“Assoc. Prof. Dr. Natthapon Aphornsujaritkul, Transplant Surgeon” spoke about kidney donation, transplantation, and the process of requesting donations, stating that these are matters that can happen to anyone when the situation arises. Therefore, both donors and recipients should be educated for the most effective kidney transplantation.
Understanding Kidneys: Kidney Recipients vs. Kidney Donors
For Kidney Recipients
All patients with end-stage chronic kidney disease, regardless of age, should be evaluated and considered for kidney transplantation unless there are contraindications or limitations, such as patients with severe infections, patients with cancer that is not yet cured, or those unable to care for themselves. These are contraindications for kidney transplantation. The starting age for transplantation can actually be as young as 2-3 years old if the body is ready. There is no fixed upper age limit for kidney transplantation. Even elderly patients aged 70-80 years, if evaluated to be physically and mentally fit and strong, can undergo kidney transplantation. Therefore, transplantation depends mainly on physical condition, not age.
- What kidney health condition qualifies for kidney transplantation?
Generally, it is misunderstood that the kidney must still be in good condition for transplantation. In fact, patients with end-stage chronic kidney disease are the ones who should be evaluated for kidney transplantation.
Patients should know that kidney failure has 5 stages. Stage 5 is called end-stage chronic kidney disease. Kidney transplantation is generally for patients with end-stage chronic kidney disease because the kidneys are damaged and can no longer function normally, so urgent kidney transplantation is required. The timing of transplantation depends on the discretion and close care of the physician.
Currently, there is a campaign encouraging chronic kidney disease patients to undergo transplantation from stage 4 to stage 5 by receiving kidneys from relatives. This is considered the best type of transplantation because it avoids waiting until stage 5 when dialysis is necessary. Transplanting at the late stage 4, when dialysis is about to start, and receiving a kidney from a relative has benefits: the transplanted kidney lasts longer, there is less chance of rejection, treatment is timely, and physical recovery is better.
- Thailand divides kidney donors into two main groups:
1. Living donors, according to the Medical Council regulations, which specify 3 cases:
- Must be parent and child
- Direct blood relatives
- Husband and wife who have been legally married for at least 3 years or have children together
2. Brain-dead donors, where patients must wait in line at the Thai Red Cross Organ Donation Center.
- Preparation before kidney transplantation, recovery, and life after transplantation
Preparation for kidney transplantation includes:
- Checking if the patient has any contraindications for transplantation. If none, care will be as per
- the doctor’s instructions following general standard protocols
- After transplantation, strict hygiene and dietary adherence according to the doctor’s advice are necessary
- Regarding lifestyle, compared to dialysis, dialysis requires frequent hospital visits for regular treatment indefinitely. However, after transplantation, patients have a better quality of life, can urinate normally, and do not need frequent hospital visits. Additionally, transplantation reduces complications related to kidney failure and helps prolong life compared to dialysis.
After transplantation, complications may occur, such as renal artery stenosis or urinary leakage, but these are generally very rare.
Kidney rejection occurs when the transplanted kidney is attacked by the recipient’s immune system. Currently, it is rare, about 5%, due to improved immunosuppressive drugs that significantly reduce the chance of rejection. However, if rejection does occur, there are treatments available to preserve the transplanted kidney.
For Kidney Donors
- What qualifications must a kidney donor have to be eligible? Donors must meet the Medical Council’s three criteria:
- Must be parent and child
- Direct blood relatives
- Husband and wife who have been legally married for at least 3 years or have children together
If all three Medical Council criteria are met, the donor must be at least 18 years old. There is no upper age limit for donation; it depends on the donor’s health evaluation. Donors must not have chronic diseases or must have controllable chronic diseases, which must be assessed by a specialist to determine if the donor is physically eligible.
- Can donors with chronic diseases such as diabetes or hypertension donate?
If diagnosed with “diabetes,” it is a contraindication for donation because it directly affects the donor, as the kidney will eventually deteriorate due to diabetes.
For hypertension that is not well controlled, it is a contraindication for kidney donation. If the doctor assesses that it is well controlled, there is a chance to qualify as a donor.
- Preparation for kidney donors
- Maintain good physical health
- Prevent infections before transplantation
- Get enough rest
- Avoid salty foods
- Exercise regularly
Living kidney donors must undergo comprehensive and thorough physical examinations. Donors must be healthier than the general population standard to qualify. Therefore, after donation, they will recover and return to normal health and daily life.
- Precautions after kidney donation Donors must follow dietary recommendations from doctors, get enough rest, and can exercise after recovery.
- Does having only one kidney increase the risk of kidney disease? If well cared for, even with one kidney, it can fully compensate for the donated kidney’s function 100%, and there is no increased risk of kidney disease compared to those who have not donated. However, if donors do not take care of themselves, eat very salty food, or do not get enough rest, there is a risk, so maintaining health is essential.
