The Kidney Transplant Pathway

Who can be considered

Eligibility is decided by a transplant team after assessment, not by age alone. Broadly, a person needs to be well enough to survive surgery and to tolerate immunosuppressive medication afterwards.

Common reasons a transplant may be deferred or declined include active infection, current cancer, severe heart or lung disease, and circumstances where taking medication reliably every day would not be possible. Several of these are temporary — being deferred is not always being refused.

Ask to be assessed before you need it. Assessment at stage G4, rather than after dialysis has started, gives the widest set of options, including the possibility of a pre-emptive transplant that avoids dialysis altogether.

Where the kidney comes from

A living donor

A healthy person can donate one kidney and live normally with the other. In India this is governed by the Transplantation of Human Organs and Tissues Act. Near relatives — spouse, parents, children, siblings, grandparents, grandchildren — follow a shorter route requiring documented proof of relationship. Anyone else may donate only with the approval of an Authorisation Committee, which exists to confirm the donation is voluntary and unpaid.

Where a willing donor is not blood-group compatible, swap donation between two such pairs is permitted. Our detailed article on the law explains each route and the documentation involved.

A deceased donor

Kidneys can be donated after brain death is certified in hospital under the procedure defined in law. Patients are placed on a waiting list by their treating hospital, and allocation follows the published priority order maintained by the state authority. In Tamil Nadu that authority is TRANSTAN.

Waiting times vary considerably and cannot be predicted for an individual. Being on the list does not prevent you from also pursuing a living donor.

No kidney is ever bought or sold

Indian law prohibits all commercial dealing in human organs. That covers offering, advertising, arranging, and negotiating — not only the transaction. Penalties apply to donors, recipients, intermediaries, and doctors alike.

Mohan Foundation does not discuss or estimate any monetary value for an organ, and does not arrange donors. If anyone offers to find you a kidney for a fee, they are describing a criminal offence, and such offers very frequently turn out to be fraud as well.

What the assessment involves

1. Referral from your nephrologist to a transplant centre.
2. Blood group and tissue typing for both you and any potential donor.
3. Cross-match testing to check your immune system does not already react against the donor.
4. Heart, lung, and infection screening to confirm you can safely undergo surgery.
5. Dental and other clearances, since infection risk rises on immunosuppression.
6. Assessment of the donor separately and independently, including a private conversation without the recipient family present.
7. Legal documentation and, where required, Authorisation Committee approval.

The paperwork stage is where most delay occurs, and incomplete documents are the usual cause. Ask your hospital transplant coordinator for the full list at the start rather than assembling it piecemeal.

Surgery and recovery

The new kidney is usually placed low in the abdomen, and the existing kidneys are generally left in place. Hospital stay is commonly around a week to ten days when there are no complications.

The first three months involve frequent blood tests and clinic visits, because that is when rejection is most likely and medication doses are still being tuned. Visits become less frequent afterwards but never stop entirely.

Life on immunosuppression

Anti-rejection medication is taken every day, for as long as the transplant functions. Missing doses is the most common avoidable cause of losing a transplant, so building a reliable daily routine matters as much as any clinical factor.

• Infection risk is higher, so fever or illness should be reported early rather than waited out.
• Skin cancer risk rises over years — sun protection and periodic skin checks are advised.
• Blood pressure, blood sugar, and cholesterol need ongoing attention.
• Many common medicines interact with immunosuppressants. Tell every doctor and pharmacist that you are a transplant recipient.
• Budget for the medication. It is a recurring cost that continues indefinitely, and it is the expense families most often fail to plan for.

How long a transplant lasts

A transplanted kidney does not necessarily last a lifetime. Kidneys from living donors generally function longer on average than those from deceased donors, but individual outcomes vary widely. If a transplant fails, returning to dialysis and being considered for a second transplant are both possible, and neither is unusual.