Kidney transplantation: When and where to perform
If patients have advanced and permanent kidney failure, kidney transplantation is the effective treatment option that allows them to live like the normal. A successful transplant needs coordinated efforts from the whole healthcare team including nephrologists, transplant surgeon, transplant coordinator, pharmacist, dietitian and counsellor. But the most important members of the team are the patients and their families. As a patient, a family member, a relative, we should know the facts about kidney transplant to help the entire team to get the best possible outcome. Kidney transplantation is a procedure that replaces the failed kidney with a healthy one from another person living or dead. However, transplantation is not for everyone. The nephrologists will select patients for renal transplantation and explained the possible outcome. The pre-transplant evaluation may require several visits over the course of several weeks or even months. Patients will need to have blood drawn and x-rays take, will be tested for blood type and other matching factors that determine whether body will accept an available kidney. Cancer, a serious infection, or significant cardiovascular disease would make transplantation unlikely to succeed. If a family member or friend wants to donate a kidney, s/he will need to be evaluated for general health and to see whether the kidney is a good match or not. Suitability of donated kidney recipient is initially based on two factors. -Blood type: Recipient's blood type must be compatible with the donor's blood type. -HLA factors. HLA stands for human leukocyte antigen, a genetic marker located on the surface of white blood cells. After transplantation, there is a fear of rejection. Recipients can help prevent rejection by taking medicines (Immuno-suppressant's) and following diet. Watching for signs of rejection — like fever or soreness in the area of the new kidney or a change in the amount of urine formation — is important. Reporting to the doctor concerned is necessary if any changes observed. Even if the recipients do everything they are supposed to do, body may still reject the new kidney and patients may need to go back on dialysis. So patient after receiving a donated kidney should be extremely cautious. Treatment for kidney failure is expensive, but now a days, it is frequently performed in different hospitals in Bangladesh which lessen the expenditures. Some more new centres are coming forward to serve patients with renal failure. There are certain Government and private hospitals which have the sophisticated set up for kidney transplantation. National Institute of Kidney Diseases and Urology (NIKDU), Bangabandhu Sheikh Mujib Medical University (BSMMU) are the centres for transplantation among Government set up whereas National Kidney Foundation Hospital, BIRDEM Hospital, Popular Specialised Hospital, Labaid Specialised Hospital, Apollo Hospitals Dhaka, United Hospital have transplantation facilities among private settings. There are two types of donation options: living donor and deceased donor (cadaveric) kidney transplant. In abroad, most transplanted kidneys come from people who have died. But in Bangladesh, cadaveric kidney transplantation has not been yet performed. Because, awareness regarding cadaveric kidney donation is extremely low. So, hardly any cadaveric kidney is found for transplantation. Many suitable kidneys go unused because family members of potential donors do not know their loved one's wishes. People who wish to donate their organs should talk about this issue with their families and National Kidney Foundation which provides organ donor cards for people who wish to give the precious live-saving gift when they die. A properly completed organ donor card notifies medical officials that the donor decided to donate his/her organs. Most living people, however, can donate a kidney with little risk. In Bangladesh, according to the current law, only relatives can donate organ. This law has imposed a bar to many patients who need kidney transplant but cannot receive as they cannot manage a relative to donate kidney. They cannot receive kidney from anonymous donor. Again, the number of kidneys donated by relatives is extremely low. A cadaveric kidney donation can remove this disadvantage and also lessen the incidence of organ trading.
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