Our body converts the food we eat into energy. The food that is not used up becomes the waste product left behind in the bowel and in the blood. This is where our kidneys do their job.
The kidneys are two bean-shaped organs, each about the size of a fist, located below the ribs toward the middle of the back. Their function is to:
- Remove liquid waste from the blood in the form of urine.
- Maintain a stable balance of salts and other substances in the blood.
- Produce erythropoietin, a hormone that aids the formation of red blood cells.
- Regulate blood pressure.
What is Kidney Disease?
The damage of the nephrons in the kidneys makes them lose their filtering capabilities and this condition is termed kidney disease. The harmful substances remain in circulation in the blood which can be life-threatening over time. Kidney disease when untreated can cause multiple organ failures and ultimately lead to death. There are different stages of kidney disease and when the person has lost 90% of the kidney function they are said to have end-stage kidney disease. A kidney transplant is the best chance of recovery and is recommended considering the kidney transplant cost in India is not as high as in other countries.
A kidney transplant is a surgical procedure performed to replace a diseased kidney with a healthy kidney from another person. One donated kidney can replace the work previously done by both your kidneys.
The donated kidney may be from:
- A living related donor — related to the person receiving the transplant, such as a parent, sibling, or child.
- A living unrelated donor — such as a friend or spouse.
- A deceased donor — a person who died recently and was willing to donate his/her healthy kidney.
The healthy kidney is transported in cool salt water (saline) that preserves the organ for up to 48 hours. This gives the medical staff the time to perform tests to ensure that the donor’s and recipient’s blood and tissue match.
A person receiving a transplant usually receives only one kidney, but, in rare situations, he or she may receive two kidneys from a deceased donor. In most cases, the diseased kidneys are left in place during the transplant procedure. The transplanted kidney is implanted in the lower abdomen on the front side of the body.
kidney transplant cost in India- Package
The need for good kidney transplant procedures in India is climbing with the steady rise in the number of patients with end-stage kidney disease. India has over 2 lakh people affected annually with end-stage kidney disease for whom dialysis or transplant is the only option. The increase in a number of cases has caused kidney transplant cost in India also to rise due to an imbalance in demand and supply ratio and other socio-economic reasons. We at Manipal Hospitals are trying to subsidize the cost so that people from all financial status are able to afford the treatment.
There are various packages to choose from. To get the exact details of the kidney transplant cost or packages we suggest you schedule an appointment with our expert kidney transplant doctors.
Local Legal Requirement
It is important that the donor and recipient understand the risks and benefits involved in kidney transplant. Our doctors advise them on the right procedures that are to be followed during the entire kidney transplant process. The donor and recipients are required to sign a consent form, ‘Organ transplant agreement’ which is formulated by the Government of India. All the rules and regulations are given in detail in the agreement. And our doctors are available to clear all your queries regarding the same.
Reasons for the procedure
A kidney transplant may be recommended for people suffering from an end-stage renal disease (ESRD), a permanent condition of kidney failure that often requires dialysis (a process used to remove excess fluid and waste from the blood). Some conditions that may lead to ESRD include, but are not limited to, the following:
- Chronic, uncontrolled high blood pressure.
- Repeated urinary infections.
- Polycystic kidney disease.
- Glomerulonephritis, which is inflammation and scarring of the kidney’s filtering units.
- Hemolytic uremic syndrome, a rare disorder that causes kidney failure.
- Lupus and other immune system disorders.
Other conditions, such as congenital defects of the kidneys, may also result in the need for a kidney transplant.
Sometimes kidney disease can be managed with diet, medication, and treatment for the underlying cause. However, if your kidneys still can’t filter your blood adequately after the initial treatment, your doctor might recommend a kidney transplant.
A kidney transplant may NOT be done if you have other chronic illness, such as infections like TB or bone infections, heart, lung, or liver disease, history of cancer or other life-threatening diseases.
Risks of the procedure
As with any surgical procedure, complications can occur. Some complications may include, but are not limited to, the following:
- Blood clots.
- Heart attack or stroke.
- Blockage of the blood vessels to the new kidney.
- Leakage of urine or blockage of urine in the ureter.
- Initial lack of function of the new kidney.
- Rejection of the new kidney – The new kidney may be rejected. Rejection is a normal reaction of the body to a foreign object or tissue.
When a new kidney is transplanted into a recipient’s body, the immune system reacts to what it perceives as a threat and attacks the new organ, not realizing that the transplanted kidney is beneficial. To allow the transplanted organ to survive in a new body, medications must be taken to trick the immune system into accepting the transplant and not attacking it as a foreign object. The medications used to prevent or treat rejection can cause a variety of side effects which can be explained by your doctor in detail before the procedure.
