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Scope of Service

The Mediclinic City Hospital Transplant program offers patients suffering from end stage renal disease an alternative to dialysis. It also offers the opportunity for families to explore the option of being a living organ donor. The transplant team provides comprehensive, multidisciplinary care for potential transplant recipients and donors, from initial consultation through to the realization of donation or transplant, and beyond.

Facilities and Staff

The transplant team is composed of experts with wide ranging international experience. They are well versed in caring for transplant recipients and donors alike.

The hospital facilities that support transplant range across the ED, Operating theatres, ICU and surgical wards. This includes supportive services from the Laboratory, radiology, pharmacy, dietetic services, and infection control, amongst others.

Partnership with (MBRU)

The Renal transplant program enjoys a strong and supportive partnership with Mohammed Bin Rashid University (MBRU). The team at MBRU has played a significant role in propelling transplant to the forefront of healthcare, in the process helping to revitalize the nation's laws on Organ Donation and Transplant and making the service available to the UAE's citizens and residents.

What is kidney transplant and what are its types?

A kidney transplant is a surgical procedure in which a healthy kidney from a living-related donor or a deceased donor is transplanted into someone with failing kidneys.

Following are the types of kidney transplants:

Deceased donor
A deceased donor is someone who has consented to donating his or her organs upon death during their life. In the event in which the deceased donor's wishes are unknown, the family members may consent to organ donation. Deceased donors are brain-dead; with no life-sustaining activities in the brain. The diagnosis is made by a specialized team of physicians who conduct extremely precise testing that confirms the brain-death diagnosis.

Living-related donor
A living-related donor is a person who is a blood relative of the potential recipient.

  • Relatives up to the 4th degree may be accepted for living donation.
  • Currently, un-related donors are not accepted and proof of relationship will be required at time of assessment in order to proceed to donation.
  • The living donor has a very special role and must be genuinely willing to donate. They cannot receive gifts of any kind, payment or favors in return for their donation. The donor must also be free from any pressure to donate from any party. This is to protect the donor's best interests and ensure their safety.
Worldwide, it is recognized as illegal and a crime for anyone to receive payments or gifts in exchange for an organ. It is also a crime to pressure or coerce someone to donate their organs. This is applicable to living donors and deceased donors and their family members.


Who are eligible for kidney transplant?

Anyone who has reached end stage kidney disease is eligible for transplant. There is no age minimum or maximum for transplant. Recipients should be healthy enough to withstand the transplant surgery, and the pre-transplant testing will assess the recipient's eligibility.

There are some contraindications to transplant and they include:

  • Untreated, uncontrolled cancer
  • Active systemic infections
  • Any condition(s) with a life expectancy < 2 years
  • Untreated cardiovascular disease
  • Chronic respiratory dysfunction
Each individual case is different, and there could be some exceptions based on the potential recipient's state.


What are the benefits and risks of kidney transplant?

Benefits of a kidney transplant for the recipient include being free from dialysis, and being able to return to normal activities of life. The recipient of a kidney can return to a healthy diet with fewer restrictions and may be free from the previous complications of end stage kidney disease.

The Following are the risks of kidney transplant:
  • Delayed graft function

    A condition in which the transplanted kidney does not function right away. This may entail a return to dialysis while the medications are managed and the kidney is given time to start working.

  • Rejection

    Occurs when the body's immune system attacks the transplanted kidney because it recognizes it as a foreign body. Rejection can be responsive to immunosuppression management, but it must be caught early.

  • Graft non function

    For various reasons, the transplanted kidney may not work at all despite medication management. This means that the recipient has to return to dialysis (if already started) and will be placed back on the transplant wait list to await another kidney if they wish.

  • Infection

    The risk of infection after transplant is related to the high doses of immunosuppression which blunt the immune response. A normal bacteria or virus that can be fought off in a healthy immune system may take longer to fight, and may cause more symptoms in a patient who is immunocompromised.

    There is also a risk of transmission of infection from a donor. Although donors go through extensive testing to ensure that they are free from infection, there is a very small risk that an infection may go undetected and be passed on to the recipient.

  • Cancer

    The risk of developing cancer after transplant may be related to:

    Genetics, the recipient has pre-disposing factors genetically (or family history) that increase his/her chances of getting cancer, or they have had cancer before

    A suppressed immune system that is not efficient in detecting and destroying cancerous cells when they form

    Cancer cells that exist in the donor organ and are transferred after transplantation. This risk is rare because of the rigorous screening that all donors go through, but there is still a chance that it may happen. This is a risk that accompanies organs that come from living and deceased donors.

Alternatives to Kidney Transplant

The alternative to transplant in end stage kidney disease is dialysis. There are two types of dialysis available: Hemodialysis and Peritoneal dialysis. These procedures have their benefits and risks and should be discussed with a physician.

