Kidney transplant in Iran: All you need to know

The kidneys are vital organs. They clean the blood of toxins and produce the urine that is used to transport the pollutants out of the body. At the same time, the kidneys regulate the body’s water balance. With kidney failure, the body poisons itself, which leads to death within a short time. A patient whose kidneys no longer work is therefore dependent on permanent dialysis treatment (machine blood purification) or on a donor kidney transplant. Since dialysis has to be carried out several times a week for several hours and thus severely restricts the patient’s everyday life, a kidney transplant surgery in Iran is usually the desired goal. In addition, a transplant improves the life expectancy of the patient.

Kidney transplantation is a surgery in which a healthy kidney is placed into the recipient’s body. the first kidney transplant procedure was performed in the United States in 1954. The donor kidney can come from either a deceased donor or a relative of the patient. All patients of any age group, from children to the elderly, can have a kidney transplant surgery in Iran if the patient is in good health and has a matched kidney donor. Also, the patient should not have cancer or infection. The urologist thoroughly examines the patient to make sure there is no problem with the kidney transplant and to eliminate any complication that affects the success of the surgery. If you also have kidney failure, read the rest of this article carefully.

When do you need a kidney transplant in Iran?

The kidney is a paired organ that is placed on both sides of the spine below the diaphragm. In an adult it weighs 120 to 300 grams and more than a liter of blood flows through the kidneys per minute. This very high blood flow rate is necessary for the clearing and filtering function of the kidneys:

• The kidneys remove endogenous waste and foreign substances (such as drugs) from the blood that are no longer required.
• They are involved in regulating the body’s water and electrolyte balance.
• They produce various hormones that are important for blood pressure, blood formation and bone metabolism (renin, erythropoietin and calcitriol).

Various diseases can lead to irreversible kidney failure. Diabetes mellitus or longstanding high blood pressure are the most common causes of kidney damage. Inflammatory kidney diseases, which are triggered by a malfunction of the body’s defense system (immune system) or the long-term use of pain medication, are less common. Young patients often have genetic defects, inflammatory kidney diseases or malformations.

Acute kidney failure develops within a few days to weeks. The causes are usually severe previous illnesses, severe fluid loss or allergic reactions to medication. In most cases, acute kidney failure heals almost completely. Permanent kidney damage (chronic kidney failure) develops slowly and often goes unnoticed for years. In most cases, damage that has occurred once does not resolve itself.

If the kidneys finally fail, their function must either be replaced by blood washing (dialysis) or by the transplantation of a donor kidney. As a rule, more donor organs are needed than are donated. This means that people who need a donor organ have to be put on a waiting list for that organ. To be placed on the waiting list for a donor kidney, there must be definitive renal failure. The patient must have dialysis or it must be foreseeable that it will be required.

• Also Read: 13 signs you may have kidney disease

Who cannot have a kidney transplant in Iran?

Not all patients with kidney failure can have a kidney transplant surgery in Iran. Patients with the following conditions are not good candidates for a kidney transplant:

• Patients with severe infections or a history of recurrent infections that cannot be completely cured.
• Patients with a cancer that has spread from its original site and has spread to other parts of the body.
• Patients with severe heart disease or any condition that generally increases the risk of surgery.

Therefore, it is recommended that you consult with your medical team about all of your issues and physical conditions before the operation. At a preoperative consultation, your urologist will tell you if you are a good candidate for a kidney transplant in Iran.

What are the medical conditions for tourists (non-Iranians) to have a kidney transplant in Iran?

Patient condition:

All evidence and medical records related to the patient’s kidney function are required, including all results related to the assessment of renal failure (GFR <10-15, chronic hypertension, serum creatinine level >12mg/dl – BUN level >40 mg/dL and the amount of proteinuria >3g in 24 hours).

Documents related to the start time, number, and duration of dialysis sessions are also required. A complete description of the patient’s cardiovascular history and whether he or she has diabetes or any other underlying condition should be included in the medical report. An ultrasound report of the kidney and urinary tract is also required.

