Kidney transplantation is a surgery in which a healthy kidney enters the recipient’s body from a donor. A healthy kidney is received from a living or deceased donor. It should also be noted that only the family of a person or persons with specific characteristics and factors can donate a kidney to you. The donor can live with a healthy kidney.
Kidney transplantation, like other surgeries, is associated with complications and risks; These side effects include the following:
Bleeding
Infection
Obstruction of blood vessels connected to the new kidney
Leakage or blockage of urine in the urethra
The new kidney does not work at the beginning of the transplant
After the transplant, your body may reject your new kidney. Rejection is a natural reaction of the body against the entry of an object or foreign tissue into it.
When a new kidney is transplanted into a person’s body, the body’s immune system recognizes the new tissue entering the body as a threat to the body and attacks the newly arrived organ.
To keep the transplanted organ healthy, doctors use various immunosuppressive drugs to prevent the rejection of the new kidney, and in fact mislead the person’s immune system, which ultimately leads to the acceptance of the new organ and to it Do not attack.
Medications that a person uses to prevent or treat rejection of a new organ have different side effects that vary depending on the type of medication.
Not all people with kidney problems can have a kidney transplant. People with the following conditions cannot have a kidney transplant:
• The presence of an infection or recurrent infections in the body that cannot be completely cured.
• The presence of cancer, if it has left its original place and has spread to other parts of the body.
Severe heart disease or severe problems that generally increase the risk of surgery.
• The problem is not resolved if the transplant is performed.
There are other risks, depending on your medical condition and the health of your body; Therefore, it is recommended that you consult with your medical team about all of your issues and physical condition prior to surgery.
To receive any non-living donors, your name must be on the waiting list of the Organ Donation Network. Extensive tests and examinations will be performed on you to wait in line for a transplant.
The transplant team is responsible for reviewing the conditions and advancing the transplant process. The transplant team includes a transplant surgeon, a nephrologist (physician specializing in and treating kidney disease), one or more nurses, a social worker, and a psychiatrist or psychologist. Other transplant teams, such as a nutritionist or anesthesiologist, may be seen on some transplant teams.
• Mental health assessment: Prior to organ transplantation, a person’s psychological and social status, including stress, financial issues, and the extent to which a person is supported by family or others is assessed. These issues can be very effective as a result of the link. Such assessments will also be performed on the individual if the organ donor is alive.
Blood test: A blood test is done to find the right donor, to check the priority of the person in the waiting line and to reduce the possibility of the organ being rejected by the patient’s body.
Examination: In the process of these examinations, the health of the person’s kidneys and the health of his body in general will be examined. These examinations and tests can include x-rays, ultrasounds, kidney biopsies, and dental examinations; For women, examinations such as Pap smears (examination of cervical cells), gynecological examinations (gynecological diseases) and mammography (X-ray of the breast) will be performed along with other tests.
In general, the transplant team determines the patient’s need for a transplant and whether the person in question needs an organ transplant before the operation by putting together medical records, the results of examinations and tests taken from the patient. Once the medical team confirms your need for a kidney transplant, your name will be on the UNOS list and you will be notified as soon as the organ is found and you will have to go to the hospital for surgery. Be present.
If the donor is a living member of your family, you will be notified of the transplant date and no longer have to wait in line to receive the organ. The important point in this situation is that the donor blood must be compatible with the patient’s blood and be in good physical condition. Prior to the transplant, a mental health test is taken from the donor to ensure that the decision is entirely his or her own.
The transplant team will explain how you work and you can clear up any ambiguities by asking a question.
You must sign a consent form that allows your medical team to have surgery. Read this form carefully and ask about it if part of it is not clear to you.
• If you had regular dialysis before the visit, you will also be on dialysis before the operation.
• If you receive an organ from a live donor, you should not eat anything for eight hours before surgery. In cases where a donated kidney has been taken from a dead body, the patient should not want anything from the time the kidney is notified that the kidney is available.
Some sedation may be used before the operation to keep you calm.
• Depending on your medical history, the transplant team may ask you questions about your specific condition to prepare for possible events ahead.
Kidney transplants are performed in a hospital setting and the procedures will vary depending on your medical team and medical condition.
