Kidney transplants: Eight common questions answered

We’ve heard people talk about kidney donation without clearly knowing the process and vulnerabilities that come with it and making it seem as easy as exhaling. Do you ever wonder why one would need a transplant and what might lead to the entire procedure?

Dr Joyce K Bwombengi, a nephrologist at Aga Khan University Hospital, emphasises the vital role of kidney transplantation in improving the quality of life for patients with kidney disease.

Dr Joyce K Bombwengi, Kidney Specialist (Nephrologist).

When does a transplant become necessary?

According to Dr Bwombengi, this treatment option becomes essential when other medical interventions are ineffective, typically in the fifth and final stage of kidney disease.

“By the time a patient gets to the fifth stage, the kidney is completely not working. There’s very little you can do medically to help the kidney along. And that point is where we send our patients for either hemodialysis or another type called peritoneal dialysis or transplantation,” she explains.

In haemodialysis, a dialysis machine and a special filter called an artificial kidney, or a dialyzer, are used to clean your blood. In peritoneal dialysis, the lining of your abdomen, the blood in your body is filtered through a soft tube in your belly called a catheter.

“Now if a patient sees a kidney specialist in good time, in the early stages of chronic kidney disease, we can reverse many of those things. But when they come later, we can only offer these three options. Of the three options, transplantation is the best,” she says.

What does finding a suitable donor entail?

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This is the first step in the kidney transplant procedure. Several tests are carried out to evaluate the donor’s suitability and compatibility between the donor and recipient is crucial.

“The best donor would be someone similar, of a close age to the recipient. The recipient is the person receiving the kidney, and the donor is the person donating the kidney. Normally, we prefer a close family relative, but we know certain conditions run in families. For example, you can get a family; all of them have diabetes, hypertension, kidney failure, or inherited kidney diseases like polycystic kidney disease,” Dr Bwombengi explains.

According to Dr Bwombengi, a “living related donor” is typically a close family member such as a sibling, parent, or first cousin, who voluntarily donates an organ, often a kidney, to someone in need. Legal documentation, such as affidavits or birth certificates, is required to verify the familial relationship and prevent potential misuse.

Can you get a kidney from a dead person?

This is called ‘deceased organ donation’, Dr Bwombengi explains. “It’s hard to get a donor. So in that case, in other countries where they’re more developed with transplantation, they have a Deceased Organ Transplant Programme. Deceased organ means for those patients who were healthy and doing well but then they get really bad injuries like road traffic accidents and then they get brain-dead,” she elaborates. “If they have healthy organs, they can be harvested in good time and transplanted into different people,” she says.

“One person can donate so many things. So that’s a very important programme. In the Health Act right now in Kenya, it’s already been accepted as one of the ways we are going to be doing transplantation. But for that to work, several things have to be put in place,” she says.

“So those are good potential donors and in other countries where they developed, like in Spain, US, there’s something called an Opt-in and an Opt-out system,” she adds.

Organ donation systems can be categorised as “Opt-in” or “Opt-out.” In an Opt-in system like in the US, people must actively sign up to a register to donate their organs after death. Conversely, in an “Opt-out” system, everyone is considered a potential donor unless they have specifically refused.

The third type of donation is “paired organ exchange,” which allows incompatible donor-recipient pairs to swap with other pairs facing similar challenges, increasing the chances of successful transplants.

“Basically, if in my family or in my group of people, there’s a potential donor but they don’t match with me, but elsewhere there’s someone who needs a kidney that will match with this person,” Dr Bwombengi elaborates.

She emphasises the need for stringent regulations and ethical safeguards to prevent organ trafficking, in line with international agreements such as the Declaration of Geneva.

How do I get my kidneys tested?

Dr Bwombengi stressed the importance of early detection and preserving kidney health. World Kidney Day, celebrated in March, provides an opportunity for nationwide screenings, where individuals are encouraged to have their blood pressure checked and undergo tests for blood sugar and urine.

“One of the wonderful things about things that are being done by the healthcare practitioners in our country is that we have World Kidney Day in March, where we do a world countrywide screening,” she says.

“That gives us an inkling of what’s happening. Then we do blood sugar and we do a urine deep stick test that already tells us who you need to prefer for further evaluation to see if there’s something wrong with the kidney,” she adds.

When should I worry about my kidneys?

Dr Bwombengi highlights several warning signs that individuals should watch out for, including upper back pain, changes in urine colour, the presence of blood in the urine, pain during urination, or reduced urine output. She stresses the importance of seeking medical attention promptly when experiencing such symptoms.

“If you are at home and you’re having pain in the upper back, where the kidneys are located or if your urine looks dark like it has blood, or you have pain when passing urine, please go to the doctor. Or even if your urine is reduced, especially for men who get prostate enlargement,” she voices.