Donor Conditions:

The donor of the kidney transplant must be alive. A family member, such as a parent, child, brother, or sister, may be a living donor (living-related donation). Someone emotionally connected to the patient, such as a close friend, spouse, or in-law, will also donate a kidney (living unrelated donation). A genetic connection between the donor and recipient is no longer needed for a successful transplant thanks to improved medications.

The donor must be in good general health and must not smoke or drink alcohol. Nor should it be treated for a specific disease. Clinical conditions of a donor include weight under 70 kg, no history of kidney disease, including kidney stones or infection, and age under 40 years.

What are the legal conditions for tourists (non-Iranians) to have a kidney transplant in Iran?

After sending the patient documents online to the transplant team in Iran and the approval of them to perform a kidney transplant, the patient and the donor must go to the Iranian embassy in their country with valid passports to examine and confirm their relationship with each other.

The donor and the patient must also submit a written mutual commitment to the embassy stating that there is no financial transaction between them for kidney transplant surgery in Iran. Before the trip, the commitment form along with scanned photos of their passports will be emailed to Iran, and after determining the time of surgery, the patient and the donor can travel to Iran.

Duration of hospitalization for kidney transplantation in Iran

• Transplant recipient duration of stay: 40-60 days (^*The duration of hospitalization of the transplant recipient during this period is 15-30 days.)
• Transplant donor duration of stay: 10-15 days (^*The duration of hospitalization of the transplant recipient during this period is 3-7 days.)

How to prepare for a kidney transplant in Iran?

To receive a kidney from a non-living donor, your name must be on the waiting list of the Organ Donation Network. Extensive tests and examinations will be performed on you to wait in line for a transplant.

The transplant team is responsible for reviewing the conditions and advancing the transplant process. The transplant team includes a transplant surgeon, a nephrologist (a doctor who specializes in and treats kidney diseases), one or more nurses, a social worker, and a psychiatrist or psychologist. Some transplant teams may include other members, such as a nutritionist or anesthesiologist.

The evaluation steps of the kidney transplant surgery team include:

• Mental Health Assessment: Prior to organ transplantation, a patient’s psychological and social status will be assessed including stress, financial issues, and the extent of support from family or other people. These issues can be very effective in the result of a kidney transplant in Iran. Such assessments will also be performed if for the donor if he or she is alive.
• Blood test: A blood test is done to find the right donor, to check the priority of the person in the waiting line, and to reduce the possibility of the organ being rejected by the patient’s body.
• Examination: In this process, the patient’s kidney condition and overall health will be examined. These examinations and tests can include x-rays, ultrasounds, kidney biopsies, and dental examinations; For women, examinations such as Pap smears (examination of cervical cells), gynecological examinations, and mammography (X-ray of the breast) will be performed along with other tests.

In general, the transplant team evaluates the patient’s medical history, the results of examinations and tests taken, and the extent to which he or she needs the transplant. Once the medical team confirms your need for a kidney transplant surgery, your name will be on the organ donation network list and you will be notified as soon as the organ is found, after which you will have to go to the hospital for surgery.

If the donor is a living member of your family, you will be notified of the transplant date and no longer have to wait in line to receive the organ. The important point in this situation is that the donor blood must be compatible with the patient’s blood and be in good physical condition. Prior to the transplant, a mental health test is taken from the donor to ensure that the decision is entirely his or her own.

What happens during a kidney transplant in Iran?

Before performing a kidney transplant in Iran, the following steps must be performed:

• The transplant team will explain how the kidney transplant is done and you can ask any question you have.
• You must sign a consent form that allows your medical team to perform the surgery. Read this form carefully and ask for further information if any part of it is not clear to you.
• If you have had regular dialysis before the visit, you will also be on dialysis before the operation.
• If the organ is received from a live donor, you should not eat anything for eight hours before surgery. If the kidney has been taken from a dead body, the patient should not eat anything from the time he or she is aware of the kidney’s availability.
• Some sedation may be used before the operation to keep you calm.
• Depending on your medical history, the transplant team may ask you some questions about your specific condition to prepare for them.

