Transplant Centre

Kidney transplant offers better quality of life and transplant patients would be able to live longer compared to dialysis patients. Anyone who has reached end stage kidney disease is eligible to be worked up for a kidney transplant. There is no age minimum or maximum for transplant. However, recipients should be healthy enough to withstand the transplant surgery.

Pre-transplant tests will determine the recipient's eligibility.

What is Kidney Failure?

Kidneys have five main jobs:

• Filter waste from your blood
• Regulate fluid balance
• Balance the acid within your body
• Help control blood pressure
• Help make red blood cells
• Activate vitamin D for healthy bones

Kidney disease is common but for most people it is mild or moderate.

About one in 10 people with kidney disease develop kidney failure. This is when your kidneys no longer work well enough to keep you healthy, and you need dialysis or a kidney transplant to stay alive.

Kidney disease stages

Stage 1 - early signs of damage shown on tests. 90% kidney function

Stage 2 - mild. 60-90% kidney function

Stage 3 - moderate. 30-60% kidney function

Stage 4 - severe. 15-30% kidney function

Stage 5 - kidney failure. Less than 15% kidney function. Many people with chronic kidney disease (CKD) will not have symptoms because it does not usually cause problems until it reaches an advanced stage.

Early stages of CKD

Kidney disease does not tend to cause symptoms when it's at an early stage.

This is because the body is usually able to cope with a significant reduction in kidney function.

Kidney disease is often only diagnosed at this stage if a routine test for another condition, such as a blood or urine test, detects a possible problem.

If it's found at an early stage, medicine and regular tests to monitor it may help stop it becoming more advanced.

Later stages of CKD

A number of symptoms can develop if kidney disease is not found early or it gets worse despite treatment.

Symptoms can include:

• weight loss and poor appetite
• swollen ankles, feet or hands – as a result of water retention (oedema)
• shortness of breath
• tiredness
• blood in your urine
• an increased need to urinate – particularly at night 
• difficulty sleeping (insomnia)
• itchy skin
• muscle cramps
• feeling sick
• headaches
• erectile dysfunction in men

This stage of CKD is known as kidney failure, end-stage renal disease or established renal failure. It may eventually require treatment with dialysis or a kidney transplant

Who can have a kidney transplant?

Most healthy people would benefit from a kidney transplant however, there are some contraindications 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 health condition. To understand your eligibility please get in touch with one of our nephrologists, you can view their profile and book an appointment by clicking on the link here.

What are the steps involved?

After a kidney transplant, your energy levels will improve, you would have a better appetite, in most cases there will not be any dietary or fluid restrictions. Most kidney transplant recipients can return to work and other normal activities within eight weeks after transplant. No lifting objects weighing more than 5kg or exercise other than walking until the wound has healed (usually about six weeks after surgery). You should be able to drive by six weeks post-surgery.

Your new kidney may pass a lot of urine in the first few weeks and you would have to drink plenty to keep up with the fluid requirement, in the first month you would be expected to attend the hospital two to three times a week for out-patient appointments, so we can keep a close eye on your transplant function.

It's normal to feel anxious or overwhelmed while waiting for a transplant or to have fears about rejection, returning to work or other issues after a transplant. Support is available if you or your loved ones are struggling or if you need to talk

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 better quality of life.

Donating is a positive experience where one can make a difference to a loved one’s life. However, a potential donor must be well informed about the process, the risk and benefits of the procedure, before proceeding to donation. 

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 recognised. 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.

• Organs for transplant come from either a living donor or a donor who has died. Kidneys can be donated from living or deceased donors
• Live donor kidneys usually last longer and work immediately compared to kidneys from deceased donors
• There are more people waiting for transplants than there are donors
• All donated organs carry some risk, but this is generally lower risk than dialysis

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

In general, the donor must be:

• Physically, psychologically and 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
• HIV + status
• History of multiple kidney stones
• Active cancer
• Active mental health disease

Identification

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 detailed consultation. The coordinator will guide the donor through the process and provide information and education.

All health related information is confidential, 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.

Consent

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.

Steps and tests towards a 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 potential 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.
• If the donor and recipient are blood group incompatible, the transplant will not proceed instead, the recipient will remain on the transplant wait list. The team will provide counselling for the next best steps for their 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 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