left donor kidney right and the right donor kidney left. It provides easy access to the ureter for the connection to the bladder (the channel that brings urine from the kidney).

The outside iliac artery and vein that causes blood supply in the area permit the donor's kidney renal artery and vein to be sewn on them.

Further bleeding at the suture lines will be checked after blood flow is established in the vessels that are newly sewn.

Now the donor ureter is connected to the bladder of the patient. With the help of surgical staples or stitches, the incision will be closed. In order to reduce swelling a drain arrangement may be done at the site of the incision.

After applying a sterile bandage or dressing the healthcare provider will shift the patient from the operation theatre.

After the patient is enlisted in the kidney transplant list, they should strictly follow the guidelines charted by their doctor to be ready for a kidney transplant as soon as a kidney is available. Any major change in the body should be immediately notified to the healthcare provider like weight or any symptoms.  As a patient, one must ask relevant questions to the doctor like kidney transplant success rate, the recovery process, and life expectancy. Ensure all tests are conducted and the patient should always attend the tests whenever recommended by their healthcare provider.

After the kidney transplant procedure, the patient is required to stay in the hospital for at least a week. The healthcare team shall monitor the vital signs and will check whether the transplanted kidneys are performing their regular functions or not. Usually, kidneys received from close relatives start functioning more quickly than other types of donors.

Before leaving the hospital, the healthcare provider will give sets of medications to manage pain and also sets of immunosuppressants to keep the body from treating the new kidney(s) as foreign matters.  Slowly the doses of immunosuppressants will be reduced as the doctors feel the body is identifying the organs as their own body parts.

One must be extremely careful and avoid infection at this point since the body is highly susceptible to infection during this time as the medication will weaken the natural immunity of the body to fight foreign bodies and antigens.

It is highly advisable to patients to talk to their doctors to understand that kidney transplant is the best option for them. They need to explore if this is not suitable then dialysis treatment can also be prescribed to them.  This is a mechanical system of purifying the blood via a chemical solution that is made to pass in the body to collect the waste products. In this treatment, the patient is expected to visit a doctor regularly and be highly dependent on this machine. Significant lifestyle changes are required.

An artificial kidney transplant may become a reality soon as this device undergoes all the necessary approvals under the FDA in the USA. This device will be placed in the abdomen and will be powered by the heart. It is almost the size of a fist and is capable of functioning as a real kidney since it will be made from the kidney cells that are nephrons.

Kidney transplants in India can range from $13000 to $16500 which is quite cheap compared to Us and Europe.