Wednesday 21 September 2016

Guidelines for Liver Transplant

Recipient’s evaluation:

You can send Following reports via email or post to confirm the requirement and cost of a Liver Transplant.
Urine protein creatinine ratio and Urine routine/microscopy
Anti HCV, HIV I & II, Liver Function Tests (LFT), P time / INR, Urea ,Creatinine, CBC / Hemogram, Sodium , Potassium, AFP, HbsAg
Triple phase CT angiography of the liver (Patients with normal ceratinine levels, urea and no contrast allergy can get this test done safely)
Your Medical Summary prepared by your doctor carrying information about your past medical history / symptoms.
Recent Upper GI endoscopy report

All these reports are required to confirm the requirement and cost of a Liver Transplant.
Nevertheless, once the patient reaches the preferred hospital in India.The liver transplant candidate would be examined again and would have to undergo certain other essential tests such as ABG, PA pressure measurements, PFT, Stress Echo for checking his fitness before undergoing the transplant surgery.

Evaluation of Donor:

1. He/She should be a relative of the patient and should be happy to donate his liver on selfless basis.
2. It is preferable that the donor must be between the age group of 18 and 45 years. He/she should be fit, strong and have a matching or compatible blood group:

Patient blood group	Matching donor groups
A+ or A-	A+/ A- /O+ / O-
B+ or B-	B+ / B- / O+ / O-
AB+ or AB –	Any blood group acceptable
O+ or O-	O+ / O

Though liver looks like a single organ but in reality it consists of 8 different lobes and thus can be separated into these lobes. Generally the donor’s right half of the liver is donated during an adult – to – adult liver transplant. Liver’s bloodless division into right and left has now become possible because of latest techniques and gadgets. A living donor can now easy donate his liver safely as the remaining left side grows back to around 80 percent of liver’s original size in few weeks and quite close to the original size within few months. The ratio of risk in liver donation is even lower than 1:200.
It is mandatory that the donor should be a psychologically-sound adult who is well aware to take any sort of decision.
If the transplant is being done by an unrelated liver donor for financial reasons, it is illegal and punishable under Indian laws. No queries in this regard would be entertained.
In case, you want to start the evaluation of the donor on an immediate basis, you can get done the Level I and Level II tests in your own country and send the reports to us by mail:

Level I: Blood group HBsAg, HbA1c, Anti HCV, HIV I & II CBC / Hemogram, Creatinine, P time / INR, LFT, Urea
After 14 hour Fasting, Serum T3, T4, Lipid profile and TSH
If the reports are fine, go on to Level II

Level II: Triple phase CT Liver Angio (donor protocol) along with a plain scan for looking at Liver Attenuation
You can courier or mail us the reports or bring along a CD in DICOM format
This scan is a crucial part of the donor work up

Level III: MRCP

Level IV: Stress Echo, Chest X-ray, ECG, Lung Function Tests USG breast & pelvis, Mammography ( less than 40 yrs ), , CA 125, HLA tissue typing, PAP smear ( married ladies), Blood group antibody screen

Tests at Level III and IV for the donor and all tests for the patient can be done within 48 hrs of arrival at a hospital in India. If the test reports are fine, liver transplant can be done quickly once permission from Government of India Transplant Authorisation Committee is taken. All this might take a week’s time

Necessary Formalities And Assistance in Visa Formalities

Step1: Obtaining No Objection Certificate from the respective embassy . Furnish the following documents at the Embassy:
A letter on the hospital’s letter head telling that the patient is undergoing the treatment
Old medical reports and health records
A small summary of the case or medical history of the patient (if referred)
An affidavit from the local government authority stating that the patient and the donor are relatives (mandatory for all Foreign Patients).
10 photographs each (patient and donor)
Salary slip or bank statement of both patient and donor as the Income proof
The consent from the next of kin of donor on a stamp paper that should carry donor’s and kin’s photograph, duly pasted. In case the donor is a cousin, it is necessary for the next of kin to be present at the Transplant Authorization Committee.
Birth certificate or marriage certificate etc as proof of relation

Step 2: The patient is required to go to the SDM office along with the donor and the relative for getting the affidavit of donor, attested by him. Following documents are needed at the SDM office:

A letter on the hospital’s letter head telling that the patient is undergoing the treatment.
NOC from the Embassy
Affidavit patient
Affidavit donor
Affidavit relative

Step 3: Notary attests the affidavits of the patient and the relative. This takes a time of a day or two.Please note if the documents are in patients local language of country of residence .The same has to be translated in English and get the translation notarised by local authority from patients country of residence.

