What is a Kidney Transplant?

Replacement of diseased or non-working kidneys with a healthy kidney from a living or brain dead donor. One can live long with one kidney also if it is functioning properly. It is for patients who have end-stage renal disease. The Kidney transplant surgeries are of two types :

• Living Donor Kidney Transplant Surgery: The kidney is taken from a close family member or spouse who is compatible and willing to donate. A thorough examination of the donor is done before accepting a candidate.
• Cadaveric or Deceased Donor Kidney Transplant Surgery: In this, the kidney is taken from a brain-dead person and the family members have consented to donate their organs. Extensive blood tests are done on both donor and recipient.

For more information on Kidney Transplantation criteria, please read Kidney/Renal Transplant Guidelines in India

The procedure of Kidney transplant :-

The procedure starts by the new kidney placed on the lower right or left side of the patient’s abdomen from where the nearby blood vessels are surgically connected. The artery and vein of the kidney will be attached just above one of the legs to an artery and vein in the lower part of the abdomen. To allow urine to pass out of the patient’s body the new kidney ureter, the tube that links the kidney to the bladder, will be connected to blood vessels and the bladder.

Benefits of Kidney Transplant :-

A successful kidney transplant can benefit the patient drastically. The patient will be able to get back to its normal lifestyle after the surgery and can go for a normal diet and opt for more fluid intake. After the transplant, the patient needs not depend on dialysis. Anemia which is a common problem with kidney failure might also be corrected. The success rate depends on the type of organ transplanted, by the number of organs transplanted and the type of disease that caused the organ to fail. For single organ transplants, the success rate is 80 % to 90 % and a 5-10 year survival rate.

It is common knowledge that the liver is the largest internal organ weighing about 3 pounds and acts as a storage house by removing toxic byproducts of certain medications. Liver Transplant is an operation that replaces a diseased liver with a healthy liver or a segment of a liver from another person called the donor. The most common technique is Orthotopic Transplantation in which the liver is removed and is replaced by the donor organ in the same anatomic location as the original liver. Liver failure can occur suddenly or as a result of complications from certain medications. Liver transplants are the most accepted treatment for end-stage liver disease and acute liver failure. After a transplant, the patient will be free from the disease and lead a fairly normal life. Liver Transplants are classified as

• Deceased Donor Liver Transplant (DDLT): The full liver is used when the donor organ comes from a brain dead but the heart-beating donor.
• Living Donor Liver Transplant (LDLT): A half (or hemi) liver is used when the donor organ comes from a living donor.
• Auxiliary Transplantation: In this, a part of the liver of a healthy adult donor (living or cadaver) is transplanted into the recipient. The patients’ diseased liver remains intact until the auxiliary piece regenerates and assumes function and then the diseased liver may then be removed.

Liver Transplant Procedure The procedure involves a few steps :

The surgery usually takes 5 to 6 hours

Liver Transplantation is performed under general anesthesia.

Prior to surgery, a tube is placed through the mouth of the patient into the windpipe to help to breathe during the operation.

A Y-shaped incision in the abdomen is made and the diseased liver is removed. The donated liver is then inserted and attached to the major blood vessels and to the bile ducts. The incision is then closed at the end of the surgery.

Advantages of Liver Transplant :-

It provides a chance for a longer active life.

If the transplant is performed before the recipients’ health deteriorates then they are able to tolerate the surgery and recovers more quickly.

The recovery can sometimes become difficult but the anti-rejection makes the process easy.

The donors will discharge in a week and recipients in 2 to 3 weeks.

Post-Liver Transplant :-

The process involves carrying out daily life activities and recovering to the level of health. The process can be slow which includes simple activities like walking, deep breathing to ensure the lungs stay healthy to prevent pneumonia, well-balanced diet and exercise to build up the muscles weakened by illness.

A special type of therapy for those patients who are suffering from certain diseases or cancers is known as bone marrow transplant (BMT). Bone marrow transplant, also known as hematopoietic stem cell transplant or stem cell transplant, includes taking of cells that can be found in the stem cells (bone marrow). These cells are filtered and are then given back to either other person or to the donor (patient). The aim of BMT (bone marrow transplant) is to transfer healthy bone marrow cells in a patient when their unhealthy bone marrow has been treated for destroying the abnormal cells. Following are the diseases that can be successfully treated by BMT that include –

Some solid tumor cancers :-

• Leukemias
• Multiple myeloma
• Severe aplastic anemia
• Immune deficiency disorders
• Lymphomas

Different Types of Bone Marrow Transplants :-

A number of bone marrow transplants are there that primarily depends on the donor that include –