Generally; Kidney transplantation is performed according to the following steps:
At first, the patient takes off his clothes and puts on hospital gowns (comfortable hospital clothes).
An IV line forms in your arm or hand. Other catheters (tubes for transferring fluids) may be placed on your neck and wrists to check your heart condition, blood pressure, and blood samples. Other parts of the body to install these catheters include the clavicle and groin arteries.
• If there is excess hair in the surgical area, the hair in that area will be shaved.
Next, a urinary catheter is attached to your bladder.
• You should lie on your back on the operating room bed.
• The patient will be anesthetized for a kidney transplant. In this case, a tube enters the patient’s lungs through the mouth; The tube is connected to a ventilator, which allows the patient to breathe during the operation.
An anesthesiologist in the operating room regularly monitors your heart rate, blood pressure, breathing status, and oxygen levels during surgery.
The skin of the surgical site is cleansed and disinfected with a disinfectant solution.
A slit is made by the surgeon in the lower abdomen and on one side of the body. Before the operation, the surgeon re-examines the donated kidney for appearance.
At this stage, the donated kidney is placed inside the patient’s abdomen. If the donated kidney is on the left side of the body, it is located on the right side of the patient’s body, and if the kidney is on the right side, it is grafted on the left side of the patient’s body; The reason for this is the easier connection of the urethra to the bladder.
In all donated kidneys, the renal artery and vein connect to the external iliac artery (external site).
• After the arteries and veins are connected, the blood flow through them is examined to detect and prevent any bleeding from the suture.
At this stage, the ureter (the tube that carries urine out of the kidney) to the donated kidney is attached to the patient’s bladder.
The patient’s incision is sutured with a surgical stapler or suture.
To prevent swelling of the wound area, a drain may be placed in the area.
In the last step, a sterile bandage is placed on the patient’s wound and carefully bandaged.
Before having a kidney transplant, it is best to talk to your doctor about the procedure and what is going to be done on your body.
After the operation, the patient is taken to the resuscitation room. Once the patient’s blood pressure, heart rate, and respiration return to normal and the person regains consciousness, he or she is transferred to the Intensive Care Unit (ICU) and monitored closely.
Once the patient has the necessary conditions to leave the intensive care unit, he / she will be transferred to the ward, at which point you can return home after recovery. Usually, after a kidney transplant, the patient must stay in the hospital for a few days before discharge.
• If the kidney is a donation from a living person, it starts producing urine immediately after being placed in the body, but if the kidney is taken from the body of a dead person, it takes some time to produce urine by it; Therefore, in this case, you should continue your dialysis after the transplant until the urine production process returns to normal.
A urinary catheter is attached to your bladder that expels urine from your body. Your doctor will also check your urine level to make sure your new kidney is working properly.
As long as you are able to eat and drink yourself, nutrients enter your body through the intravenous (IV) line.
• Your medical team will monitor the effectiveness of antiretroviral drugs (antirejection drugs or immunosuppressive drugs that prevent rejection of the transplanted organ) at all times so that you can get the best dose and combination of your medications during this time. Consume.
You will also usually have a blood test. To check the condition of your new kidney and other organs of your body including the liver, lungs and circulatory system.
Over time, your nutrition will slowly shift from liquids to solid, normal foods; But in general, you will have nutritional limitations until your new kidney is fully functioning in your body, and you should follow your doctor’s advice.
Usually after one day of the transplant, you can move; After your doctor allows you to move, you should get out of bed several times a day and be active.
• If you have pain, you should take painkillers under your doctor. Be careful not to use aspirin or painkillers that increase the risk of bleeding. Under any circumstances, take only the medications recommended by your doctor.
• Nurses, pharmacists, nutritionists, physiotherapists and other specialists on your transplant team will teach you how to take care of your body and your wounds so that you can take good care of yourself after your discharge from the hospital.
• Once your vital signs have stabilized, your transplanted kidney function is working well, and you no longer need hospital care, you are ready to be discharged and go home.
Here are some things to look for after a kidney transplant:
• Once you are discharged from the hospital and return home, it is very important that you always keep your wound dry and clean; Your doctor will instruct you on the correct bath in this situation. In general, since moisture increases the risk of infection, the wound area of your body should not enter the water. The stitches or staples of your wound are removed under the supervision of a doctor during the appointments you see your doctor.