Step 4: After the affidavits get attested, these documents are taken to the Authorization Committee of the hospital for approval. At the same time, the concerned doctors conduct some important tests on the patient and the donor. All this takes around 2 week’s time.

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Tuesday 20 September 2016

Best Kidney Transplant Hospital in india

What are Different Types of Kidney Failures?

Acute Prerenal Kidney Failure
Insufficient blood flow to the kidneys can cause acute prerenal kidney failure. The kidneys can’t filter toxins from the blood without enough blood flow. This type of kidney failure can usually be cured once the cause of the decreased blood flow is determined.
Acute Intrinsic Kidney Failure
Acute intrinsic kidney failure can be caused by direct trauma to the kidneys, such as physical impact or an accident. Causes also include toxin overload and ischemia, which is a lack of oxygen to the kidneys. Ischemia may be caused by:
severe bleeding
Shock

Renal blood vessel obstruction

glomerulonephritis, which is an inflammation of the tiny filters in your kidneys
Chronic Prerenal Kidney Failure
When there isn’t enough blood flowing to the kidneys for an extended period of time, the kidneys begin to shrink and lose the ability to function.
Chronic Intrinsic Kidney Failure
This happens when there is long-term damage to the kidneys due to intrinsic kidney disease. Intrinsic kidney disease is caused by a direct trauma to the kidneys, such as severe bleeding or a lack of oxygen.
Chronic Post-Renal Kidney Failure
A long-term blockage of the urinary tract prevents urination, which causes pressure and eventual kidney damage

When kidneys fail, there are three treatment choices:

hemodialysis,
peritoneal dialysis
kidney transplantation.

What are the Types of Kidney transplant?

The Kidney transplant surgeries are of two types :

Living Donor Kidney Transplant Surgery : A living donor may be someone in your family. It may also be your spouse or close friend. In some cases, it may be a stranger who wishes to donate a kidney to anyone in need of a. Thorough examination of the donor is done before accepting a candidate.

Cadaveric or Deceased Donor Kidney Transplant Surgery : In this the kidney is taken from a brain-dead person and the family members have given consent to donate the organs. Extensive blood tests are done on both donor and recipient

What are the Types of Kidney Treatments?

The two treatments for kidney failure are kidney transplantation and dialysis. Two different types of dialysis can be done – hemodialysis and peritoneal dialysis.
Kidney Transplantation. This is an operation that places a healthy kidney into your body. The kidney can come from someone who has died or from a living donor. A new kidney will usually function immediately. You will need special medicines to prevent your body from rejecting the new kidney. If rejection happens, dialysis is needed and you can consider a second transplant. A kidney transplant is a treatment, not a cure. Kidney transplant recipients still have chronic kidney disease, and you may still need some of the other medicines you took before the transplant.

Hemodialysis (HD). Hemodialysis is a treatment that removes wastes and extra fluid from your blood. It can be done at home (“home hemodialysis”) or in a dialysis center. During hemodialysis, your blood is pumped through soft tubes to a dialysis machine where it goes through a special filter called a dialyzer (also called an artificial kidney). As your blood is filtered, it is returned to your blood stream. Only a small amount of blood is out of your body at any time. In-center treatment time is 3-5 hours, 3 times a week. People who do home hemodialysis have more flexibility about how often it can be done. If done daily, treatment time would be 1½ to 2 hours. You will need an access into the bloodstream for placing needles needed for hemodialysis. Types of access include:

Fistula. A fistula is the recommended choice for an access. You will need a minor operation to create a fistula. It is made by joining an artery to a nearby vein under your skin to make a bigger blood vessel. This type of access is preferred because it has fewer problems and lasts longer. However, some people may not be able to have a fistula because of their physical condition. Sometimes, it may be possible to switch to a fistula from another type of access. If you do not have a fistula, ask your dialysis care team if a switch would be possible.

Graft. If your blood vessels are not suitable for a fistula, a graft may be used. This involves joining an artery and a nearby vein with a small, soft tube made of synthetic material. The graft is entirely beneath your skin. You will need a minor operation to create a graft.

Catheter. The third type of access, called a catheter, is inserted into a large vein in your neck or chest. The ends of the tubes sit on your skin outside your body. This type of access is generally used when you need dialysis for a short period of time. Catheters are used as a permanent access when a fistula or a graft cannot be placed.

