Are you on the way to Kidney Transplant? We got direction boards

Kidney failure, this is something sounds like end. But, it’s no more dead end because of medical supremacy which introduced kidney transplants and saved many lives. Kidney transplant is a journey in its own. It’s a new birth to a person with new kidneys. In this tough journey we tried navigating you through this transplant series.

We know you are on tough ride and we are with you to help you get easy access to all information related to kidney transplant. Here, in this kidney transplants series we have covered important consideration directs.

It includes

Legal forms

Form 1

Donor has given authorisation

Form 2

Donor is in proper health to donate organ, registered medical practitioner will sign the form 2

Form 3

Concerned practitioner form given

Form 4

Concerned practitioner form given

Form 5

Live consent for removal of organ

Form 6

Near relative consent form for deceased removal of the organ

Form 8

Brain death certification form board of medical experts

Form 9

Consent form for removal of organ of deceased minor

Form 10

Live donor

Application for transplantation of organ

Form 11

Application for registration for hospital to carry on the transplantation

Form 12

Certificate of registration for hospital to transplant

Form 13

Considering facilities and standards of the above said hospital the Appropriate Authority hereby renews the certificate of registration of the said hospital for the purpose of performing organ transplantation for a period of five years.

Rashtriya Arogya Nidhi (RAN)

The Scheme provides for financial assistance to patients, living below poverty line and who is suffering from major life threatening diseases, to receive medical treatment at any of the super specialty Government hospitals / institutes.

Budgetary provisions are made to fund the RAN Scheme.

Financial assistance towards treatment in Government hospitals including  super specialty Government hospitals / institutes, as per guidelines.

To avail financial assistance under RAN, the patient is required to submit :

1. Application form in prescribed proforma duly signed by the treating doctor and countersigned by the Medical Superintendent of the Government hospital/institute.
2. Copy of the income certificate.
3. Copy of the ration card.
4. Revolving Funds have been set up in 13 Central Government Hospitals/Institutes and funds upto Rs. 50 lakhs (Rs. 90 lakh in case of AIIMS, New Delhi) are placed at their disposal for providing treatment upto Rs. 2 lakh in each case..
5. Cases involving treatment beyond 2 lakh are referred to Ministry of Health & Family Welfare, Government of India for providing funds.

 PM relief fund

Assistance from PMNRF is also rendered, to partially defray the expenses for medical treatment like heart surgeries, kidney transplantation, cancer treatment and acid attack etc. The fund consists entirely of public contributions and does not get any budgetary support. The corpus of the fund is invested in various forms with scheduled commercial banks and other agencies. Disbursements are made with the approval of the Prime Minister. PMNRF has not been constituted by the Parliament. The fund is recognized as a Trust under the Income Tax Act and the same is managed by Prime Minister or multiple delegates for national causes. PMNRF operates from the Prime Minister’s Office, South Block, New Delhi-110011 and does not pays any license fee. PMNRF is exempt under Income Tax Act, 1961 under Section 10 and 139 for return purposes. Contributions towards PMNRF are notified for 100% deduction from taxable income under section 80(G) of the Income Tax Act, 1961. Prime Minister is the Chairman of PMNRF and is assisted by Officers/ Staff on honorary basis. Permanent Account Number of PMNRF is AACTP4637Q.

The Pradhan Mantri National Dialysis Programme was rolled out in 2016 as part of the National Health Mission(NHM) for provision of free dialysis services to the poor. 

Directory of essential documents

Directory of essential documents required for kidney transplantation

• Identity proofs

          Aadhar card

          Voter ID, 

          Driving Licence,

          Birth Certificate 

          Pan Card.

• Residential proof:

           Electricity Bill/ Water Bill

• Financial proof

          BPL or Ration Card.

• Donor recipient relation proof

          (Marriage certificate for Husband and Wife).

.

• Medical history Reports.

• Lab Test reports

• Mentally fit certificate of the donor.

• In case of any health insurance claim, documents need to be submitted at the time of transplant.