What is the process to be selected for wait list?

To be active on the transplant wait list, the recipient must go through the pre-transplant testing and be free from any of the contraindications to transplants mentioned above.

The pre-transplant testing will include the following:

  • Blood group1 and HLA typing and cross match2
  • PRA screening3
  • Testing for blood borne infections such as hepatitis and HIV
  • Blood work to assess kidneys, heart, liver, etc.
  • Chest X Ray
  • Abdominal ultrasound
  • Thorough cardiac (heart) assessment


There are other tests that could be ordered based on the individual cases

1. Blood group matching

  • Testing for the blood type of the recipient and the kidney is done to establish compatibility.
  • The transplant center does not perform incompatible blood group transplants
  • If the donor and recipient are not matching, the transplant will not be done, and the kidney will be allocated to another matching patient, and the recipient will remain on the transplant wait list.

2. HLA Tissue typing and crossmatch
  • Human Leukocyte Antigen (HLA) is a type of protein marker found on cells in the human body. These are unique to every person, except identical twins. The human body uses these cells to identify which ones belong to the body and which do not.
  • The closer the match of HLA markers between donor and recipient, the better the outcomes of the transplant. But it is possible to have mismatches and still transplant under certain conditions.
  • The crossmatch is a very important test that identifies if the recipient's body will react to the donor's tissue. In this test, the donor's blood sample is mixed with sample from the recipient. If the recipient's blood has antibodies (proteins produced in the blood in response to a foreign cell or antigen; antibodies destroy antigens) to the donor's sample, it means the crossmatch is positive.
  • A positive crossmatch indicates that the recipient's body will attack and destroy the donor's kidney. In such a case, the transplant cannot take place, and the search for another donor must resume.

3. PRA Screening
  • Panel of reactive antibodies (PRA) screening is a test in which the level of antibodies in the system is measured and is used to calculate a percentage (%) estimate of donors who the body will reject.
  • The PRA can range from 0% to 99%. A PRA can be high because of previous blood transfusions, pregnancy, illness or other reasons that increase the system's antibody levels.
  • If the PRA is high, it means that it may take longer to find a donor kidney as the body is more likely to reject most donated kidneys. For this reason, patients with high PRA values receive high level priority during kidney allocation.
  • While on the transplant wait list, a PRA screening is done at regular intervals to detect increased sensitivity. Typically it is done every 3 months, and repeated after a blood transfusion.


What to do on while on the wait list

The potential recipient is expected to maintain his/her health in the best possible state while awaiting transplant. The wait time could be short or long depending on the availability of the deceased donors. The recipient should continue dialysis (if already started), and maintain appointments with the nephrologist and blood draws (for PRA screening).

How is kidney allocated?

Kidney allocation is decided by unanimous agreement of the Transplant team members and is based on several factors. When a kidney is donated, the following is considered:

  • In which patient does this kidney have the best chance of success?
  • Which patient needs this kidney the most at the time?

If a donated kidney becomes available, and there is a perfect match (HLA and ABO compatible), the kidney will be allocated to that particular patient. If no patient matches the kidney perfectly, the next best match is considered. If there is more than one patient matching the kidney, it will be allocated based on the following factors:

  • Age (younger patients receive priority)
  • Age difference between donor and recipient (smaller age gap is favored)
  • Time spent on dialysis (patients who have been on dialysis longer will be favored)
  • Time spent on the wait list (patients who have been waiting longer will receive priority)

There is a chance that the kidney might be allocated to two equally matching recipients. At the time of allocation, the potential recipient will be notified if he/she is the primary or secondary candidate for that particular kidney. Both candidates will be asked to come to the hospital for further assessment while the kidney is being harvested/transported. Having the secondary candidate available on site will reduce the time that the kidney has to wait on ice; decreasing damage to it and enhancing the transplant results. If after the final assessments on the primary recipient and kidney show any contraindications for transplant, the secondary recipient will receive the kidney.

This is done in the best interest of the recipients. The transplant team cannot perform a transplant if it is contraindicated in any way for the recipient's health after the final checks.

The transplant surgery

Just before the surgery, the recipient will be started on immunosuppression medications, and will have a few investigations such as blood work, chest x-ray and an ECG.

The transplant surgery takes 3-5 hours. Once the recipient and the kidney are verified for the surgery, a central IV will be inserted to administer the rest of the immunosuppression medications, and allow for fluid administration. A urinary catheter will be inserted after anesthesia to monitor the urine output.

An opening (about 12cm) is made in the lower part of the abdomen, on the right or left side, and the new kidney is placed there. Blood vessels from the kidney will be connected to the recipient's blood vessels, and the ureter (urine tube) will be connected to the bladder.