Peritoneal Dialysis (PD). Peritoneal dialysis is a home-based treatment that can be done anywhere (at home, work, or when sleeping). It must be done daily. You will need a minor operation to place a catheter in your abdomen (belly). With peritoneal dialysis, the blood is cleaned inside your body, not outside. The lining of your abdomen (the peritoneum) acts as a natural filter. During treatment a cleansing solution, called dialysate, flows into your abdomen (your belly) through a soft tube called a PD catheter. Wastes and extra fluid pass from your blood into the cleansing solution. After several hours, you drain the used solution from your abdomen and refill with fresh cleansing solution to begin the process again. Removing the used solution and adding fresh solutions takes about a half hour and is called an “exchange

Procedure of Kidney transplant

The kidney transplant procedure involves three main stages:
First, an incision (cut) is made in your lower abdomen (tummy), through which the donated kidney is put into place. Your own kidneys will usually be left where they are, unless they’re causing problems such as pain or infection.

Second, nearby blood vessels are attached to the blood vessels of the donated kidney. This is to provide the donated kidney with the blood supply it needs to function properly.

Finally, the ureter (the tube that carries urine from the kidney to the bladder) of the donated kidney is connected to your bladder.

Rejection of Kidney

Rejection’ means that someone’s body recognises that the transplanted kidney is not ‘its own’ and tries to ‘reject’ it from the body. Even when someone is ‘well matched’ with their transplant kidney (in terms of blood group and tissue type), some degree of rejection is common. The severity of rejection varies from patient to patient. Rejection may be either acute or chronic). With Medical advancements today there are drugs that can help prevent and treat the rejection process.

Benefits of Kidney Transplant

Kidney transplants are very successful, with more than 96 percent of the kidneys, or grafts, transplanted by Alphine life solutions associated doctors and hospital and are still working after 5 years. Transplants last on average for 10 to 20 years. Patients feel better and have more energy to spend time with their family, do their hobbies, travel and go back to work. Patients also say they have more time – time that would have been spent on dialysis treatments. dialysis can only do 10% of the work of a functioning kidney.

Port Operative care for Kidney Transplant

Patient’s are required to stay in the Hotel/apartment/guest house before the transplant, for investigations. The hospital stay is for 10 days which includes one day before the surgery and then 9 days after the surgery, Afte the transplant 30 days stay in the Hotel/apartment/guest house is necessary for the follow up treatment.

What is the Cost of Kidney Transplant in India?

After Comparing to international healthcare costs, cost of kidney transplant in India (with dialysis) is low. Hospitals in India have the latest technology treating almost 15,000 kidney patients annually from all over the world, providing the best medical care at considerably low prices.

Guidelines and formalities on Renal (Kidney) Transplantation

The primary legislation related to organ donation and transplantation in India, Transplantation of Human Organs Act is aimed at regulation of removal, storage and transplantation of human organs for therapeutic purposes and for prevention of commercial dealings in human organs.
The various forms outlined in the rules are as follows:

Form 1: Near-relative consent
Form 2: Spouse consent
Form 3: Other than near-relative donor consent
Form 4: Psychiatrist evaluation of the donor
Form 5: HLA DNA profiling report
Form 7: Self consent for deceased donation
Form 8: Consent for organ donation from family (also applicable for minors)
Form 9: Consent for organ donation from unclaimed bodies
Form 10: Brain death declaration form
Form 11: Joint transplant application by donor / recipient
Form 12: Registration of hospital for organ transplantation
Form 13: Registration of hospital for organ retrieval
Form 16: Grant of registration
Form 17: Renewal of registration
Form 18: Decision by hospital authorization committee
Form 19: Decision by district authorization committee
Form 20: Verification of Domicile for non near-relative
Form 21: Letter from Embassy

Necessary Formalities to be completed in India:

Step1: Obtaining No Objection Certificate from the respective embassy in India. Furnish the following documents at the Embassy:
A letter on the hospital’s letter head telling that the patient is undergoing the treatment
Old medical reports and health records
A small summary of the case or medical history of the patient (if referred)
An affidavit from the local government authority stating that the patient and the donor are relatives (mandatory for all Foreign Patients).
10 photographs each (patient and donor)
Salary slip or bank statement of both patient and donor as the Income proof
The consent from the next of kin of donor on a stamp paper that should carry donor’s and kin’s photograph, duly pasted. In case the donor is a cousin, it is necessary for the next of kin to be present at the Transplant Authorization Committee.
Birth certificate or marriage certificate etc as proof of relation
Step 2: The patient is required to go to the SDM (Sub Divisional Magistrate
) office along with the donor and the relative for getting the affidavit of donor, attested by him. Following documents are needed at the SDM office:
A letter on the hospital’s letter head telling that the patient is undergoing the treatment.
NOC from the Embassy
Affidavit patient
Affidavit donor
Affidavit relative
Step 3: Notary attests the affidavits of the patient and the relative.
Step 4: After the affidavits get attested, these documents are taken to the Authorization Committee of the hospital for approval. At the same time, the concerned doctors conduct some important tests on the patient and the donor.

