Kidney transplant in India: the process step by step

A kidney transplant can feel like a long road with many tests and papers. Knowing the steps in advance makes it easier for the patient and the family. This guide follows the process used for kidney transplant in Lucknow at Precision Urology Hospital, where Dr. Aditya P.S. Sengar is Head of Renal Transplantation and has been part of more than 500 transplants. The order of tests can differ slightly from patient to patient.

Step 1: First consultation

Bring all reports: creatinine and other blood tests, ultrasound, dialysis records and a list of medicines. The team checks whether a transplant is suitable and explains the options, including a living family donor or the deceased donor waiting list. Families can also send reports on WhatsApp first.

Step 2: Tests for the patient (recipient)

These check that the body can safely take a new kidney and the medicines that follow:

• Blood group, HLA typing and antibody tests
• Heart tests: ECG, echocardiogram and, in some patients, a stress test or angiography
• Chest X-ray and lung check
• Tests for infections such as HIV, hepatitis B and C and tuberculosis
• Ultrasound of the abdomen and a check of the bladder
• Dental, and for women gynaecological, check-ups to rule out hidden infection
• Vaccinations that should be given before the transplant

Step 3: Tests for the donor

The donor has a full health check, including kidney function, CT angiography of the kidneys, heart tests and a psychological assessment. Donating is allowed only if it is safe for the donor. Details are in who can donate a kidney in India.

Step 4: Matching

The patient's blood is tested against the donor's cells (crossmatch) to make sure there are no harmful antibodies. If the blood groups do not match, an ABO-incompatible transplant with extra treatment, or a swap with another family, may still be possible.

Step 5: Documents and approval

Under the Transplantation of Human Organs and Tissues Act, every living donor transplant needs approval. The family submits identity and relationship documents, and the donor and patient are interviewed by the Authorisation Committee. The hospital's transplant coordinator guides the family through this.

Step 6: Admission and preparation

The patient and donor are admitted a day or two before surgery. Dialysis may be done the day before. The anti-rejection medicines usually start just before the operation.

Step 7: The day of surgery

• Donor: the kidney is removed by keyhole (laparoscopic) surgery through small cuts in most cases.
• Patient: the new kidney is placed in the lower right or left side of the abdomen and joined to the blood vessels there and to the bladder. The patient's own kidneys are usually left in place.
• The recipient operation takes about 3 to 4 hours. The new kidney often starts making urine on the table.

Step 8: Hospital stay and follow-up

The donor usually goes home in about 3 to 5 days, and the patient in about 1 to 2 weeks. The first 3 months need frequent blood tests and visits. Read life after a kidney transplant for what to expect at home.

How long does the whole process take?

With a family donor who is ready and fit, the tests and approvals often take about 4 to 8 weeks. It can take longer if extra tests or treatment are needed, or if a deceased donor kidney is awaited. Starting the work-up early, before dialysis or soon after, saves time. Compare kidney transplant and dialysis if you are still deciding.