Being a Dialysis Care provider for more then one and a half decade and now for over 5 years providing holistic care through Epitome Kidney Urology Institute, New Delhi; I have had opportunity to witness patients closely, interact with them, understand their fears, pain, suspicion of every recommendation their doctors may give them, their confusion whether to start dialysis, go for kidney transplant or just live life without any treatment.
Witnessing all these situations, emotions, and expressions long back, I had started believing that the patients deserve to know everything they are going through and may experience in the future. And for a patient or their family, the only way to gain this knowledge is by asking questions. So I thought of curating a list of questions a patient should ask to get relevant information at any specific stage of their journey with kidney failure.
In this blog post, I will list down questions the patients should ask their Nephrologist and treating team when considering a Kidney Transplant.
Initially, I assumed compiling transplant questions would be simple. But as I began, I quickly realized how challenging it truly is. If, after fifteen years in this field, I found it difficult, imagine how overwhelming it must feel for patients. That realization inspired me even more, hoping my efforts could be of some help.
Let’s begin with the list :-
While considering the Kidney Transplant
- Am I a good candidate for Kidney Transplant ?
- The kidney transplant process ?
- Who can donate a kidney to you ?
- Laws that regulate organ transplants including kidney transplant in India, and how does the legal approval process work ?
- What if my relatives/people who want to donate a kidney do not match blood group ?
- What is a swap transplant ?
- What are antibodies and what role they play in success of transplant ?
- Details of Pre-Transplant formalities, tests and regulatory approvals ?
- How much does Kidney Transplant cost ? And what will be the associated costs of medicines after the transplant?
- How does donating a kidney impact the donor ?
- How complex is the surgery and how long does it take ?
- What is the ideal recovery time to start living life normally after a kidney transplant for Kidney Donor and Kidney Recipient?
- What can go wrong during Kidney Transplant surgery ?
- What is the average life of a Transplanted Kidney ?
- Lifestyle freedom or restrictions one will have to follow after a kidney transplant ?
- Precautions to take after a Kidney Transplant ?
Every individual and every patient is different and hence depending on your specific health and other conditions, the answers to the above questions may differ from others. Let me remind you again: this blog or any other content will help you identify the questions you should discuss with your treating Nephrologist and medical team. In no manner is this information complete and necessarily specific to your clinical needs. Use this information to better prepare for your meeting with your treating doctors.
Let’s pick one question at a time and try to address it for general awareness.
Am I A Good Candidate For A Kidney Transplant?
As someone who has worked extensively with kidney failure patients, I can tell you that kidney transplant is often the best treatment option for patients with end-stage kidney disease, offering better quality of life and longer survival compared to dialysis.
However, not everyone is an ideal candidate, and several factors determine your eligibility.
Let me break down when you might be a good candidate:
- If you have chronic kidney disease (CKD) stage 4 or 5, or you’re already on dialysis (whether it’s hemodialysis or peritoneal dialysis), you’re likely tobe in the consideration zone.
- You need to be generally healthy enough to undergo major surgery and tolerate immunosuppressive medications – I know it sounds daunting, but your doctors will assess this thoroughly.
- Your cardiac health matters a lot because the surgery puts stress on your heart. However, considering many kidney failure patients suffer compromised heart health due to ESRD itself, a transplant may be great for their heart health as well.
- You shouldn’t have active infections, untreated cancer, or severe mental health conditions that could affect your post-transplant care. These aren’t permanent barriers in many cases – we just need to address them first.
- Here’s something important – you need to be committed to lifelong medication adherence and regular follow-ups. I tell all my patients this is a partnership, not just a one-time procedure.
Few Factors that may affect candidacy:
- Advanced age (though age alone isn’t a barrier—biological health matters more)
- Uncontrolled diabetes or severe vascular disease
- Active substance abuse or smoking
- Morbid obesity (BMI >40) may require weight loss before transplant.
- Recent history of cancer (waiting periods vary by cancer type)
Important: Each patient is unique, and a comprehensive evaluation by a transplant nephrologist in Delhi or your city will determine your specific candidacy. Centers like Epitome Kidney Urology Institute conduct thorough pre-transplant assessments to ensure patient safety and transplant success.
What Is The Process Of Kidney Transplant Or The Steps Involved In Kidney Transplant?
A clear understanding of the kidney transplant journey helps patients and families prepare better, both psychologically and logistically. To better understand, we can break the entire process into several stages, right from evaluation to care required after transplant.
Pre-Transplant Evaluation Phase (2-4 weeks):
- Patient’s complete evaluation, including blood tests, imaging, heart/cardiac assessment, and psychological evaluation, HLA matching, antibody screening, etc.
- A similar evaluation is done for potential kidney donors related to the patient.
- Registering in Cadever Donor Registries (an option people shall explore)
- Legal documentation and authorization committee approval
- Financial counseling and insurance verification
- If no suitable living donor is available, you may consider enrolling for the deceased donor waitlist (though waiting times in India can be lengthy).
- Swap transplant programs at Epitome Kidney Urology Institute can be of help if direct donation isn’t possible.
- Asking a family member to donate kidney can be a daunting task in itself but this is a topic that requires a lot detailed discussion & tobe dealt with separately.
Hospital Admission & Surgery (7-10 days):
- Patient and Donor both are admitted at least. The transplant surgery itself takes 3-4 hours which includes process of taking out kidney from Donor and transplanting it to the receipient.
- The Kidney donor generally is shifted to the room post-surgery and is discharged within 3-4 days post-surgery.
- The kidney recipient is kept under strict observation in “Kidney Transplant Unit” or KTU, which is actually an ICU specifically designed to keep kidney transplant patients immediately after transplant.