Kidney transplant surgery in Iran is performed in a hospital setting and the methods used will vary depending on your medical team and medical condition. In general, kidney transplantation procedure is performed according to the following steps:

• Initially, the patient takes off his / her clothes and puts on hospital gowns (comfortable hospital clothes).
• An IV line is placed in your arm or hand. Catheters (tubes for transferring fluids) may also be placed on your neck and wrists to check your heart condition, blood pressure, and taking blood samples. Other parts of the body to install these catheters include the clavicle and groin area.
• If there is excess hair in the surgical area, it will be shaved.
• Then, a urinary catheter is attached to your bladder.
• You should lie on your back on the operating room bed.
• The patient will be fully anesthetized for a kidney transplant. In this case, a tube enters the patient’s lungs through the mouth; The tube is connected to a ventilator that allows the patient to breathe during the operation.
• An anesthesiologist in the operating room regularly monitors your heart rate, blood pressure, breathing status, and oxygen levels during surgery.
• The skin of the surgical site is cleansed and disinfected with a disinfectant solution.
• An incision is created by the surgeon in the lower abdomen and on one side of the body. Before the operation, the surgeon re-examines the donated kidney.
• At this stage, the donated kidney is placed inside the patient’s abdomen. If the donated kidney is on the left side of the body, it is located on the right side of the patient’s body, and if the kidney is on the right side, it is grafted on the left side of the patient’s body; reason for this is the easier connection of the urethra to the bladder.
• In donated kidneys, the renal artery and vein are connected to the external iliac artery (external site).
• After the arteries and veins are connected, the blood flow through them is checked to identify and prevent any bleeding from the sutures.
• At this stage, the ureter (the tube that carries urine out of the kidney) of the transplanted kidney is attached to the patient’s bladder.
• The patient’s incision is closed by a stapler or suture.
• To prevent swelling of the wound area due to fluid accumulation, a drain tube may be placed in the area.
• In the last step, a sterile bandage is placed on the patient’s wound and it is carefully bandaged.

What happens after a kidney transplant in Iran?

After a kidney transplant in Iran, the patient is taken to a recovery room. Once the patient’s blood pressure, heart rate, and respiration are stable and the patient regains consciousness, he or she is transferred to the Intensive Care Unit (ICU) and monitored closely. When the patient is ready to leave the intensive care unit, he or she is transferred to the general ward. Usually, after a kidney transplant, the patient needs to stay in the hospital for a few days and will be discharged after complete recovery.

• If the kidney is donated from a living person, it begins to produce urine immediately after being placed in the body, but if the kidney is taken from a dead donor, it takes some time to start producing urine; Therefore, in this case, you should continue your dialysis after the kidney transplant surgery in Iran until the urine production process returns to normal.
• A urinary catheter is attached to your bladder that expels urine from your body. Your doctor will also check your urine level to make sure your new kidney is working properly.
• As long as you are able to eat and drink yourself, nutrients enter your body through the IV line.
• Your medical team will monitor the effectiveness of anti-rejection drugs that prevent transplant rejection (including immunosuppressive drugs that prevent immune system attack to the new kidney) at all times so that you can find the best dose and combination of your medications.
• A blood test will usually be taken from you. The purpose of this test is to check the condition of your new kidney and other organs in your body, including your liver, lungs, and circulatory system.
• Over time, your nutrition will slowly shift from liquids to semi-solid and then normal foods; But in general, you will have nutritional restrictions until your new kidney is fully functioning in your body, and you should follow your doctor’s instructions.
• Usually, after one day of the transplant, you can move; After your doctor allows you to move, you should get out of bed several times a day and be active.
• If you have pain, you should take painkillers under the supervision of your doctor. Be careful not to use aspirin or painkillers that increase the risk of bleeding. Under any circumstances, use only medications that are recommended by your doctor.
• Nurses, pharmacists, nutritionists, physiotherapists, and other specialists on your transplant team will teach you how to take care of your body and your wounds so that you can take good care of yourself after your discharge from the hospital.

Once your vital signs have stabilized, your transplanted kidney function has begun well, and you no longer need hospital care, you are ready to be discharged and go home.