Kidney Transplant’s Pre-conditions:

It is prefered that the donor should a first degree family member with the same or compatible blood group. Other relatives ca n also be considered but with proper documents and DNA typing to support their relationship.
The donor should be Physically and mentally fit
He/She should be between the age group of 18 and 60 years
The donor should not be suffering from chronic diseases such as HIV, Severe Hypertension, Hbs Ag, Diabetes etc The donor and the attendant should be near relatives.

Sunday 18 September 2016

Kidney Transplant in India

Kidney Transplant

Kidneys are bean shaped organs which serve many essential regulatory roles in the human body such as purification of blood by maintaining the balance of electrolytes and also pH homeostasis. They also remove excess organ molecules from the blood and are essential to the body’s urinary system. Kidney Transplant is necessitated as a result of kidney failure which happens due to cancer, diabetes and a whole host of other reasons, many of which are associated with a bad lifestyle.

Reasons for kidney failure

Nephritis
Nephropathy
Hyperfiltration
High blood pressure

What are the Types of kidney transplant?

Living donor kidney transplant– In this procedure, a kidney is taken from a donor(mostly a family member or a close friend) and transplanted to the patient
Deceased donor kidney transplant – In this procedure, a kidney is taken from a brain dead person after his/her family members have given the requisite consent

The kidneys are bean-shaped organs that serve several essential regulatory roles in vertebrates. They remove excess organic molecules from the blood. Kidneys are essential to the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and regulation of blood pressure. Located at the rear of the abdominal cavity in the retroperitoneal space. A kidney transplant is an operation in which a person with kidney failure receives a new kidney. The new kidney takes over the work of cleaning the blood.

Condition of kidney failure

Kidney failure is due to reasons stated below and process of slowing down kidney function is called kidney disease. There are two types of kidney diseases- acute kidney disease where damage is sudden quickly and the other is chronic kidney disease where the kidney function declines slowly and progressive.

What are the Types of kidney diseases?

Kidney cancer
Early kidney failure
Chronic renal insufficiency
Diabetic nephropathy
Nephritis
Nephropathy
Hyperfiltration (Stage 1)
Mild microalbuminuria ( Stage 2 )
Clinical albuminuria ( Stage 3)
Advanced clinical nephropathy (Stage 4)
Kidney failure (Stage 5)
Causes of Kidney Diseases

Kidney disease is most often caused by other conditions that put a strain on the kidneys. High blood pressure (hypertension) and diabetes are the most common causes of kidney disease

Diabetes mellitus, Diabetes mellitus, usually called diabetes, is a disease in which your body does not make enough insulin or cannot use normal amounts of insulin properly With diabetes, the small blood vessels in the body are injured. When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly.

High blood pressure or hypertension if left untreated will damage the glomeruli which filters waste from the body.

Glomerulonephritis : Glomerulonephritis is a group of diseases that injure the part of the kidney that filters blood (called glomeruli).

Polycystic Kidney disease : Polycystic kidney disease (PKD) is an inherited kidney disorder. It causes fluid-filled cysts to form fluid in the kidneys. PKD may impair kidney function and cause kidney failure

Renovascular disease Renovascular disease is a progressive condition that causes narrowing or blockage of the renal arteries or veins. These are the blood vessels that take blood to and from the kidneys and this disease causes decreased blood flow to the kidneys.

Chronic Pyelonephritis : it is is a type of urinary tract infection (UTI) that affects one or both kidneys . The urinary tract is the body’s drainage system for removing wastes and extra water · Systemic Lupus erythematosus also known as lupus in short it is a disease where body mistakenly attacks own kidney tissues.

Obstructive Nephropathy Obstructive uropathy occurs when urine cannot drain through a ureter (a tube that carries urine from the kidneys to the bladder). And this blockage causes damage to kidneys.

Analgesic Nephropathy and Drugs Analgesic nephropathy involves damage within the internal structures of the kidney. It is caused by long-term use of analgesics medications such as aspirin, phenacetin, and paracetamol.