• You will not be allowed to drive after the transplant unless your doctor has given you permission; So someone should help get you from the hospital to the house or from the house to the doctor’s office for examination.
• Any activity or situation that puts pressure on the new kidney should be avoided.
Check your blood pressure and weight every day at home; An increase in these cases can indicate that your kidneys are not doing their job well. If you see this, contact your transplant team immediately for a thorough review.
Fever, which may indicate rejection of a new organ or infection in the body.
Redness, swelling, bleeding, or discharge from the cleft palate.
Increased pain in the cleft palate, which may indicate new organ rejection or infection.
Fever and allergies in the kidneys are one of the most common symptoms of organ rejection. Elevated blood creatine levels (as determined by a blood test) or high blood pressure can also be a sign of rejection. In general, the symptoms of rejection can be similar to other medical conditions and diseases; That’s why you should talk to your medical team about the smallest details and take your routine checkups seriously.
Avoid going to places where a person may be sick and have the disease transmitted to you; This is because the medications you take suppress your immune system to prevent kidney failure, so your body will be vulnerable to a variety of diseases. Therefore, you should be cautious in the field of various diseases for the rest of your life.
Note that in this article, you will be given superficial and general information, but depending on each person’s condition, his medical team will prescribe unique instructions for him; Therefore, in these situations, be sure to follow your doctor’s recommendations.
In order for the new kidney to remain healthy in your body and not be rejected, your doctor will prescribe medications that you must use for the rest of your life; Each person’s body response to these drugs can be different. Anti-rejection drugs are constantly being developed and upgraded, and your medical team will prescribe the right drugs for you by examining your body condition.
You will usually be given a specific set of painkillers at the beginning, but they may be given in different doses depending on your individual condition. Because anti-rejection drugs weaken the immune system, your risk of infection is much higher if you take them; Therefore, the use of these drugs should be in such a way that in addition to not rejecting your kidneys, your body is not defenseless against infection and has resistance that is controlled by your doctor.
Some of the most common infections you may have are: thrush (white-gray bumps on the mucous membranes of the mouth or tongue), herpes, and respiratory infections.
Therefore, do not be in the crowd or in contact with people who are at risk for infections for several months after the transplant.
You will need treatment when your kidney function is impaired; There are generally two treatments for an unhealthy kidney: dialysis or a kidney transplant. Many people find kidney transplantation to be a better method because they think it will give them more freedom of action and less restraint for the patient. To decide on the right treatment, it is best to consult with people who have had a kidney transplant, your doctor or family members. Here are some common questions about kidney transplants and the answers to them:
When a kidney transplant is performed before a person needs dialysis, it is called a preventive kidney transplant, which eliminates the need for dialysis altogether. When a transplant is performed shortly after kidney failure (after a short period of dialysis), it is called an early kidney transplant. Both methods have benefits for the patient, and research in this area has shown that performing a transplant before dialysis or after a short period of dialysis is more effective in the long run. The use of these two methods, in addition to reducing the cost of treatment, makes the patient less restrictive after transplantation and has a better quality of life.
Kidney transplants can be performed for all ages, from children to the elderly. First you need to be healthy enough to do this; You should also not have cancer or infection. People who want to have a kidney transplant undergo a variety of medical and psychological examinations to make sure they are suitable for organ transplantation. Preoperative examinations identify problems in the patient’s body that can be resolved by the time the transplant is performed. In general, for most people with kidney problems, a kidney transplant is a good option for treatment.
In many cases, people who are elderly or have certain complications, such as diabetes, can have a successful kidney transplant. To have a successful transplant in this situation, careful examinations must be performed so that the doctor can reduce the potential risks as much as possible. Your doctor may also ask you to do things that will help reduce your risk and increase your chances of a successful transplant; For example, your doctor may ask you to lose weight or quit smoking if you smoke.
If you have diabetes, you may also be able to have a pancreas transplant. To do this, you should talk to your doctor about having a pancreas transplant along with a kidney transplant.
One of the things you and your medical team need to be aware of after a transplant is kidney rejection. Kidney reflux occurs without any symptoms and can occur even after a period of surgery.
