Kidney Transplant Scenario in India

Kidney Transplant Scenario in India

Kidney Transplant Scenario in India

By Dr. Ramesh Jain, HOD - Centre for Kidney Transplant & Renal Sciences, Saroj Super Speciality Hospital, Delhi , 0

Dr. Ramesh Jain has over 17 years of experience in Nephrology, Dialysis and Kidney Transplantation, during which he has worked at major healthcare institutions such as Sir Ganga Ram Hospital Delhi, Sanjay Gandhi Post Graduate Institute Lucknow, Sunder Lal Jain Hospital, Ashok Vihar, Delhi, Saroj Hospital & Heart Institute, and Maharaja Agrasen Hospital.

Kidneys are bean shaped organs placed on either side of the spine just below the rib cage. The main function is to filter and remove excess waste, minerals and fluid from the blood by producing urine. Kidney transplant is a procedure done though surgery to place a healthy kidney from a live or deceased donor. The transplanted kidney takes-over the work of two kidneys that failed, so that the patient doesn’t need dialysis. Kidney transplant is done when the kidneys lose the ability to filter, and thus harmful level of fluid and waste accumulate in your body, which can raise the blood pressure and result in all kinds of symptoms like swelling of body, low hemoglobin, anorexia, Nausea, irritable itching, and easy fatiguability.

During the transplant surgery, new kidney is placed in the lower abdomen and connects the artery and vein of the new kidney to new body’s artery and vein. The new kidney starts making urine as soon as the blood starts flowing through it. But sometimes it takes few weeks to start normally.

The theme of this year’s World Kidney Day is to raise awareness on the increasing burden of kidney disorders and the ways to prevent it, with an aim to highlight the importance of preventive interventions available. While prevention can be categorized into three phases – primary, secondary and tertiary, lifestyle practices play a vital role. Primary prevention includes certain lifestyle modifications to prevent the onset of kidney damage. Secondary prevention refers to timely diagnosis and optimization of leading factors to kidney damage like hypertension and diabetes. Tertiary prevention is to manage the kidney disease in order to control its progression.

India’s Position at Kidney Transplant in the World
The wait for new and right kidney can be very long sometime in India. Generally, the transplanted kidneys come from the dead donors and some come from family members. About two lakh patients In India are waiting for organs with mere 15000 donors available. The ministry of health calculation says that the annual requirement for kidneys could range between 2-3 lakh with a mere 6,000 transplants occurring in reality.

The variance between demand for and supply of kidneys has led the government to push deceased donor or cadaver donations. The old statistics from the Indian Transplant Registry, a non-governmental initiative by the Indian Society of Organ Transplantation, says that out of the 21,395 kidneys transplanted in India between 1971 and 2015 only 783 were from cadaver or deceased donors.

Also, the lack of awareness and hesitation from the family is some of the main reasons for lower cases of
deceased donors in India. Well post 2012, there is significant increase in the organ donations. The live kidney transplant programme in India has evolved from the past 50 years and is currently the second largest program in numbers after the US.

In respect of making the organ donation program a success the early identification, certification and maintenance of potential donors in the intensive care units is important

The better immuno suppressive drugs and induction agents stop early rejection events and also there has been a various changes regarding using high dose steroids to prevent graft rejection, and this has resulted in lower incidence of post-operative complications after transplant surgery. There have been vast changes in the methods also of transplant. Now, there are minimal invasive methods for managing transplant surgery complications.

Since 2011, there has been a rule in Indian law and amendments that there is a provision of ‘required request’ to the intensive care doctors to ask for organ donation in the event of brain death. As it also makes it mandatory to register it nationally and counsel relatives for organ donation, this has also improved the rate of donation in India.

The responsibility of making donations happen is with hospitals. So in respect of making this program a success, the early identification, certification and maintenance of potential donors in the intensive care units is important. The states that have relatively better are from south India such as Tamil Nadu, Puducherry, Kerala, and Andhra Pradesh. In north, Chandigarh has done well in terms of donors as per million population. As of now, the kidney transplant costs between Rs. 5-6 lakh in private hospitals in the country. And post treatment, the monthly cost is around Rs. 15,000 and life-long medicines that cost Rs. 10,000 per month.

The records in Indian Transplant Registry reported that hat between 1971 and 2015, a total of 21,395 kidneys were transplanted in India, out of which a mere number of 783 kidneys belonged to deceased or cadaver donors. This is mainly due to lack of knowledge of the process and apprehension among Indian families, thereby decreasing the number of deceased donors in the country. The report also says that more than 2.5 lakh people suffer from last stage kidney diseases every year. In that, seven out of 10 patients go for dialysis, and nearly six out of those 10 can’t continue due to heavy treatment fees. There are dialysis centres, but majorly based in cities.

India is the diabetic capital of the world, and increase in the diabetes also leads to proportionate increase in the chronic kidney disease. For patients suffering from kidney disease and come-up at end stage, dialysis and kidney transplant is the only option. Post the transplant, one of the major challenges is to sensitize the patient about the importance of the post-transplant care and due to any negligence which can worsen the condition further and can be fatal.

Kidney transplants and dialysis are two meaningful replacement therapies available which can provide good quality of life or longevity to the patients suffering from kidney failure at affordable costs. Never let any kidney patient feel helpless, or as if ‘the end of life’ is knocking at the doors.