• Verification certificate in respect of domicile status of recipient or donor [To be issued by Tehsildar or any other authorised officer for the purpose (required only for the donor - other than near relative or recipient if they do not belong to the state where transplant hospital identified for operation is located)

• In case of foreigners,

• Form 21 from the embassy of that particular country needs to be submitted, which is proof of relation between the donor and recipient.
• No foreigner can undergo transplantation with an Indian donor. They can bring the donor from their country of origin duly forwarded by their Embassy for transplantation in India. Transplantation can be done only after the authorization committee approves the donor.
• Certificate of relationship between donor and recipient in case of foreigners (To be issued by the Embassy concerned)

Cadaver Donor

“Cadaver donation is an earthly heaven story which begins with end of one mortal life giving life to another”

Let me introduce you with

“Cadaver donation”

1. In the process of organ donation when individual make a decision to donate in his lifetime .He or she can fill up a donation form to register and express intent to donate. Once registered, he/she will get donor card. But the card is not legally binding and the final consent to donate rest in family member’s hand

1. Another way that deceased donation takes place is when a patient is declared brain dead, which means a there has been a permanent damage of all brain functions and the condition is irreversible.

What is process to declare Brain Death?

A person is brain death when kept on artificial life support machine and no longer has any brain functions. 

To make sure that the patient is brain dead, a team of hospital doctors and one civil/government doctor conduct a series of tests twice in a time frame of 4-6 hours. A death certificate is issued after no stimuli are monitored.

What after declaration of Brain Death?

Post declaration of brain death, death certificate is issued; the treating doctors inform the family about the functioning organs that can be donated.

If patient is registered donor then process of convincing the family becomes easier as the donor card advocates the patient’s will to donate organs. However in both the scenarios, whether the patient is a registered donor or not, the final decision lies with the family when they give their consent to donate the organs.

Track Recipient

Person who is in need of organ transplant has to register in the waiting list handled by National Organ and Tissue Transplant Organisation (NOTTO). 

Then registered recipient has to wait until a matching donor comes in place. 

When organ transplant suitable donor is recognized based on medical compatibility, the recipient is informed about the donor and that the transplant may take place.

How Is Recipient Shortlisted?

• If the recipient is registered in the same hospital where the deceased donor is then the organ is directly given to the patient. 
•  If the latent donor is not found within the hospital, then the transplant coordinators of the hospital will notify NOTTO. It operates as the centre which takes care after the nationwide coordination and networking for procurement and distribution of organs and tissues.
• Waiting list is categorised in four parts based on the blood group type. From this waiting list, the NOTTO will find out the recipient matching donor.
• Once the retrieval process is done, the departed body is handover to the family in a dignified way without any kind of mutilation. 
• Right from the time the family gives consent for organ donation till the time they receive the body, all the expenses are borne by the hospital.

Live Donor

All you need to know about living donation

 What is Living-donor kidney transplant?

Living-donor kidney transplant is a process in which a kidney from a living donor is removed and placed into a recipient whose kidneys no longer function properly.

Who can be living donors?

• The living donor can be a family member, such as a parent, child, brother or sister.
• Living donation can also arrive from someone who is emotionally connected to the recipient, such as a good friend, spouse or an in-law .
• Also, living donation can be from a stranger hidden in name of anonymous or non-directed donation. 

What is the process of living donor transplantation?

The first stair in process involves matching kidney type 

It involves tests like (Test should be done from a NABL Lab)

• Blood Type
• Blood hemolysis
• Condition of the patient
• Tissue type

After successful match donor has to fill forms regarding authorisation of organ removal and consent relating it.

Then next step is verification by the registered doctor. They do the interview part for verifying the data given. Once they submit “NO OBJECTION”  the further process can be done by the Registered Hospital.

What is Swap Transplantation?

When a near relative living donor is medically incompatible with the recipient, the pair is permitted to do a swap transplant with another related unmatched donor/recipient pair.

Cadaveric donor

What is cadaveric kidney transplant?