There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the kidney transplant procedure.
Before the kidney transplant procedure
Before you plan your transplant, you’ll need an evaluation to determine whether you meet the center’s eligibility requirements for a kidney transplant.
Components of the transplant evaluation process include, but are not limited to, the following:
- Psychological and social assessment – Psychological and social evaluation is done to determine whether you fully understand the risks of a kidney transplant. Factors involved in kidney transplantation, such as stress, financial issues, and support system, are assessed. These issues can significantly impact the outcome of a transplant. The same kind of evaluation is performed for a living donor.
- Laboratory tests – Blood and urine tests are carried out to help find a good donor match and to help improve the chances that the donor organ will not be rejected.
- Diagnostic tests – Diagnostic tests are conducted to assess your overall health especially your kidney. These tests may include X-rays, ultrasounds, kidney biopsy, heart tests, and dental examinations. Women may receive a Pap test, gynecology evaluation, and a mammogram.
- The transplant team will factor in all information from interviews, your medical history, physical examination, and diagnostic tests in determining your eligibility for kidney transplantation.
A kidney donor can be living or deceased, related or unrelated to you. The medical team will consider several factors, such as blood and tissue types when evaluating whether a living donor will be a good match for you. Family members are often the most likely to be compatible kidney donors. But many people undergo successful transplants with kidneys donated from people unrelated to them.
Preparing for your transplant
It is imperative that you stay healthy whether you’re awaiting a donated kidney or near the time of your transplant. Being healthy and active (as per your condition) will help you better prepare for the transplant surgery when the time comes. It may also expedite your recovery from surgery. You should:
- Take your medications as prescribed.
- Follow your diet and exercise guidelines.
- Keep all appointments with your medical team.
Stay in touch with your transplant team and inform them of any significant changes in your health. If you’re waiting for a donated kidney, ensure that you are easily reachable. You will need the support of family/friends. Inform them in advance.
The following steps will precede the transplant:
- Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
- You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully and ask questions if something is not clear.
- You will be put on dialysis prior to the procedure if you have been on routine dialysis before the procedure.
- For a planned living transplant, you should fast for eight hours before the surgery. In case of a cadaver organ transplant, you should begin to fast once you are notified that a kidney has become available.
- You may receive a sedative prior to the procedure to help you relax.
- Based on your medical condition, your doctor may request other specific preparation.
During the procedure
Kidney transplantation requires a stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.
Generally, a kidney transplant follows this process:
- You will be asked to remove clothing and given a gown to wear.
- An intravenous (IV) line will be started in your arm or hand. Additional catheters may be inserted to monitor the status of your heart and blood pressure, and for obtaining blood samples.
- If there is excessive hair at the surgical site, it may be clipped off.
- A catheter will be inserted into your bladder.
- You will be positioned on the operating table, lying on your back.
- The surgery will be performed while you are asleep under general anesthesia. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
- The skin over the surgical site will be cleansed with an antiseptic solution.
- The doctor will make a long incision into the lower abdomen on one side.
- The doctor will visually inspect the donor kidney before implanting it.
- The donor kidney will be placed into the abdomen. A left donor kidney is implanted on your right side and a right donor kidney is implanted on your left side. This allows the ureter (the tube that links the kidney to the bladder) to be accessed easily for connection to your bladder.
- Your original kidneys will be left in place unless there are medical problems causing complications such as high blood pressure, kidney stones, pain or infection.
- The renal artery and vein of the donor’s kidney will be attached to the external iliac artery and vein.
- After the artery and vein are sewn, the blood flow through these vessels will be checked for bleeding.
- The donor ureter will be connected to your bladder.
- The incision will be closed with stitches or surgical staples.
- A drain may be placed in the incision site to reduce swelling.
- A sterile bandage or dressing will be applied.
Kidney transplant surgery usually lasts about three to four hours.
After the procedure
After the surgery, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you may be taken to the intensive care unit (ICU) where you will be closely monitored for several days. Kidney transplant surgery requires an in-hospital stay of 7-14 days or longer. Upon recovery, you will be discharged from the hospital. A kidney from a living donor may start making urine immediately, but urine production in a cadaver kidney may take longer. Until urine output is normal, dialysis may be required.
A catheter may be placed in your bladder to drain your urine. The amount of urine will be carefully measured to evaluate the new kidney’s function. We will prescribe drugs and the diet you would need to follow. Drugs called immunosuppressants help keep your immune system from attacking your new kidney. Additional drugs help reduce the risk of other complications, such as infection, after your transplant. Your medications will be closely monitored to ensure that you are receiving the optimum dose and the best combination of medications.