Today, thanks to advanced anti-rejection drugs, the likelihood of transplant rejection is greatly reduced; However, the probability of this occurring in different people is different. For most people, rejection can be stopped if they use certain anti-rejection drugs. In general, the best way to prevent this from happening is to have regular check-ups and examinations, which will ensure that your new kidney is functioning properly and that the body is not rejecting it.
When you can start your career depends on how well you improve, your job and your medical condition. Many people can start working about eight months or more after their transplant. In this regard, the medical team will advise you on the decision to return to work.
People who do not have satisfactory sex due to kidney problems will notice a positive effect on their relationship as the recovery period progresses. In addition, your fertility will increase after the transplant. Men who have a kidney transplant, healthy children, and women who have had a transplant will also have successful pregnancies. If you are planning to have a baby, it is best to talk to your doctor about the timing.
Women who have had a kidney transplant should refrain from becoming pregnant for some time after the operation; Most authorities agree that women should wait a year or more after pregnancy to become pregnant. Pregnancy should be well planned and medications that can harm the developing fetus should be stopped six weeks before pregnancy; Contraceptive counseling can also be helpful in this regard. Another important point is to protect yourself against sexually transmitted diseases, in which case it is recommended that you observe the necessary health items.
In general, people who have had a kidney transplant should eat a heart-healthy diet (eat low-fat, low-salt foods) and drink plenty of fluids. If you have diabetes or other problems, you may have restrictions on your diet, depending on the circumstances. A nutritionist can help you plan the right meals.
As mentioned, you can get a transplanted kidney from a deceased person who donated your kidney, or a living person can donate one of his or her kidneys to you. Although in both cases your kidney is working well, if you receive it from a live donor, the transplanted kidney will not only start working faster in your body, it will also have a better quality of work and will last longer.
To receive a kidney from a deceased donor, your name will be placed on a waiting list to receive a transplant once it is determined that you need a transplant; In these cases, it may take years for a kidney to fit your condition.
You may also need dialysis from the time your name is listed until the kidney is found; You should also have regular blood tests during this time to make sure you are ready to receive a kidney if it is found.
Your health center will provide the necessary tests to perform the necessary tests, and since it must notify you immediately after the kidney is found, it is necessary to have the information necessary for immediate access to the persons on the list. Once all the right transplants have been found, the transplant should be done as soon as possible.
One of the disadvantages of this method is that a healthy living person has to undergo surgery and a healthy kidney is removed from his body. It also takes time for the kidney donor to recover and return to a normal life due to surgery. However, with advances in surgery, there are methods (called minimally invasive surgery or laparoscopic surgery) that can be used to make very small incisions instead of large incisions in the body. Shrinking incisions in the patient’s body means shorter recovery times, less pain, and a quicker return to normal life.
Live organ donors are usually between the ages of 18 and 60, although the acceptable age for organ donation can vary depending on the health center and the individual’s health. To donate an organ, the donor must have factors that match the recipient, including blood type, tissue type, and so on.
The donor undergoes rigorous laboratory tests, examinations and physical tests; These tests are done to make sure that the person is healthy and that he or she has made an informed decision. The final decision on whether the donor will be accepted for organ donation will be made by the medical team at the medical center after the necessary examinations.
The important thing to keep in mind is that buying and selling organs is completely illegal, and if you do, it will be prosecuted and punished.
The positive aspects of organ donation from a living person to the recipient
Quality of life: The transplant operation for the recipient can greatly improve his health and quality of life and allow the person to return to a normal life. After an organ transplant, recipients can spend more time with family and friends, be more physically active, and pursue their interests more seriously.
Increase life expectancy: Kidney transplantation can increase a patient’s life expectancy by about ten years and improve his quality of life. As you know, dialysis is not a good alternative to a healthy human kidney. People who have had a kidney transplant, in addition to no longer needing weekly dialysis, do not have the side effects of dialysis, including nausea, vomiting, low blood pressure, muscle cramps, and itchy skin.
Short waiting time: Due to a shortage of donated organs, people who have been waiting in line for a list of deceased organ transplant recipients usually have to wait a long time (sometimes several years) to receive an organ. Patients who find their living donor will not have to wait in line for an organ donation.