“If you wake up in the morning and your face is swollen or at the end of the day your legs are swelling, dizziness, fatigue out of the ordinary. You’re trying to walk up a staircase, you’re short of breath. Please come and see a doctor.”

Where are my kidneys located?

Dr Bwombengi also touches on the importance of understanding the kidney’s location, as many people lack awareness of their kidneys’ position in the body. This awareness can be crucial for early recognition of kidney-related issues.

“We had a challenge last year for World Kidney Day and we asked different people in different hospitals, ’Where are your kidneys?’ And they shared on social media. So when we were doing this challenge where we’re showing people, ‘This is where your kidneys are’. It’s very important for patients,” she states.

“If you’re having this back pain after being managed for back pain for 10 years, then you come and we tell you that you have end-stage kidney disease. You had something that could have been sorted out a long time ago,” Dr Bwombengi states.

Dr Bwombengi shares insights on who vulnerable populations are, stressing that selling one’s kidney due to financial desperation is a risky decision and should be avoided.

“The people who are desperate and need to get some money and want that quick money. So they say, ‘I’m selling my kidney.’ Those are vulnerable populations because you should not sell your kidney.”

How do I take care of my kidneys?

She also touches upon the importance of drinking an appropriate amount of water for healthy kidneys, not overdoing it, and adjusting water intake based on factors like weather and personal needs.

“Not a lot; you can get water poisoning. But for your height and weight, there’s a certain amount of water you can take. So these eight glasses per day—6 to 8 glasses for a standard 70kg adult,” Dr Bombwengi says.

“If it’s a very hot day and your urine is very dark, that means you’re sweating more than what you’re putting in your urine, then you drink more. On a cold day, you’re less likely to drink water. You’re feeling cold, so the body is conserving the heat and the water, so you will not be as thirsty. So water is good, but don’t overdo it,” she says.

What if someone asks me to be a donor?

Dr Bwombengi highlights the significance of kidney transplants and the impact they can have on saving lives. She explains that, in many cases, the old kidney remains in the body alongside the new one if it’s not causing complications.

Dr Bwombengi explains living-related donors and the necessity of family relationships to ensure safety and ethical organ transplantation.

“In Kenya, what we do is living related donors; we have to have a family relationship and it’s usually siblings, parents, cousins and a spouse. A spouse is a relative but not a friend, not a pastor. No, none of those. It has to be a living-related donor,” she notes.

“So once you come in, we do several things. We have to ensure that you’re healthy—your blood pressure, blood sugar, your body—generally, you’re healthy. We do several tests to confirm that.”

She also explains the matching process, including blood group compatibility and human leukocyte antigen matching.

“We also do blood group matching. Here in our country, we prefer to do blood group-matched donations. But in countries where they’re more advanced, we’ll have the ABO-incompatible transplantation. But we have more success when your cells are similar to the person who’s donating to you. So the blood group is an entry point,” Dr Bwombengi says. “We also make sure that the person who’s donating does not have any infectious diseases that can be transferred to the donor.”

“There’s something called HLA, human leukocyte antigen, the special tags on your white cells and on your cells that say that you are like this, you are like this, you are like this,” she explains.

“If we are similar, we look at different; they’re like six components that we usually look at. If five of your things match with five of my things, then we have a 5 / 6 match. That’s a good match,” Dr Bwombengi explains.

“My body is likely to accept your body organ in my body, and it’s likely for the body to attack that kidney. So that’s one of the things that we do and we do it at the very end after we have confirmed that the donor is healthy, that they do not run a risk of complications after transplantation,” she adds.

Dr Bwombengi addresses common myths and fears surrounding kidney transplantation, such as concerns about inheriting negative traits or a lack of understanding about the process.

Myth 1

“Most people fear donating their kidneys because they think that they run the risk of having problems going forward. Which is a true fear. When we do our evaluation, we look at all those factors and if indeed you’re at risk, we will not take you as a potential donor,” Dr Bwombengi says.

“The fear of the surgery—not knowing what’s going to happen or what else is going to be affected? For the donors, one of the challenges they have; If you have a forum of patients who’ve had a kidney transplant or have been seeking an active donor, people demand things like money and land,” she affirms

“Donation should be altruistic; it’s an act of love. I should give out of the love of my heart. You should not want anything in exchange; you cannot put a value on a kidney,” she stresses.

Myth 2

“Some of the people who we’ve asked, why don’t you want a kidney transplant? They’re like, Oh, I don’t know who’s going to give me their kidney. Will I inherit their bad behaviour? Will I inherit some traits from them?” Dr Bwombengi says.

Myth 3

“Another thing is that in Kenya, people do a lot of herbs, herbs that are not regulated and they damage the kidney and the nubile. So I want to just say that when you are told you have kidney failure, don’t take off and start trying all these alternative methods before having a good, concise plan with your doctor because they are trained to sort out all these problems and slow down prevention,” she explains.

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