In cadaveric transplant a kidney removed from someone who has died. following with series of tests to  get sure that the donor is brain dead. It means that the fraction of the brain called the brainstem, which controls breathing, has permanently stopped working. A brain-dead patient is only being kept alive on life-support machine. 

What is the process of cadaveric donation?

When the person is brain dead, Hospital staff or Organ Proportionate Organization team will request the member of the family and Authorised possessed dead body owner to donate the donatable organs.

They need to sign forms and consent related to permission of organ donation by relative of deceased who have lawful authority over deceased body. 

How kidneys are stored?

The donated kidney is stored on ice or connected to a machine that provides oxygen and nutrients until the kidney is transplanted into the recipient. 

Kidney compatibility

“Chase for the Best Match”

Kidney transplant with the best match can reap a more successful transplant. 

Let’s explore,

Compatibility criteria’s for kidney transplant 

Blood typing (ABO compatibility)
Blood type of the donor must be compatible with the recipient. If the donor's blood type works with your recipient type, the donor will move to the next blood test (tissue typing). The following blood types are compatible:

Tissue Typing

Tissue typing is also called HLA matching. HLA stands for human leukocyte antigen.. Often it is observed that the better the HLA match, the more successful the transplant will be over a longer period of time. the way chromosomes/DNA are inherited down in a family, a parent and child would have at least a 50 percent chance of matching, siblings match ranges from zero to 100 percent match, and unrelated donors would be less likely to match at all. 

Another reason for HLA matching is to measure antibodies; this check is done for the patient only and is repeated frequently. HLA antibodies can turn to be harmful for transplanted organ and they can increase or decrease over time needs to be checked. 

Serum Crossmatch
A serum crossmatch is a blood test which recipient and the donor will have to do many times. In this test, cells from the donor are mixed with recipient serum. If recipient serum posses antibodies against the donor's cells, the antibodies will bind the donor cells as detected. If antibodies are at high levels, the donor cells will get destroyed. It declares that the transplant cannot take place.

THO Act

“Hey! You are here, I know you, you are a great fighter. ”

But are you aware of The Transplantation of Human Organs Act, 1994?

Yes the THOA act of 1994 which guides and regulates storage, removal, and transplantation of human organs strictly for therapeutic purpose. It also includes clause for prevention of commercial dealings in human organs and for matters connected there with it. Also it aims to accept brain death and making it possible to use these patients as potential organ donors.

Now you might be wondering whether this Act is applicable in entire India.

At present The Transplantation of Human Organs Act, 1994, is applicable to all over India except state of Jammu & Kashmir .

Also ,

Under this act you can donate heart, kidneys, liver, lungs, intestine, pancreas and tissues being, skin, bones, blood vessels, heart valves, corona, ear drums for therapeutic purpose.

Now you might be thinking about donors , Who all can  donate?

As per the act, Donor can be categories as;

Living Donor : one who is above 18 any and willingly authorizes the removal of any of his organ or tissue.

Deceased Donor : Anyone can become a donor of any organ and/or tissue after his/her death (Brainstem/Cardiac). A person who is in legal possession of the dead body or the free consent of ‘near relative [Section 2(i)]’ is required. 

You might have heard brain death. What is it? And is legal?

According to Section 2 of THOA, 1994 defines brain stem death, it is stage at which all functions of the brain stem have permanently ceased but it is subject to certification. Through this act brain death has been legalized in India.

Now tell me who do you think will bear cost of organ donation, retrieval, transportation or preservation? 

This need to borne by the recipient/ institution/ government/ NGO or society, and not at all by donor or donor’s family.

Also, commercial dealings in human organ  is strictly prohibited under THOA  Act. Any sort or any type of commercial dealings in human organ would lead to punishment beneath this Act.