The recovery period for the transplant will vary from one patient to another. Generally, the hospital stay is expected to be from 5-7 days, sometimes longer.

The central IV catheter is removed on day 4 post-op, or after the last dose of the IV immunosuppression medication. The urinary catheter keeps the bladder empty, which gives a chance for the stitches to heal, therefore it may be left in for 4-5 days. If any drains were used at the wound site, they will be removed once the drainage has decreased.

The surgical wound will be closed with staples. These will be removed gradually as per the surgeon's orders and based on individual cases.

Immediately post-surgery, the recipient will be in 'reverse' isolation (patient is protected from environment) because of the immunocompromised state. During this time, visitors must be limited, and isolation precautions are followed by everyone who enters the room (must wear gloves, mask, and a gown). The recipient will be placed in a private room on the ward after discharge from the ICU.

At all times after the transplant, excellent hand hygiene and infection prevention must be practiced.

The recipient can expect to begin to eat and drink one day after the surgery, and are encouraged to get up and walk.



After the transplant, the recipient will continue to take their immunosuppression medications for life. This will prevent the body from rejecting the transplanted kidney. The typical transplant medications include:

  • Calcinurine inhibitors (Prograf)
  • Mycophenolate mofetil (Myfortic or Cellcept)
  • Steroids (Prednisone)

These medications or their dosages could differ based on individual cases. Regular blood work is required to adjust the dosages of immunosuppressant medications.

There are other medications that are prescribed and may include the following:

  • Antivirals
  • Antibiotics
  • Stomach protection

Graft survival rates
A kidney transplant on average lasts 15 years. The international average for graft survival rates for the first year post-transplant is 90-95%; 85-90% at 5 years; and 85-80% at 10 years.


Insurance coverage for transplant

Each insurance company has its own criteria for coverage of the transplant, its associated testing and living donors. At the time of assessment, the transplant team will work with you to clarify insurance coverage and help you make the best decision for your care.

Kidney Donation

Donating a kidney to a family member in need is one of the greatest gifts one can give. It is a selfless act that allows the sufferer of kidney disease to avoid, or be free from, dialysis, and enjoy a higher quality of life.

Donating is a positive experience, but you must be well informed about the process, the risks, and the benefits before proceeding to the actual donation stage.

An important fact that all donors must be aware of is that it is ILLEGAL and a CRIME to buy or sell organs. This is internationally recognized. A donor must be genuinely willing to donate to help someone. The donor is NOT allowed to receive ANY form of compensation for donating a kidney, this includes gifts of all kinds, money, loans, vacations, etc. The donor is required to disclose to the team ANY instances in which they feel pressured or intimidated by anyone, including the recipient, to donate. The transplant team takes great care in assessing the donor for potential inducement or coercion. This is one of the reasons that the testing process for all donors is very detailed.

Who identifies the donors?

The transplant team does not make first contact with the donor. The donor must initiate the process and contact the team. The transplant coordinator will get general information from the interested donor and help with booking the next appointment for a more detailed consultation. The coordinator will guide the donor through the process and provide information and education.

The transplant team cannot and will not disclose any information to family members or the recipient about the donor's test results or status. This information is STRICTLY CONFIDENTIAL. It is up to the donor whether they want to disclose any of the information they receive from their testing.

The consent to donate

The donor is completely free to withdraw their consent to donate at ANY point of the donation process up to the actual surgery. This is a preserved right of the donor. Reasons for withdrawing consent are confidential and will never be shared by the transplant team with the recipient or family, unless directed by the donor.

What are the advantages of becoming a living donor?

  • Recipient receives the kidney much sooner and can avoid years of waiting on dialysis
  • Recipients usually have better short and long term outcomes because living donor kidneys last longer
  • The surgery is scheduled at a time that is convenient for patients and their families
  • The living donor has the advantage of time which allows for more thorough medical testing that helps provide a kidney of high quality for transplant
  • The recipient will receive the donated kidney immediately after the donor surgery, limiting the time the kidney is cold, helping preserve its function and decreasing chances of complications


Who is a good donor?

All potential donors MUST go through rigorous medical testing and psychological assessments

In general, the donor must be:

  • Physically/Psychologically/Medically fit
  • Between 18 and 65 years old (exceptions for some cases)
  • A blood relative of the recipient, up to the 4th degree.


Conditions that may prevent donation

  • Diabetes
  • Obesity
  • HIV + status
  • History of Hepatitis infection
  • High blood pressure or use of blood pressure medications
  • History of kidney stones
  • Chronic use of certain types of medications
  • Cancer
  • Mental illness
  • A strong family history of diabetes or kidney disease


How long does the testing process take?

