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Journalism of Courage
With reports of actor Satish Shah having undergone a kidney transplant and his past history of dialysis and a heart procedure, many questions are being raised on whether transplants are safe for all patients of kidney disease. That’s what Dr Debabrata Mukherjee, senior director, nephrology, renal care, Medanta, Gurugram, is being asked. “Unfortunately, people often look at health issues from the prism of celebrityhood. But fact is the fitness of both the donor and patient needs to be within parameters. That is the uppermost. Then a transplant, done at a good centre with experienced hands, has a success rate of about 98 per cent. I have patients, who had a transplant 30 years ago, following up with me regularly and leading normal lives,” he says.
He then tells the story of two transplantees, who met in his OPD, got married and now have a healthy child. Both were in their early 30s and had chronic nephritis, a condition common in the under 40-group. “It is a long-time inflammation of the kidneys that impairs their functions. This is caused by autoimmune diseases, hereditary conditions and untreated infections that damage the kidneys’ filtering units. Risk factors like diabetes can speed up kidney damage in young people,” says Dr Mukherjee.
“The man got a kidney from a family member, the woman got it from a cadaver. It was during recovery and follow-ups that they met during a work-up. They got married and the wife became pregnant. Then they faced another challenge, that of Covid (any infection is a matter of concern for organ recipients). Both recovered, the woman delivered and both are very diligent about their follow-up, disciplined, into exercises and particular about taking their medication at the right time,” says Dr Mukherjee. Excerpts:
One should not have any comorbidity or a pre-existing condition. That basic fitness is non-negotiable. Shah had obesity and a history of heart disease. Always remember the kidney, liver and heart are entwined and diabetes, obesity and hypertension impact all three. You can say they are a gang, each of which feeds off the other. So a transplant failure can have an underlying trigger.
Post-operative patients may get blood clots, which may travel through the bloodstream and block blood supply to organs. This is called embolism, which can trigger strokes. Sometimes high-dose steroids are given to prevent rejection, some of which can cause irregular heartbeats and electrical dysfunction of the heart, which can lead to sudden death. Post-operative infections may cause complications but these do not cause sudden death. Age is another factor.
The right dosage of the drug to pacify the immune system is the most critical factor. The immune system is designed to reject anything that is foreign to your body. So we have to tell it to accept the kidney but continue to do its normal functions in other parts of the body. It is like telling the house guard to let some visitors in and keep the others out. This requires a delicate balance and monitoring the right dosage as the patient improves.
Often patients, particularly those who have had frequent dialysis and hospital visits, may feel that a transplant doesn’t require them to be as strict about follow-ups. Since immunosuppressants also have side effects, like loss of hair and abrupt growth of facial hair, some patients stop them midway. Post-transplant caution, hygiene protocols, avoidance of even a mild infection and discipline are the most important.
Since a kidney recipient cannot afford infection, they should not have cut fruits or vegetable salads where bacteria tend to grow faster. Peeled fruits are allowed. Rest have to be steamed or cooked. Cleanliness and hygiene should be followed life-long. You have to be cautious about exercise the first six months because of surgical scars. But after that a recipient can be as active as anybody else. We even host transplant games where kidney recipients participate in cycling and swimming competitions.
We have one lakh new dialysis cases every year. Only about 10,000 of these get a kidney for transplant. Now with late parenthood and longevity going up, even older parents cannot donate for their sick single children. One lakh road accidents and brain deaths happen every year. So if we can donate organs, many lives would be saved.