Government Schemes for financial aid

Ayushman Bharat Yojana

• Also known as Pradhan Mantri Jan Arogya Yojan (PMJAY). 
• Aim of the scheme is to provide free health cover of Rs 5 lakh per family, per year, for secondary and tertiary care hospitalisation.
•  The family included are based on the deprivation and working criteria of Socio-Economic Caste Census 2011 for rural and urban areas.
• The receiver get an e-card that is used to avail cashless services at an empaneled hospital (public or private), anywhere in the country.
• It covers three days of pre hospitalisation and 15 days of post-hospitalisation expenses. Approximately 1,400 procedures with all binding costs like OT expenses are covered under the scheme.
  
  

Pradhan Mantri National Dialysis Programme

• The Pradhan Mantri National Dialysis Programme was launched in 2016 as part of the National Health Mission (NHM) with motive to avail free dialysis services to the poor.
• At present, under NHM 100 % of the service procedure fees for patients from below poverty line (BPL) economic group is covered. However, non BPL patients get the benefit of accessing the services close to the community at the district hospitals at similar rates as paid by the Government for the BPL patient.

Hemodialysis services:

• According to the guidelines, the private partner is to provide medical human resource, dialysis machine  with Reverse Osmosis (RO) water plant infrastructure, dialyzer and consumables.
• The space, power, and water supply within District Hospitals is provided by the State Government..

Guidelines for peritoneal dialysis services:

• Reduction in procurement costs like production of PD solution bags, abolition of statutory duties on PD supplies and bulk procurement of PD supplies.
• Sole survival on PD so that patients are not forced to transition to HD by developing a trained cadre of PD providers at all levels (physicians, nurses, clinical coordinators, etc)
• With rare exemption, all End stage kidney failure (ESKF) patients are suitable for PD. 

Rashtriya Swasthya Bima Yojana

• Identifying the necessitate for providing social security to workers, the Central Government has introduced the Rashtriya Swasthya Bima Yojana (RSBY)
• This scheme aims to provide health insurance coverage to the unrecognised sector worker who belongs to the BPL category.
• It provides cashless insurance for hospitalisation in public as well as private hospitals. 
• This enables patient to receive medical care of up to ₹30,000 () per family per year in any of the empanelled hospitals. 

Regional schemes for financial aid

Regional schemes

Bhamashah Swasthya Bima Yojana

• This is Rajasthan state exclusive scheme.
•  Bhamashah Swasthya Bima yojana is a scheme aimed on helping the IPD and other patients and offers them with access to cashless facilities for treatment.
• The scheme offers treatment for both secondary and tertiary illness. 
• The sum amount insured for secondary illness is Rs.30000 and for tertiary illness it is Rs.300000. Also this scheme would cover pre-hospitalization charges for up to seven days and a post-hospitalization charge for up to 15 days. There will also be a transportation coverage given from Rs.100 to Rs.500.
• It has been declared that patients will be benefitted for 500 packages under critical illness, 1045 packages under general illness and 170 packages are reserved for government hospitals.
• The package cost under the scheme will include hospital bed charges, consultant fees, boarding and nursing charges, medicine, implants, blood, anesthesia and pathological diagnostic charges. 

Tamil Nadu Chief Minister Comprehensive Health Insurance Scheme (CMCHIS)

• It is also known as the Amma Health Insurance scheme, which is designed for low- annual income families.
•  With the help of this scheme, patients do not have to go through a financial problem at the time of a medicinal emergency. 
• This scheme was launched by the Tamil Nadu CM to offer coverage to the entire family with the help of cashless amenities.

West Bengal Health Scheme 

• This scheme is also known as the West Bengal Health for All Employees and Pensioners Cashless Medical Treatment Scheme.
• The beneficiary can avail cashless indoor treatment up to Rs. One lakh in an empanelled hospital. If the cost exceeds the limit, the extra amount in the bill shall be settled by the beneficiary.
• As per this scheme, eligible people can avail cashless treatment in the stated list of hospitals, also known as empanelled hospitals and Health Care Organisations (HCO)

• This scheme is directed towards state government employees, government employees who benefit pension, and their families.

