“Doctor…is there any risk involved if I donate one of my kidney to my ****”, is what a transplant nephrologist invariably has to answer while attending a prospective donor who has been bewildered by an array of unscientific facts. This uncertainty is one of the many and probably the driving force behind not opting to donate kidneys by the medically fit donors. Today, both world over and in India there is a colossal crisis of the donor kidneys for the prospective renal recipients. This void is tried to be nullified by a strong deceased donor programs (where in kidneys are retrieved from brain dead otherwise healthy patients) in the international arena. But in India, barring few places, still such divine and humane programs have to be developed.
Now let me share some information which most of the patients and their relatives fail to understand when hinted by the nephrologists. To begin with, let me start with the basics. Both dialysis and kidney transplant are a form of renal replacement therapy whereby lost functions of the permanently failed kidneys is tried to be compensated by artificial means, to support the vital functions of the body. Even the best form of dialysis, both hemodialysis (blood based therapy) and peritoneal dialysis, commonly known as ‘water dialysis’ or ‘home dialysis’ will only be able to achieve 10-15% of the function of the normal kidney. As per the data from the Unites States of America, once renal replacement therapy is initiated, the range of the expected remaining lifespan in the dialysis dependent population is approximately 8 years for patients between 40 to 44 years of age and approximately 4.5 years for those between 60 to 64 years of age. To further explain, survival of the patients on any form of dialysis after one year is 75-80% and after 5 years is only between 35-40%. These values are worse when they are extrapolated to the Indian population with the existing medical infrastructure. The information could be demoralizing but this is the bitter fact which we all should understand. Now when we compare this data to the survival data of the kidney transplant recipients, both from India and the world over, barring the initial 2 weeks, the overall survival benefit is of the magnitude of around 70%. Kidney transplant recipients survival at 1 and 5 year post surgery is around 97% and more than 90% respectively.
There may be certainly many arguments against patients undergoing renal transplantation, but in my opinion, if the family can afford the cost of the therapy for their loved ones, they should always decide in favor of renal transplantation. One may argue that the surgical procedure involves a great deal of risk both to the recipients and the donors but when selection of the patients is done after performing all necessary investigations prior to surgery, such risks can be and should be taken. Financial burden is another limiting condition which discourages many families to opt against kidney donation. However, in recent times many government schemes have come up through which the cost of the entire procedure would come down drastically.
Leaving aside all the above discussion, in my personal opinion what discourages anybody from donating his or her kidney the most is the uncertainty in the mind of the prospective donor about the life after kidney donation. His decision against donating the kidney is largely influenced by many unscientific reasons. I would now try to clear many of these myths through this literature. These are the most common questions which I routinely have to answer to the prospective kidney donors and their relatives.
1. What are the immediate risks to the donor after the surgery?
Answer: Leaving aside minor complications, major complications including surgery and anesthesia related ones are only 2-2.5%. This would certainly vary from centre to centre but in any case studies have shown that mortality rates among donors in the first 90 days is 3 per 10,000 donors which means that risk involved is very low. Pertinent to this discussion is another useful information. Beyond the perioperative period, survival after living kidney donation is the same as for similar matched individuals who did not donate.
2. When can the donor start his routine activities after getting discharged from the hospital?
Answer: Kidney donors are usually discharged 5-7 days after the surgery. They can start their routine and office work after 2 weeks. In case the job requires heavy work, then this should be avoided for at least 6 weeks. Heavy weight lifting should be avoided for 1 month.
3. Can a kidney donor land on dialysis after the surgery?
Answer: The answer is a bit tricky. If we have to compare the kidney donors to their counterparts who are equally healthy, then the data would say that the kidney donors at a higher risk of landing on dialysis as compared to the healthy counterparts, (dialysis risk approximately 90 per 10000 in the donors and 15 per 10000 in the similar healthy non donors). However this risk is very low as compared to the risk in the general population i.e. 326 per 10000 persons. And we must also learn that most of these studies are always biased towards the healthy non-donors thus giving an exaggerated difference. Even if not so, I would presume that the family members would be ready to take this infinitesimal risk for their dear ones.
4. Can women donate kidneys?
Answer: Female gender is not a contraindication to donate kidneys. However, it is advised that female donors ideally should have completed their family before opting for kidney donation. Nevertheless, given the generally good pregnancy outcomes after donation, women should not be excluded based on plans for possible future childbearing alone. All women who become pregnant after donation should receive regular prenatal care as there is slight increased risk during such pregnancy. This minimal risk can definitely be negated by a good medical follow up during pregnancy period.
5. Is there an increased risk of cancer after kidney donation?
Answer: Till date as per the different studies, the overall risk of developing cancer does not appear to be increased among donors.
6. What is the success rate of the transplant surgery?
Answer: Whenever a patient is counseled for kidney donation, there is an understandable apprehension in his or her mind regarding the fruitfulness of the donation, i.e. whether the kidney given by him to the recipient would work or not. So, as far as the success rate is concerned graft kidney, which is how the transplanted kidney is medically known, survival at 1, 5, and 10 years is approximately 97, 91, and 86 percent, respectively, which is very much reassuring.
7. Is there any other risk involved to the donor?
Answer: Life after kidney transplant is usually the same as it would have been without having been donated the kidney. Post donation, there is definitely increased risk of acquiring diseases like hypertension and gout (increased uric acid in the blood), but a careful follow up in the post operative period can tide over such minor ailments and should not discourage kidney donation. With the above information, I would now believe that most of the disbelief in the mind of the readers would have vanished. As such kidney donation is extremely safe in the era of modern medicine and with the latest technology. It, in most of the cases brings smiles in the family of the recipient who may be the only bread earner for his family or only son or daughter of the unfortunate parents. One can donate kidney to save the life of his or her spouse, mother, father, sister or brother. Though legally not allowed in most places in India, altruistic donation (unrelated donation) is becoming very common practice in the western world and this should also encourage us to donate kidneys to our needy family members.