The Madras Medical Mission College in the Tamil Nadu state capital Chennai performed a kidney transplant for a 41-year-old man – the third time he has undergone such a procedure.
Reports indicate that the man, who is said by surgeons to be recovering well, experienced kidney failure aged twelve and subsequently underwent his first kidney transplant. After nine years, he underwent a second kidney transplant. However, that transplant also failed and after twelve years, he was placed on dialysis which lasted for four years until the third operation. He remains under observation.
According to Dr S. Saravanan, one of the surgeons, “his first and second transplant failed due to his uncontrolled hypertension. To complicate things more, he underwent a triple bypass surgery to repair blocks in the heart in March at our hospital.” The procedure became a more complex affair due to the presence of donated organs from other donors. The individual in question possesses two of his original kidneys and two donated ones, now with an added fifth. As Saravanan explains, “connecting them with the blood vessels was even more challenging. With four dysfunctional kidneys, there was hardly any width left in the arteries or veins.”
In detail, Saravanan outlined that “there were four challenges in performing this surgery – firstly, a lack of space for the new kidney in the retroperitoneum; second is the lack of width on the native blood vessels to connect the renal artery and vein. Thirdly, the bladder is scarred with earlier surgeries and finally, the patient tends to develop a lot of antibodies from the earlier surgeries, and plasmapheresis [filtering the blood] has to be performed before the new kidney is placed.”
The risk of haemorrhage deterred the transplant surgeons from operating to remove existing dysfunctional kidneys. As Saravanan states, “when that happens, the patient will require blood transfusion. This could lead to the production of antibodies which could cause rejection of the new kidney.” The approach utilised, he said, “is rarely performed”, referring to a transperitoneal procedure which means the surgeons operated via the gut.
The story highlights the need for greater awareness of kidney transplants and organ transplantation in general in India. According to Organ Donation India, India requires an estimated five lakh organs per annum but only two to three percent of this demand is met with an organ donation rate of 0.86 per million population. Consequently, many Indians die needlessly due to organ failure. End-stage organ failure affects roughly one million Indians, but just 3,500 organ transplants are carried out each year as of 2019 (although the Union Ministry of Health and Family Welfare estimated 5,000 procedures annually).
Nonetheless, it is crucial to note India has a dual burden of organ failure and its organ transplant deficit. In the case of kidney transplants, in a country with a significant burden of chronic kidney disease but where many languish on the waiting list for a life-saving transplant, the dearth of organ donations is painfully apparent. The news of the individual in Chennai receiving his third is good news. It is a shame, however, that such good news is not so often available.