Mahatma Jyotirao Phule Jan Arogya Yojana

• Mahatma Jyotirao Pule Jan Arogya Yojana is a flagship health insurance scheme of Government of Maharashtra. The scheme offers end to end cashless services for identified diseases through a network of service providers from Government and Private sector
• Beneficiaries under Mahatma Jyotirao Phule Jan Arogya Yojana:

Category A: Families having Yellow ration card, Antyodaya Anna Yojana ration card (AAY), Annapurna ration card, Orange ration card (annual income up to INR 1 lakh) issued by Civil Supplies Department, Government of Maharashtra for 36 districts of Maharashtra.

Category B: White ration card holder farmer families from 14 agriculturally distraught districts of Maharashtra (Aurangabad, Jalna, Beed, Parbhani, Hingoli, Latur, Nanded, Osmanabad, Amravati, Akola, Buldhana, Washim, Yavatmal, and Wardha).

Category C: 1. Children of Government Orphanages, Students of Government Ashram Shala, female inmates of Government Mahila Ashram & senior citizens of Government old age homes. 2. Journalists & their dependent family members approved by DGIPR 3. Construction workers and their families having live registration with Maharashtra Building & other Construction worker Welfare Board .

Mukhyamantri Amrutam Yojana

• Mukhyamantri Amrutum Yojana is a health care plan implemented by the Government of Gujarat to help poor families in their major adversities. 
• This scheme provides financial support to BPL and lower income families living in Gujarat. 
• Beneficiary with total annual income less than Rs.2.5 lakh is eligble for this scheme.
• This scheme offers a sum insured amount of Rs.3 lakh on a floater basis 

Karunya Health Scheme

• The government of Kerala launched the Karunya Health Scheme mainly to ensure health insurance coverage for the underprivileged sections of the society at a nominal premium charge. 
• Funding for this scheme is collected through Kerala Lottery, and the amount is directly transferred to provide settlement for the empanelled hospitals.
• People belonging to below poverty line and above poverty line sections of the society can apply for this coverage.

Telangana State Government Employees and Journalists Health Scheme

• Telangana State Government offers Employees and Journalists Health scheme that provides cashless treatment to all the State government employees including the pensioners (state government) along with their dependent family members at network hospitals of Aarogyasri Health Care trust. 
• Through this scheme, policyholders can also enjoy the benefits of post-operative care and treatment of chronic diseases that do not need hospitalization and treatment in empanelled hospitals.

Post kidney transplant

Regional schemes

you should avoid LIVE vaccines including:

• Varicella zoster
• Rubella
• Oral polio
• Bacillus Calmette-Guerin (BCG)
• Smallpox
• Intranasal influenza
• Live oral typhoid Ty21a and other newer vaccines
• Measles (except during an outbreak)
• Mumps

Also keep away from direct contact with anyone who has received a live vaccine:

• Children who got oral polio vaccine for 3 weeks
• Children who have been given measles or mumps vaccines
• Adults who got vaccinated with received attenuated varicella to prevent zoster (shingles)
• Children or adults who have obtained the nasal influenza vaccine

Necessary test after transplant

While leaving from hospitals with your new kidney, you will also receive follow up tests and check up schedule. Certain test will be performed to monitor your blood counts, kidney function, liver function, electrolytes, and the medication levels in your blood. 

Some of the tests are.

• Blood Count to monitor WBCs, HCT etc.
• Kidney Function measure Creatinine and BUN to know working of kidney.
• Electrolytes measure Calcium, phosphorus, magnesium, potassium, and sodium, if required supplemented externally.
• Additional Blood Tests  measure the amount of Prograf®, Neoral®, and Rapamune® in your blood. They need to be checked regularly to evade levels that are too high or too low.
• Kidney Biopsy is usually operated to check for rejection or drug toxicity and other problems. 
• Ultrasound  allows us to be sure that the main blood vessels leading to the kidney are functioning normally.

Precautions should be taken before transplant

1. Deplete your high cholesterol levels
2. Control your elevated levels of blood pressure
3. Diabetic!, then keep it in control.
4. Keep your diet and lifestyle healthy.
5. Higher risk of cancer! Then talk to your physician about reducing the risk of cancer.
6. Avoid transfusion of blood and other blood products.

