Talk was given at gathering of general physician in Hoshangabad and Sehore

2. Causes of kidney failure

3. Treatment of ESRD

4. Kidney Transplantation
Surgical Milestones
 Ulman, 1902 – kidney to neck vessels
 Carrel, 1912 – vascular techniques
 Kolff, 1940’s – dialysis machine

5. Kolff, 1940’s :
Hemo-dialysis
machines

6. Hume, 1950’s – kidney to femoral vessels

7. Murray, 1956 – current transplant position

8. Transplant – Historical
Aspects
1. 1967 - First successful cadaver
Kidney Transplant in India at
KEM Hospital, Bombay
2. 1994 - First successful heart
transplant done at AIIMS, New
Delhi
3. 1995 - First successful multi-
organ transplant done at Apollo
Hospital, Chennai
4. 1998- First Successful Lung
transplant, Madras Medical
Mission Hospital, Chennai
5. 1999- First Pancreas Transplant,
Ahembdabad

9. Advantage of kidney
transplant
 Benefits:
 Diet less limited
 No time consuming HD
 Feel better physically
 Better quality of life
 More likely to stay
employed
 Less expensive than
HD after 1st year
 Reduced risk of heart
attack, stroke, heart
failure.
 Disadvantage
 Major surgery under
GA
 Need life long
immunosuppression
 Frequent cheeck for
rejection
 Risk of infection

10. Disadvantage of Hemo
dialysis
 Frequent hospital visit –
4hrs X 3 times a week
 Dependence on family
 Dietary restriction
 Access site problems
 Loss of job
 Hemodynamic instability
 Feeling sick all the time
 Costly – 25 – 30000 per
month

11. Comparative analysis

12. Types of Kidney
Transplant
 Living donor
 Related
 Unrelated
 Deceased donor
 Brain dead
 After Cardiac Death

13. Who can donate
 Near relative
 Emotionally related (un related)
 Altruistic donor (USA)
 Paired or Swap transplant

14. Government regulations
 HOTA ACT 1994
 Legalized brain death and removal of organs for
therapeutic purposes
 Banned commercial trading of organs from living
unrelated donor

15. LIVING DONORS

16. Documents - required
 Identity proof – ADHAR card, Voter card, Passport, Ration Card
 Relation proof- marriage certificate , family photographs
 Residence proof
 Affidavit – from donor and recipient and relatives for no
objections
 Income tax return – last 3 years
 Police verification of address

17. Recipient work up

18. Blood group

19. Cross match

20. Donor surgery
Open donor nephrectomy Laparoscopic donor nephrectomy

21. Recipient surgery

22. Cadaver transplant
- Irreversible brain damage.
- Normal renal function appropriate for age.
- No evidence of preexisting renal disease.
- No evidence of transmissible diseases.
- ABO blood group-compatible.
- Negative cross-match.

24. NOTTO( national organ and tissue transplant organization)
Allocation of organs Cordination
Appropraie authority/COUNSELLING
Notify notto Allocation of organs
Transplant cordinater/nephrologist
Call prospective recipient Ready transplant team

25. KIDNEY LIVER HEART
APPROPRIATE AUTHORITY

27. Local authority/SOTTO
COMMISSIONER/COLLECTOR
TRANSPLANT CENTERSAIRPORT AUTHORITY
POLOCE DEPARTMENT
GREEN
CORRIDOR

30. Results

31. Immuno suppresion
 Tacrolimus
 Mycophenolate mofetil
 Prednisolon
 IV solumedrol
 IV basiliximab
 IV ATG

32. Other medication
 Vancyclovir
 Septran
 Pantoprazole
 Fluconazole

33. SWAP transplant

34. ABO incompatible
transplant
 Removal of antibodies before transplant
 Plasmapheresis
 Double filtration plasma pheresis
 IV IG

35. Financial Aspect
 APPROX cost 4,50,000/-
 Donor and recipient work up – 70000/-
 Monthly medication 8-10,000/-
 Government help available for BPL patients
 Some insurance company also cover.

36. Bansal Hospital
 40 transplant till now
 Desensitization
 Post CABG
 Pediatric patient
All donor – laparoscopic kidney retrieval