Dr. PS Vali | Apr 25, 2020, | Who requires Kidney Transplantation
Kidney Transplantation is a procedure where one kidney is removed from a person and implanted into another person with permanent Kidney Failure. The person who donates a Kidney is known as a Donor and the one who receives the kidneys is known as the recipient.
The answer is No. All patients of kidney failure don’t require kidney transplantation.
There are two primary types of kidney failure.
First category of kidney failure is Temporary Kidney Failure. This is technically known as Acute Kidney Injury (AKI), where in Kidney failure occurs because of a temporary insult and is potentially recoverable if that insult is eliminated within a particular time frame. These patients with Temporary Kidney failure don’t require Kidney Transplantation as Kidney failure is temporary.
The Second category of Kidney Failure is End stage Kidney Disease (ESRD). The other term for this entity is CKD/Stage 5-D (Chronic Kidney Disease/ Stage 5 requiring Dialysis). These are the patients whose both the kidneys have failed permanently and completely. These are the patients who are left with only 5-10% of net kidney function and this is deemed irreversible. These are the patients who mandate either Kidney Transplantation or lifelong Dialysis to move forward.
Fundamentally there are two categories of Kidney Donors.
The first Category being Living Kidney Donors and the Other Category being Deceased Kidney Donors. Living kidney donors are usually the individuals who are either biologically or emotionally related to the patient. The classical example of Biologically related individuals are parents and siblings. The most appropriate example of an emotionally related Living donor is Spouse.
The second category of Donors are Known as Deceased Donors. They are the donors whose brain is completely and irreversibly damaged but whose heart is still beating. Such a condition is medically termed as “Brain Death”. That is though they are biologically alive; due to the irreversible damage to the Brain they are technically dead as organs in the body cannot function when the Brain is irreversibly damaged. If the grieving family members are willing to donate the Kidney of their loved ones who are in a state of Brain death, Kidneys along with Liver, Heart and lungs are retrieved after following a stringent legal procedure as mandated by the law.
The fundamental requirement for kidney donation is the matching of Blood groups. The person who donates the kidney should have the same blood group like the patient or the donor should belong to the “O” Blood group. The Person with O Blood Group is regarded as a universal donor as such a person can donate a kidney to a person of any blood group.
The other prerequisites being the biological relation or undisputed emotional relationship as defined by the law. The tests such as HLA matching will decide the extent of biological matching between the donor and the recipient.
Kidney donation is a safe and well established procedure due to the adoption of stringent measures to evaluate the donor’s health prior to the donation. Every donor will undergo critical analysis of all the organ systems prior to donation. They will be evaluated in depth to assess their kidney functions and would be methodically analysed if the person can sustain kidney donation. If the entire evaluation reveals normal results, then only donation will be permitted. If this stringent process is followed, Donation is usually an acceptably safe procedure subject to subtle biological variations.
To conclude, Kidney Transplantation is indicated in patients with Permanent Kidney failure whose net kidney functions have dropped below 5-10%. Kidney donors can be biologically or emotionally related individuals or Brain dead individuals. Kidney donation from living donors is usually a safe and established procedure subject to the stringent evaluation of donor’s health status.
Dr P S Vali,
MD (Gen Med) DM (Nephro)