Transplant Rejection

Every individual is “one of a kind” collection of cells, tissues, and organs. The body machine that recognizes a person’s own cells originality from other cells and tissues is called the immune system. When immune system identifies “foreign” cells and tissues in the body, it attempts to destroy them to protect the body from harm.

Immune system of the person who received transplanted kidney sees it as foreign, and attempts to reject it by producing cells or antibodies that invade and damage the kidney. To prevent the immune system from destructing the transplanted kidney, you will take immunosuppressive (anti-rejection) drugs. 

Types of kidney rejection 

1. Hyperacute rejection is very rare today as it can be prevented by tissue cross matching. It is caused by pre-formed antibodies concentrating against the donor kidney cells. It happens within minutes to hours of transplantation and totally destroys the kidney transplant. 
2. Acute rejection can happen at any time, but it is most common to take place from one week to three months after transplant surgery. When treated in initial stages, it is reversible in most cases. The possibility of rejection decreases as the kidney continues to function healthy.

Chronic rejection takes place over time and is owed to scarring within the transplanted kidney. It may occur with variation of time period from months to years after your transplant. If the kidney transplant is rejected, you may be required to receive another transplant in the future. on instances the transplanted kidney must be surgically removed and another transplant takes place .

Immunosuppressant

“They create comfort for to new kidney in your body”

When body’s immune system realizes that the kidney is from someone else, then there are chances it will reject new kidney. To avert this mishap, transplanted patient must take medicines to weaken immune system. These medicines are called Immunosuppressant, or anti-rejection medicines.

Immunosuppressant and other medicines should be taken exactly the way doctor instructed. If you ever fail taking your medicine, contact doctor your immediately. 

Anti-rejection medicines brings along risks and side effects.

One of the major effects of Immunosuppressant is infection. Another general side effect is stomach upset. Immunosuppressants cause side effects but they are very necessary drugs in keeping your new kidney healthy and working.

Regulatory bodies

Now let’s explore about authoritarian stations in the journey of organ transplant

These stations regulate, control and counsel organ transplantation processes.

Station no 1

Advisory community

It consists of administrative expert, who is not below the rank of the Secretary to the State Government for a period of 2 years to aid. Its purpose is to aid and advise the appropriate authority (AA).

Station no 2

Appropriate Authority (AA)

Appropriate Authority’s purpose is to regulate human organs:

• Removal
• Storage
• Transplantation
• It looks after inspection and registration of hospitals for transplant surgery.
• It carries out regular inspection of the hospital to examine the quality of transplantation and trail medical care of donor and recipient.
• It also conducts investigation for any breach of the Act.
• The AA issues a license to a hospital for a period of 5 years and after that it has to be renewed. Each organ requires a separate license.

Station no 3

Authorization Committee (AC)

One state-level authorization committee should establish constitute in each state. Compositions of hospital-based, state-level authorization committee have been clearly defined. When the transplantation is between other than near relatives or foreigner donor/recipient, then the authority of permission is authorization committee.

Station no 4

Competent authority (CA)

 When transplantation is between near relatives, then authority for permission is competent authority. 

Station no 5

Medical Board (Brain Death Committee)

This board has panel of doctors accountable for brain death certification. If there is non-accessibility of neurologist or neurosurgeon, any surgeon, physician, anaesthetist or intensivist who is listed by medical administrator in-charge of the hospital may declare and certify brain death.

Success rate of transplant

• The success rate of kidney transplantation price in India is highly spirited in the entire world. It’s incredible!
•  Live donor transplants have a better success rate when compared with the deceased donor.
• Success rate of Living donor transplants is 90-95 percent, whereas dead donor transplant comes with an 85-90 percent achievement rate for year.
• Also, a blood-related donor fetch better results when compared with non-blood allied donor.
• Cross-matching and HLA typing reports transcend major role in creating kidney transplantation effective.