The length of the donation testing varies from one donor to another depending on how many tests are required and the health of the donor. It may take from a few weeks to a few months. The team will work to accommodate the needs of the donor and the recipient, but appointment times may be limited and may change.

Steps to donation

A transplant will not take place until the entire donor and recipient work ups are done with satisfactory results. The recipient has to be tested first and approved for transplant. They will be placed on the wait list whether they have a living donor or not.

1. Blood group matching
  • Testing for the blood type of the donor and potential recipient is done next to establish compatibility.
  • The transplant center does NOT perform incompatible blood group transplants at this time.
  • If the donor and recipient are not matching, the transplant will not be done, but they will remain on the transplant wait list. The team will provide counselling for the next best steps for care.
2. HLA Tissue typing and crossmatch
  • Once blood group compatibility is established, tissue typing and cross-matching will be done.
  • Human Leukocyte Antigen (HLA) is a type of protein marker found on cells in the human body. These are unique to every person, except identical twins. The human body uses these cells to identify which ones belong to the body and which do not.
  • The closer the match of HLA markers between donor and recipient, the better the outcomes of the transplant. But it is possible to have mismatches and still transplant under certain conditions. 
  • The crossmatch is a very important test that identifies if the recipient’s body will react to the donor’s tissue. In this test, the donor’s blood sample is mixed with sample from the recipient. If the recipient’s blood has antibodies to the donor’s sample, it means the crossmatch is positive.
  • Antibodies are proteins produced in the blood in response to a foreign cells called “antigen”; antibodies destroy antigens.
  • A positive crossmatch indicates that the recipient’s body will attack and destroy the donor’s kidney. In such a case, the transplant cannot take place, and the search for another donor must resume.
3. Pre-donation evaluation
  • If the initial testing goes well, the donor will move forward with the process.
  • The donor will be assessed more thoroughly by the nephrologist, and the transplant surgeons.
  • This phase will include all of the following tests:
  • Past medical history
  • Complete physical
  • Bloodwork
  • Urine samples
  • Infectious disease testing
  • Chest x-ray
  • ECG
  • Other testing might be ordered based on the donor’s health
The Surgery

The surgery to take out the kidney is called a "nephrectomy", and sometimes called recovery or harvesting. It is about 3 hours long, and this may vary depending on the donor's anatomy or health state.

There are two nephrectomy techniques performed at Mediclinic City hospital, they are:

1. Laparoscopic
  • In a laparoscopic surgery, the surgeon creates three small incisions in the abdomen for the insertion of a camera and tools, and creates a larger incision (about 5 cm) a few centimeters below the belly button through which the kidney will be removed.
  • This technique is the preferred one for nephrectomy as it leads to smaller surgical wounds that may speed up the healing process, shorten the hospital stay, and improve post-operative pain levels.

2. Open
  • The open technique is the traditional long incision to open the side where the chosen kidney will be taken from. The incision will span from the side of the abdomen to side of the back on the level of the kidney. This technique leaves a bigger scar and may take longer to heal.

The surgeons will choose the type of technique based on the clinical evaluation of the donor. Some donors may not be good candidates for one technique versus the other, and this will be decided before the surgery. However, there is a chance that during the surgery that the surgeon will feel that a different technique is required for safety, and to achieve the best results for donor and the recipient.

There is a chance that after the surgery begins that the surgeon will discover an issue that leads to the cessation of the procedure. This means that the donation surgery will stop and after the donor recovers, the case will be re-assessed.

Hospital stay and discharge

The hospital stay after donation is two to five days. Most donors are able to return to work after 4-6 weeks post-surgery.

Pain after the surgery is expected, but donors typically report being pain free 3 weeks after the surgery. In some cases, pain can last longer and the team will assist in its management.

The donor will be required to attend scheduled follow-up appointments with the surgeon and the transplant team at regular intervals for post-donation testing.

Living with one kidney

After the initial follow-up appointments with the transplant team, the donor is advised to continue to have annual check-ups with their family physician. It is advised and encouraged that donors adopt a healthy lifestyle of appropriate exercise, well-balanced diet, adequate water intake and avoidance of heavy salt intake.

Consequences of donation

Studies do not show any significant long term risks after donation. Donors may be at a slightly higher risk of developing high blood pressure, and there is a small risk of developing kidney failure, but this risk is not higher than the general population of the same demographic.

In general, most donors enjoy good health due to the close medical monitoring and the healthy lifestyle they must follow.

Each case is unique and depends greatly on the donor's previous medical and psychological history, and how well they take care of themselves and follow medical advice after the donation.

The above is a quick guide and frequently asked questions about donation, designed to give you GENERAL information. The kidney transplant coordinator is available to guide and provide you with more detailed answers about any of the phases of donation and will assist you in meeting with the physicians and surgeons on the team if you wish to proceed to a more detailed consultation.


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