• Allogeneic Bone Marrow Transplant: This implant requires a genetic type of donor similar to the patient. The stem cells are then taken by apheresis or bone marrow harvest from a genetically-matched donor. This generally involves a sister or brother. Some of the other donors are-
• Unrelated Bone Marrow Transplants: An unrelated donor provides genetically matched stem cells or marrow. National bone marrow registries can provide these types of donors.
• A Parent: When the genetic match is minimally identical to the recipient and a parent is a donor then it is known as a haploid-identical match.
• Umbilical Cord Blood Transplant: Right away after the delivery of an infant, the stem cells are then taken from an umbilical cord. They then reproduce into functioning and mature blood cells that more effective as compared to those stem cells taken from the bone marrow of other adult or child.
• Autologous Bone Marrow Transplant: A patient is itself a donor. In this transplant, stem cells are taken from a patient by apheresis or bone marrow harvest. These cells are then given back to a patient after they have been frozen. Rescue is the name given to this process.

When do people need stem cell transplants?

A bone marrow transplant is required for certain reasons. A normal bone marrow transplant can be provided to those –

• Patients who are suffering from a genetic disease that may affect different body organs.
• Patients whose bone marrow has been damaged by radiation therapy and chemotherapy for treating cancer.
• Patients whose bone marrow stem cells are defective or abnormal.
• Patients who are relatively in good health in spite of their associated condition.

What is Corneal Transplant?

Cornea transplant (corneal grafting) is the process by which a diseased cornea of the patient is replaced by the donated cornea graft or tissue. The surgery can be done in total with penetrating keratoplasty and also in part with lamellar keratoplasty. In this procedure, a clear healthy corneal is placed by removing the diseased opaque cornea in order to restore the lost sight by permitting the light rays to enter with the help of the clear transplanted cornea.

Types of Cornea Transplants :-

• Penetrating (full thickness) Cornea Transplant: This kind of transplant involves transplanting all the layers of the cornea from the donor.
• Lamellar Cornea Transplant: In this, the surgeon only replaces some of the layers of the cornea with the transplant.
• Lamellar transplants are the most appropriate transplant when the disease process is limited to only a portion of the cornea.

Indications of a Corneal Transplant?

• Vision cannot be corrected with eyeglasses or contact lenses
• In the case of swelling which cannot be healed by any medications.
• Hereditary corneal failure, such as Fuchs’ Dystrophy
• A steep curving (Keratoconus) of the cornea
• Corneal failure after other eye surgery, such as cataract surgery
• Injury leading to scarring

Procedure for Corneal Transplant :-

The surgical process of cornea transplant does not require any hospitalization and is performed under general anesthesia. The tissue is examined thoroughly before donor corneas are used for transplant. To control the continuous blinking and eye movement, an injection is released into the eyes of the patient. Many times a surgeon also uses eye drops to numb the eye.

The surgeon then examines the concerned area to understand the requirement of the size of the donor tissue. The surgeon first removes a similarly shaped button part of the tissue from the patient’s affected cornea and then places a similarly shaped button from the donor tissue. This button is then sutured into a proper place. In the end, the surgeon will cover the patient’s eye with a plastic shield to protect it from being rubbed.

Heart transplantation is a surgical process that undertakes to replace a diseased or non-functioning heart with a healthy one. The surgeon removes the heart of patients by making a transaction in the aorta, the main pulmonary artery and the superior as well as inferior vena cavae, and then dividing the left atrium. This leaves the back wall of the left atrium that has the pulmonary vein openings in place. After this, the donor’s heart is connected by sewing together the recipient and donor vena cavae, aorta, pulmonary artery and left atrium.

The donor for a heart transplant is someone who is either brain dead or on ventilation. After removing the healthy heart from such a patient it is dipped in a solution before the transplant takes place.

Who needs a heart transplant?

There is a very careful selection of the patients who need this procedure. More patients need a transplant as their hearts can no longer pump enough to supply the blood with oxygen and nutrients to the other organs. While the others have a good heart pump, but a bad “electrical conduction system” that determines the rate, rhythm, and sequence of contraction of the heart muscle. This might become a reason for various problems.

Many people with “end-stage” heart disease where the heart is not functioning properly, but the other important organs should be in good shape. But if the patient is suffering from an infection, cancer, bad diabetes mellitus, or smoke/alcohol abuse, they cannot undergo the surgery.

It is necessary that the patients should experience psychological testing whether they can good in compliance with medications, changes in lifestyle and recovery after the surgery. Even the donor should also be well-matched with the blood type and body size of the patient.