What Is Kidney Transplant surgery?

A kidney transplant is the surgical placement of a healthy kidney from a donor into a person whose own kidneys have failed. It offers better long-term survival, improved quality of life, freedom from dialysis, and the ability to return to normal activities.

The THOA Act governs all organ donation and transplant activities in India. Compliance is compulsory before any transplant.

A. Types of Donors Allowed

1. Living Related Donors

   • Parents, spouse, siblings, children, grandparents.

   • Supported by documents proving genetic or legal relationship.

2. Living Unrelated Donors

   • Only allowed when there is no commercial intent.

   • Requires special permission from the Authorization Committee with detailed justifications.

3. Deceased Donor (Cadaveric) Donation

   • Donation after brain stem death certification by an approved panel of doctors.

Pre-Operative Work-Up

A. Recipient Evaluation

1. Blood Tests

• CBC, LFT, KFT, electrolytes.

• Blood group.

• Viral markers: HIV, HBsAg, HCV.

• Coagulation profile.

• Blood sugar & HbA1c.

2. Immunological Tests

• HLA typing

• PRA testing (Panel Reactive Antibody)

• Cross-match test (CDC & Flow cross-match)

• Donor-specific antibody (DSA) testing
  These reduce the body's rejection rates to the donor kidney.

3. Cardiac & Functional Tests

• ECG

• 2D Echo

• Stress test or coronary angiography (if age >40 or comorbidities)

• Chest X-ray / HRCT if needed

4. Infection Screening

• Urine culture

• Dental evaluation

• ENT evaluation

• Hepatitis viral load (if positive)

• Tuberculosis screening (Quantiferon TB Gold / CT scan)

5. Other Tests

• Prostate evaluation in men >50 years

• Mammogram / Pap smear in women as per guidelines

• Social worker and psychologist assessment

B. Donor Evaluation

• Complete physical exam

• Kidney function tests, GFR

• CT Angiography to study kidney vessels

• Urine analysis & culture

• Metabolic evaluation (diabetes, lipids)

• Cancer screening as per age

• Anesthesia fitness

• Nephrologist and Urologist clearance

Surgical Procedure

A. For the Recipient

1. Performed under general anesthesia.

2. A small incision is made in the lower abdomen (usually right side).

3. The donor kidney is placed extraperitoneally.

4. Blood vessels (renal artery and vein) are connected to the patient’s iliac vessels.

5. The ureter is joined to the bladder (ureteroneocystostomy).

6. A small stent may be placed temporarily.

7. The kidney usually starts working immediately, but some may take days (Delayed Graft Function).

B. For the Donor (Living Donor Nephrectomy)

Most donor surgeries are done laparoscopically or robotically:

• 3–4 small holes

• One small incision for kidney removal

• Faster recovery and minimal pain

• Donor can resume routine life in 2–4 weeks

• No long-term health compromise as the remaining kidney enlarges and functions normally

Immediate Post-Operative Care

A. For the Recipient

1. ICU Monitoring (24–48 hours)

   • Vital signs, urine output, fluid balance

   • Kidney function monitoring

   • Immunosuppressive medications started immediately

2. Medications

   • Immunosuppressants: Tacrolimus / Cyclosporine, Mycophenolate, Steroids

   • Antibiotics

   • Pain relief

   • Medicines to prevent infection (CMV, PCP prophylaxis)

3. Potential Early Complications

• Delayed graft function

• Rejection episodes (hyperacute, acute)

• Infections

• Surgical issues: urinary leak, lymphocele, bleeding

• Vascular thrombosis (rare but serious)

4. Hospital Stay
   10–14 days typically.

A kidney transplant provides the best quality of life for kidney failure patients but requires thorough medical evaluation, compliance with THOA Act regulations, skilled surgery, and lifelong follow-up. With proper care, transplanted kidneys can last 10–20+ years, and many patients live normal, productive lives.

Kidney Transplantation