You may need to take IV fluids until you are able to take in adequate food and fluids. Your liquid intake may be restricted until the new kidney is fully functional. Your diet will be gradually modified from liquid to solid depending on how well you can tolerate it.
Blood samples will be frequently collected to monitor the status of the new kidney, and other organs, such as the heart, liver and lungs. You should get out of bed and move around several times a day as per the doctor’s advice. You will be given pain-relieving medication for soreness around the surgical site. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
Nurses, pharmacists, dieticians, physical therapists, and other members of the transplant team will teach you how to take care of yourself once you are discharged from the hospital. However, follow-ups visit the kidney transplant department will be required. The transplant team will develop a checkup schedule for you.
Aftercare at home
Keep the surgical area clean and dry once you are at home. Check with your doctor on the kind of precautions you should take while bathing. The stitches or surgical staples will be removed during a follow-up hospital visit.
You need a go-ahead from your doctor before you resume driving. You should avoid any activity or position that causes pressure to be placed on the new kidney. Other activity restrictions may apply.
Inform your doctor if you experience the following symptoms, which may indicate rejection or infection:
- Pain or discomfort, such as swelling, tenderness, redness or bleeding, at the incision site.
- Vomiting and/or diarrhea.
Rejection of the new organ may also be indicated by an elevation of your blood creatinine level (blood test to measure kidney function) and/or blood pressure (monitored by your doctor).Consult your transplant team with any concerns you have. Frequent visits to and contact with the transplant team are essential.
Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.
The recovery period is about six months. You will need to have regular check-ups with blood tests and x-rays for many years. Many kidney transplant patients are able to return to work within a few months following a successful surgery. However, various aspects of the recovery process can affect the timing of your return.
You will not injure yourself or your new kidney if you follow some of these general guidelines:
- Avoid lifting heavy objects and strenuous physical labor for at least 6-8 weeks following surgery. It is important that you also do not lift anything heavier than 10 kg for 2-3 months, and nothing heavier than 20 kg for 4-6 months from the date of your surgery.
- Avoid driving for at least six weeks following surgery. Plan ahead to arrange for a driver or ask someone to help out during this time. Always wear a seatbelt when you are in a moving vehicle.
- Exercise is encouraged, and it is recommended beginning with stretching exercises and walking. Other excellent exercises that you can take up include jogging, hiking, bicycling, tennis, golf, swimming, and aerobics. All of these can help you regain your strength and maybe started gradually after your incision has healed. Check with your doctor.
- As a general rule, rough contact sports should be avoided since they might cause injury to your transplanted kidney. If you have doubts about any activity, please ask the transplant team.
After the transplant, skin checkups with a dermatologist to screen for skin cancer and keeping your other cancer screening up to date is strongly advised.
Dialysis at Manipal Hospitals
Dialysis is given when kidney functions have largely deteriorated and the waste material is getting accumulated in the body, as in End Stage Renal Disease(ESRD) and Acute Renal Failure(ARF). It thus helps to save a life by replacing the critical functions of the kidney. It helps to sustain life when a kidney transplant is not immediately possible to be done. It is of two main types-Hemodialysis(where the dialysis machine pumps blood through the dialyzer which cleans the blood and is then returned to the bloodstream) and Peritoneal dialysis(utilizes the lining of the abdominal cavity for the exchange). Depending on the condition of the patient, the dialysis sessions may be scheduled once to thrice per week or more. It is given under the supervision of a Nephrologist.
Mobile dialysis units have been introduced for people with renal failure who are unable to commute from their homes for the treatment.
Infrastructure and kidney dialysis cost in India
Manipal hospital is known to have the state of the art infrastructure in all departments which holds true for the nephrology department as well.
It has over 25 dialysis stations which are maintained in aseptic conditions throughout. We also offer subsidized ambulance service for easy transportation of dialysis patients. Our nocturnal dialysis service is aimed at working class to avail these services without hindering their normal routine. Our mobile dialysis unit launched a few years back has been a huge success and is equipped with clinical, technical and support staff required for dialysis. Also, we offer our kidney dialysis service at reasonable and competitive rates as compared to the Rs. 20,000 average cost per month in India. Our main aim is to help our patients get the best treatment at a reasonable cost.
Thus if you suspect that you are suffering from kidney failure or if you would like to get a second opinion from our world-class nephrologists log on to our website or call our helpline to schedule your appointment.