Post-kidney transplant care

The following tips are important for patients who have had a kidney transplant surgery in Iran:

• You will not be allowed to drive for a while after the kidney transplant in Iran; So, someone should get you from the hospital to home and from the home to the doctor’s office for an examination.
• After you leave the hospital and return home, the important thing is to always keep your wound clean and dry to reduce the risk of infection.
• The patient must visit the nephrologist (kidney specialist) regularly, who will check the function of the donor kidney and recognize the early warning signs of rejection or infection.
• The sutures or staples of your wound are removed under the supervision of a doctor during the appointments after surgery.
• Additional medication and food supplements (including over-the-counter or herbal ones) must always be discussed with a doctor in order to avoid interactions with the immunosuppressants.
• Smoking and passive smoking are prohibited, especially when waiting for the donor organ.
• Personal hygiene requires special attention because microorganisms can be dangerous for immunocompromised patients.
• Dental procedures often require the preventive intake of an antibiotic to prevent bacteria from entering the bloodstream.
• Keeping pets should be done with caution and preferably with the use of masks and gloves.
• Contact with patients with infectious diseases should be avoided as far as possible.
• Sport and exercise are important to keep the body healthy. However, intensive training must be discussed with the doctor.
• Since immunosuppressed patients are more prone to skin tumors, very good protection against sun radiation is always necessary.
• Any activity or situation that puts pressure on the new kidney should be avoided.
• Check your blood pressure and weight every day at home; An increase in these items may indicate that your kidneys are not working well. If you see this, contact your transplant team immediately for a thorough examination.

What are kidney transplant rejection signs and how to prevent it?

You should tell your doctor if you have any of the following symptoms as they can be a sign of rejection:

• Fever, which may indicate the rejection of a new organ or the presence of an infection in the body.
• Redness, swelling, bleeding, or discharge from the incision.
• Increased pain in the incision area, which may indicate rejection of a new organ or infection.
• Sensitivity of the kidneys
• Elevated blood creatine levels (as determined by a blood test)
• high blood pressure

In general, the symptoms of rejection can be similar to other medical conditions and diseases; That’s why you should talk to your transplant team about the smallest details and take your routine checkups seriously.

To prevent kidney transplant rejection and maintain kidney health, your doctor may prescribe medications that you should use for the rest of your life; Each patient’s body response to these drugs can be different. Anti-rejection drugs are constantly evolving and upgrading, and your medical team will prescribe the right medications for you based on your condition.

Life expectancy after a kidney transplant in Iran

After a kidney transplant, the patient’s life is much more self-determined, as the patient no longer has to rely on the stressful dialysis treatments several times a week. However, the body recognizes a transplanted organ as “foreign” and tries to reject it. To prevent this from happening, the patient’s immune system must be permanently suppressed with medication. This immunosuppression makes the body susceptible to many other diseases that can subsequently become a problem. Some of the most common infections you may have are: thrush (white-gray bumps on the mucous membranes of the mouth or tongue), herpes, and respiratory infections.

A healthy lifestyle and increased hygiene in everyday life are therefore important. Nevertheless, the life expectancy and quality of life of patients after a kidney transplant are significantly higher than that of patients undergoing dialysis.

Hopefully, the success rate of the kidney transplant is good: after a year, around 80 percent of the transplanted organs are still working. A donor kidney can function for ten to 15 years, sometimes significantly longer. However, this time specification can differ significantly from one patient to another and depends heavily on the patient’s state of health.

If at some point the kidney no longer works properly, the patient has to have his blood regularly cleaned by dialysis again. If necessary, another kidney transplant is an option. In general, however, the following applies: Patients with a transplant usually live longer than dialysis patients and also have a higher quality of life and a more self-determined everyday life.

What are the risks of a kidney transplant?

Kidney transplant surgery, like other surgeries, may be associated with complications and risks, such as:

• Bleeding
• Infection
• Obstruction of blood vessels connected to the new kidney
• Leakage or blockage of urine in the urethra
• New kidney failure at the beginning of the transplant

The most important complication after a kidney transplant is that your body may reject your new kidney. Rejection is the natural reaction of the immune system against the entry of a foreign antigen or tissue into the body. When a new kidney is transplanted into a person’s body, the body’s immune system detects it as foreign tissue and attacks it.

To keep the transplanted organ healthy and preventing the immune system to attack it, doctors prescribe various immunosuppressive drugs to weaken the immune system. These drugs may also have side effects that vary depending on the type of drug and the patient’s health condition.