Kidney Transplantation

Who May Benefit

Assessment for transplantation may be appropriate if you:

• Have end-stage kidney disease and are on dialysis, or approaching the need for it
• Have advanced chronic kidney disease and want a pre-emptive transplant before starting dialysis — which generally gives the best outcomes
• Have a willing and healthy living donor, whether related or as permitted under law
• Have a donor who is blood-group incompatible and want to know whether ABO-incompatible transplantation is possible
• Have no compatible donor within the family and wish to explore paired kidney exchange
• Have a higher body weight or previous abdominal surgery, where a minimally invasive approach may be advantageous
• Have a failing previous transplant and need assessment for a second graft

When Transplantation May Not Be Possible

• Active infection, or a cancer requiring a period of remission before transplantation is safe
• Severe heart or lung disease that makes surgery and immunosuppression too risky
• Circumstances in which lifelong immunosuppressive medication could not be taken reliably — this is discussed openly and supportively, not judgementally
• Every case is assessed individually by the transplant team; an initial “no” elsewhere does not always mean a permanent one

The Procedure and the Alternatives

Robot-Assisted Kidney Transplantation with Regional Hypothermia

The graft is introduced through a small incision and cooled inside the body with sterile ice slush while the artery, vein and ureter are connected robotically. Cooling protects the kidney during the period without blood flow. Compared with open transplantation, published outcomes show less wound-related morbidity, particularly relevant for patients with a higher body mass index.

Open Kidney Transplantation

The established standard approach, performed through an incision in the lower abdomen. It remains the right choice in many cases — complex vascular anatomy, certain re-transplants, or where robotic access would add risk rather than reduce it.

Living Donor Nephrectomy

The donor kidney is retrieved laparoscopically, allowing donors a shorter recovery and earlier return to work.

ABO-Incompatible Transplantation

Where the donor and recipient blood groups do not match, antibody removal by plasmapheresis or immunoadsorption combined with targeted immunosuppression allows transplantation to proceed. This requires additional preparation before surgery.

Paired Kidney Exchange

Where a willing donor is incompatible with their intended recipient, pairs can be matched with other pairs so that both receive compatible grafts.

The Alternative: Dialysis

Haemodialysis or peritoneal dialysis remains the alternative to transplantation, and the right choice for some patients. Transplantation generally offers better survival and quality of life, but it is a treatment, not a cure, and it carries its own obligations.

Investigations Usually Required

For the Recipient

• Blood group and tissue typing — HLA typing, panel reactive antibody, and crossmatch against the intended donor
• Kidney function and dialysis records — creatinine, eGFR, urine output, dialysis adequacy
• Cardiac assessment — ECG, echocardiography, and stress testing or angiography where indicated; cardiovascular fitness is the most common limiting factor
• Infection screening — hepatitis B and C, HIV, CMV, EBV, tuberculosis screening
• Imaging — CT or ultrasound of the abdomen and pelvis, including assessment of the iliac vessels where the graft will be connected
• Urological assessment — bladder function evaluation where there is a history of obstruction or reflux
• Age-appropriate cancer screening and dental review

For the Living Donor

• Split renal function and CT renal angiography — to confirm two healthy kidneys and map the vascular anatomy
• Full medical evaluation — kidney function, blood pressure, glucose tolerance, infection screening
• Independent psychosocial assessment and legal authorisation — as required under the Transplantation of Human Organs and Tissues Act

Important Limitations and Risks

• A transplant is a treatment, not a cure. Grafts have a finite lifespan. Many function well for well over a decade, but some fail earlier, and a return to dialysis or a further transplant may eventually be needed.
• Lifelong immunosuppression is mandatory. Stopping or missing medication is the commonest avoidable cause of graft loss. These drugs increase the risk of infection, certain cancers, diabetes and high blood pressure.
• Rejection can occur at any time. Acute rejection is usually treatable if detected early, which is why regular monitoring matters. Chronic rejection is a leading cause of late graft loss.
• Surgical risks — bleeding, infection, lymphocele, urine leak, and vascular thrombosis of the graft, which is uncommon but serious.
• Delayed graft function — some kidneys, particularly from deceased donors, do not work immediately and require dialysis for a period after surgery.
• ABO-incompatible transplantation involves additional preparation, higher immunosuppression intensity, and a somewhat greater risk of infection and bleeding.
• Donor risk is real. Living donation is safe in carefully selected donors, but it is major surgery on a healthy person, with a small operative risk and long-term follow-up obligations. Donor safety is never subordinated to recipient benefit.
• Robotic transplantation is not suitable for everyone and is chosen on the merits of each case rather than by default.

What a Consultation Involves

A transplant consultation is usually longer than a routine appointment, often 45 minutes or more, and involves both the recipient and, where relevant, the prospective donor:

• Review of your kidney disease — cause, current function, dialysis history, and how urgently transplantation is needed
• Donor discussion — who is available, blood group compatibility, and what donor evaluation will involve
• Explanation of the options — living versus deceased donor, robotic versus open, and where ABO-incompatible or paired exchange might apply
• Assessment of fitness — what further cardiac or other workup is needed before you can be listed
• The commitment involved — medication adherence, follow-up schedule, and lifestyle considerations after transplantation
• Legal and regulatory process — documentation and authorisation requirements under Indian law, explained clearly
• Your questions — from both the recipient and the donor, separately if preferred

Please bring dialysis records, recent blood results, and any previous transplant documentation. Prospective donors are welcome at this consultation and will also be assessed independently.