- Post-operative monitoring for 3-5 days.
- Close monitoring of new kidney function and medication adjustments
Post-Transplant Follow-Up:
- Frequent visits in first 3 months (weekly, then bi-weekly)
- Regular blood tests to monitor kidney function and medication levels
- Gradual spacing of visits to monthly, then quarterly after the first year
- Lifelong immunosuppressive therapy to prevent rejection
Who Can Donate A Kidney To You?
This is one of the most hopeful questions I hear.
One of the most encouraging aspects of kidney transplant is that living donation is possible, and here’s something important: kidneys from living donors generally perform better and last longer than those from deceased donors.
Kidney donation in India is strictly governed by the Transplantation of Human Organs and Tissues Act (THOTA), 1994 (with amendments and rules, notably the 2011 amendment and 2014 rules), with an aim to regulate transplants and prevent sale/purchase of organs and abuse of power or exploitation of any kind and I am really glad with the strict provisions of THOA Act.
As per THOA Act any Near Relatives can donate you kidneys without much extensive legal formalities. Below relatives are categorised as Near Relatives as per act.
- Parents (Mother and Father)
- Siblings (Brothers and Sisters)
- Children (Son and Daughter)
- Spouse
- Grandparents (Recently included in the definition)
- Grandchildren (Recently included in the definition)
Any transplant center approved under law in India can do kidney transplant with approval from internal committee for transplant where donor is a near relative donor. However, in case of a non-related donor the approval is tobe taken from an external government-approved committee.
- To further simplify let me list the work an authorizing competent committee does :-
- It verify your donor-recipient relationship to make sure it’s legitimate
- Ensure there’s no commercial transaction happening under the table
- Confirms voluntary consent without any coercion – this is big point for me personally
- They assess medical suitability for both i.e. the donor and receipient.
- Interview you and your donor separately. Don’t worry, it’s not as scary as it sounds – they’re just being thorough.
What If My Relatives Who Want To Donate A Kidney Do Not Have The Same Blood Group As Mine?
I get this question all the time, and I can see the disappointment in families’ eyes when they discover a blood group mismatch. But here’s the good news – and I mean really good news – blood group incompatibility used to be an absolute barrier to kidney transplant, but medical advances have changed things and made it possible (for most of the cases).
In medical terminology we call this ABO Incompitable Transplant.
What is a Swap Transplant?
I feel this is one of the very interesting and most underutilised solutions in kidney transplant and something I find genuinely exciting. Kidney swap transplantat (we also call it paired exchange) helps patients whose willing donors are incompatible.
So how does a swap transplant actually work? Let me explain it simply:
- Imagine two or more incompatible donor-recipient pairs – let’s say you and your donor can’t match, and another patient and their donor can’t match either
- Through a swap program, we match these donors to the compatible recipient in the other pair
- Here’s a real example I often use: If Patient A needs a kidney but their donor (Donor A) is incompatible, and Patient B has an incompatible donor (Donor B), then we have Donor A donate to Patient B and Donor B donate to Patient A. Everyone wins!
- The surgeries typically happen simultaneously at the same hospital or we coordinate between facilities. We do this to ensure fairness and that no one backs out at the last minute.
- The Swap can be among two pairs, 3 pairs or even more at times.
- These programs significantly expands the donor pool and patients who thought they had no options suddenly have hope. However, its not as simple as it may sound. There are lot of complexities which your Medical team will have to take care of.
What If My Relatives Who Want To Donate A Kidney Do Not Have The Same Blood Group As Mine?
I get this question all the time, and I can see the disappointment in families’ eyes when they discover a blood group mismatch. But here’s the good news – and I mean really good news – blood group incompatibility used to be an absolute barrier to kidney transplant, but medical advances have changed things and made it possible (for most of the cases).
In medical terminology we call this ABO Incompitable Transplant.
What Is A Swap Transplant?
I feel this is one of the very interesting and most underutilised solutions in kidney transplant and something I find genuinely exciting. Kidney swap transplantat (we also call it paired exchange) helps patients whose willing donors are incompatible.
So how does a swap transplant actually work? Let me explain it simply:
- Imagine two or more incompatible donor-recipient pairs – let’s say you and your donor can’t match, and another patient and their donor can’t match either
- Through a swap program, we match these donors to the compatible recipient in the other pair
- Here’s a real example I often use: If Patient A needs a kidney but their donor (Donor A) is incompatible, and Patient B has an incompatible donor (Donor B), then we have Donor A donate to Patient B and Donor B donate to Patient A. Everyone wins!
- The surgeries typically happen simultaneously at the same hospital or we coordinate between facilities. We do this to ensure fairness and that no one backs out at the last minute.
- The Swap can be among two pairs, 3 pairs or even more at times.
- These programs significantly expands the donor pool and patients who thought they had no options suddenly have hope. However, its not as simple as it may sound. There are lot of complexities which your Medical team will have to take care of.
What Are Antibodies And What Role Do They Play In Success Of A Kidney Transplant?
Okay, I know “antibodies” sounds technical and maybe a bit scary, but understanding this is actually quite important for your transplant success. Let me break it down in a way that makes sense.
So what are antibodies, really?
- Think of antibodies as your immune system’s souldiers. They’re produced to fight foreign substances like viruses, bacteria, and yes, foreign tissues.
- In transplant, these antibodies can recognize your transplanted kidney as “foreign” and potentially attack it.
- If you have pre-existing antibodies against your donor, they can cause immediate or accelerated rejection. This is why we test for them so carefully.
Again this is something you don’t have to be worried about too much, considering your treating Nephrologist and medical team will already be taking care of it and advise you accordingly.