Better results: Patients who need a kidney transplant receive better results than those who have received a kidney from a living donor. In most cases, a kidney received from a living person has a longer lifespan than a kidney received from a dead body. Also, the genetic compatibility between the living donor and the recipient patient reduces the risk of organ rejection.
Immediate operation: The kidney that is transplanted from a living person will start working immediately after being placed in the recipient’s body. In some less common cases, when a transplanted kidney from a dead body is placed in the recipient’s body, it takes some time for it to start working, during which time the person will need dialysis.
Kidney donation for the donor includes good aspects such as:
Experience the good feeling: Saving the life of a fellow human being will definitely make the donor feel very good. Serving humanity and giving life to another human being is one of the positive aspects of organ donation.
Spending more time with loved ones: One of the best options for organ donation is our close people and loved ones. By donating an organ to a loved one, we can increase his or her lifespan and, as a result, spend more of our lives with the person in question.
Benefits for both the donor and the recipient
Flexibility: Kidney transplantation can be performed at any time that is convenient for the donor and recipient, so the necessary planning can be done easily.
More opportunities for people on the membership list: By receiving a membership from a living person, you do not need to register on the membership list, thus increasing the opportunity for people on the list, which is about one hundred and fourteen thousand people to receive membership. By doing so, people who are unable to find a living donor can be given a chance at life.
Immediate effect: The effect of a living donor organ transplant is very rapid, so that the patient will feel the impact on his health immediately after surgery.
Organ donation will not affect the life of the donor, and most donors, after recovery, will continue to live a normal, healthy life. In kidney transplants, the recovery period for donors is short, and in general, a person can return to a normal life after two to six weeks.
Although the organ transplant process is often successful, it can also have side effects for the donor or recipient; So before doing anything, make sure you get the necessary information about this field and future conditions from a specialist doctor.
Impact of the transplant on the body: In people who have donated one of their kidneys, the other kidney gets a little bigger, because it has to do what the two kidneys do at the same time alone.
Potential risks to the donor: Like all surgeries, organ donation may have short-term or long-term consequences for the donor. Complications of surgery include pain, infection, blood loss, blood clots, allergies to anesthetics, pneumonia, damage to tissues or organs around the surgery site, and even death. However, due to the fact that organ transplantation is a common operation and the technology of surgery is also advancing, the potential risks of this operation are decreasing day by day.
There is currently no long-term, comprehensive global information on the risks of organ donation; But now in this field, studies have been done and information has been collected. However, based on the limited information available on the risks of organ transplantation, the risks of this surgery are generally considered low. The risks of organ transplantation can vary depending on the donor and the donated organ.
In the case of a kidney transplant, there is only a one percent chance that the donor will have kidney failure in their lifetime. To look at this perspective, it is good to know that 3% of people worldwide are at risk for kidney failure.
In general, three out of ten thousand people may die during a surgery; It should also be noted that in the practice of organ donation, neither the life of the donor is reduced nor his quality of life and health is endangered. Another potential risk factor for a kidney donor is high blood pressure.
Limited information on the impact of organ donation on donors’ lives in the long run: Unfortunately, there is limited information on organ donation life in the long run on the Organ Donation and Transplant Network (OPTN). According to data collected from the network from 1998 to 2007, of the 59,075 people identified as living kidney donors, at least 11 have registered on the kidney transplant list for transplantation; Of course, it is not clear whether the registration of donors in the kidney receiving list had anything to do with donating their organs.
Pregnancy: Studies have shown that donating a kidney or part of a liver will not affect a woman’s pregnancy or childbearing; However, if you want to donate an organ, you should definitely talk to your doctor about your plans for having a baby. Everyone has different medical and physical conditions and in this regard, only a specialist doctor can make the right prescription for you. According to a recent study in Toronto, women who have had a kidney donation are more likely to develop high blood pressure during pregnancy or preeclampsia; According to the same research, the risk increase in this case was not very high (about six percent) and in fact women who have donated their kidneys can also successfully go through their pregnancies.
Restrictions on finding a job for the donor: Some organizations and departments, such as the police, fire department, military unit, and… may not employ people with a kidney; Therefore, before donating an organ, get the necessary information in this regard.
