Kidney Transplantation at AIIMS

The Department of Nephrology AIIMS provides kidney transplantation of patients suffering from End Stage Kidney Disease as per the Certificate of Registration granted by appropriate authorities. We follow the Transplantation of Human Organs Rules, 1995 and the subsequent amendments (as and when amended). The procedure for kidney transplantation at AIIMS is as under:

I. Registration of Patient for Transplantation

Patients with kidney disease have to come to the renal clinic, AIIMS, run by the department of Nephrology. Initial evaluation is done to know the cause of kidney disease, its severity, its reversibility (if any) and co-existing conditions (co-morbidities).  Subsequently patients are advised renal replacement therapy if they have End Stage Kidney Disease i.e. when patient cannot be maintained on medical treatment alone (Chronic Kidney Disease Stage 5).  Renal replacement therapy consists of hemodialysis, Chronic Ambulatory Peritoneal Dialysis (CAPD) and/or Kidney transplantation.  Patient is advised kidney transplant ONLY once he/she is fit for transplant. Some important contraindications for transplantation include:

1)      Coronary artery disease

2)      Active infection

3)      Malignancy

In case of coexisting conditions, they are treated appropriately before consideration for kidney transplantation. Other investigations needed for transplantation are also carried out.  If he/she has any other associated illness, then that illness is investigated in detail and appropriately treated on its own merit, before kidney transplant may be possible.

 II. Donor Registration

Patients are counseled to bring donor for registration as per existing laws.  After checking blood group compatibility, complete physical examination is done.  This is followed by basic laboratory investigations to assess fitness.  Subsequently detailed tests to assess kidney function and vascular anatomy are done.  All these tests are done in step-wise manner so it takes some time. The patient is included in the waiting list after it is documented that the donor has two normal and equal functioning kidneys.   The date of initial registration of the living donor is taken for the purpose of seniority.  Donor work-up takes about 4-6 weeks. 

In case living donor is not available, the patient’s name is registered in the cadaver (deceased) donor kidney transplantation waiting list.

III. Inclusion in the Dialysis Programme at AIIMS

Since facilities for hemodialysis are limited, it is not possible to include all patients registered for kidney transplant with us in our hemodialysis programme immediately. A waiting list of all such patients registered for kidney transplantation is maintained accordingly to the date of registration of the living donor. Patients are included in our dialysis program as per their seniority. Currently we are able to include patients in our dialysis programme only 1-2 months prior to transplantation. Patents in the cadaver donor waiting list have to take dialysis outside this hospital.

IV. Cost of transplantation:

Essential Basic costs:

Note: This does not include the cost of hemodialysis outside, prior to inclusion in the hemodialysis programme at AIIMS.

Additional Cost/s (as needed):

Some patient may require following therapy on medical grounds, which will add to the cost mentioned above:

·         Induction therapy with monoclonal antibodies at the time of transplant

·         CMV prophylaxis after transplant

·         CMV treatment after transplant

·         Anti-rejection therapy with monoclonal antibodies after transplant                                                

·         Antifungal treatment with liposomal Amphotericin after transplant

    Poor patients may apply for various government sponsored illness assistance funds for which they should contact the hospital social workers.

    Four to Six units of blood need to be arranged for transplant surgery, though all may not be utilized in every case.

V. Waiting period for Living Transplantation

At present AIIMS is doing two transplants in a week; and in view of large number of patients registered for renal transplant, current waiting period is 10 -12 months.

Procedure for Registration in cadaver transplant waiting list:

·     Patients with end-stage kidney disease on dialysis (maintenance hemodialysis or chronic peritoneal dialysis) first must register in the Renal Clinic, AIIMS.

·     There is no  suitable living donor

·     Patients on maintenance hemodialysis have to continue taking hemodialysis outside AIIMS

·     Necessary pre-transplant investigations will be done

·      Patients will be investigated for associated illnesses.  If present, associated illnesses will be treated appropriately. Patients with untreated associated illness cannot be registered for cadaver transplant.

·     In order to remain in the active cadaver transplant waiting list, the patients must follow-up in the Renal Clinic, AIIMS at least once every three months, or as and when required on medical ground.

No specific waiting period can be specified for patents in the cadaver transplantation waiting list, since it is totally unpredictable when a cadaver donor may be available.