Introduction

Kidney transplantation is a major surgery that involves the placement of a healthy kidney in the body of the patient. The doctors conduct the surgery only when both the kidneys are not functional or when the patient has end-stage kidney disease.

The healthy kidney is retrieved from the body of a suitable living donor. The living could be related to the patient or completely unrelated, yet emotionally attached to the patient. A majority of countries, however, do not allow kidney transplantation from an unrelated donor. Singapore and Turkey are two such countries that allow kidney transplantation from an unrelated yet known donor.

Some countries allow the use of a kidney from a cadaveric donor as well. In such cases, it is mandatory that the deceased person is registered as a donor. If the deceased person was not a donor, the immediate family members can give their consent to donate the organs of the cadaver. However, a majority of countries allow kidney transplantation from a cadaveric donor for their own nationals and not a patient from abroad.

The kidney transplantation legal formalities and laws for foreign nationals, however, varies from one country to the other. It is a complex and major procedure that involves a series of testing on the patient and the donor. It also involves a thorough review and scrutiny by the Ethics Committee in case of an unrelated donor. The purpose of this scrutiny is to check that it is a genuine case of kidney transplantation and there is no illegal organ donation involved.

The objective of this Kidney Transplantation Cost Guide is to brief you about the costs and expenses that you may have to incur while undergoing kidney transplant abroad. Additionally, it provides a detailed break-up of what you should expect before, during, and after kidney transplantation in terms of expenses.

When is Kidney Transplantation Advised?

Doctors recommend kidney transplantation to patients with end-stage renal disease (ESRD) or Stage 4 or Stage 5 chronic kidney disease (CKD). The doctors first conduct a series of tests to check the functioning of the kidneys, including the glomerular filtration rate (GFR) and creatinine levels. If indicated, they may recommend kidney transplantation to extend the life of the patient.

Choosing to Go For Kidney Transplant vs. Staying On Dialysis

Patients with ESKD are advised to undergo dialysis once, twice, or thrice a week, depending on the medical condition of the patient. Dialysis is important to ensure that the body of the patient keeps functioning normally and the waste products are eliminated from the body. An alternative to dialysis is kidney transplantation, following which dialysis is no longer required in the long term.

Kidney transplantation is an expensive procedure as compared to dialysis. However, a kidney taken from a donor lasts for around 10 to 15 years. However, dialysis is required at regular intervals.

Therefore, in terms of cost-effectiveness, kidney transplantation is preferred as compared to dialysis. This is because every time a patient gets dialysis done, he or she has to pay for the procedure and also bear the hospital bed charges.

Factors Affecting the Cost of Kidney Transplantation

Kidney transplantation is a complex procedure. There are several factors that control the cost of the procedure. It is likely that the cost of kidney transplantation varies from one patient to the other because each patient is different with respect to individual parameters, medical history, and needs. Similarly, the characteristics of the donor vary from one individual to the other.

While the cost of other medical procedures and surgeries may remain more or less the same among patients, transplant procedures are different. This is because an organ transplantation surgery involves two parties – the recipient and the donor. The parameters of the donor and the recipient may vary among different cases, which, in turn, affects the total cost of transplantation.

The following are some of the top factors that affect the cost of kidney transplantation:

The Choice of Country

Kidney transplantation cost in India is much less as compared to other medical tourism destinations. For example, the cost of kidney transplantation in Singapore can be as high as five to ten times as compared to India. On the other hand, the kidney transplantation cost in Turkey is close to that of India. It is, however, an expensive procedure in Thailand and Israel.

Number of Dialyses Required

During the course of pre-surgery investigations, the donor requires regular dialysis to keep the body functioning until the doctors conduct transplantation. Sometimes, a couple of dialyzes are also required during the first two weeks after transplantation until the new kidney fully adjusts to the body of the recipient. This has an impact on the total cost of treatment.

Recipient and Donor Parameters

The doctors conduct order a series of blood and other biochemistry tests for both the recipient and the donor before the actual surgery. Sometimes, a few parameters of the donor or recipient could be abnormal, thus requiring some form of medical management. This affects the total cost of treatment.

Type of Donor

An additional medical management and monitoring are required in the case of an unrelated donor that has no blood connection with the patient. In such cases, the kidney transplantation cost may go higher as the recipient requires an extra dose of anti-rejection medicines and higher monitoring levels.

Total Hospital Stay

The cost of treatment goes up as the number of days that the recipient and donor are required to stay in the hospital increases. Usually, in case of no complications, the donor is discharged after five days of the surgery. On the other hand, the recipient is discharged after 10 to 12 days of the surgery. In case any complication arises, the patient or the donor may be required for an extra number of days, which may increase the hospital bill.

First Transplant vs. Second Transplant

The chances of rejection are higher when the patient has had a kidney transplant done before. Therefore in the case of repeat or second kidney transplantation, the level of care and the dose and type of medications required as compared to the first transplant cases exceeds. The re-transplant patients often require intravenous immunoglobulin (IVIG) treatment, which costs additional to the kidney transplantation procedure.

Chances of Rejection

The cost of kidney transplantation also depends on the chances of organ rejection by the donor. This is mostly figured out at the time of pre-surgery investigations.

For example, if the patient has a positive panel-reactive antibody (PRA) test for Class 2, then preoperative plasmapheresis, IVIG, rituximab treatment may be necessary before the transplant surgery. This reduces the chances of ejection. However, this treatment is given at an extra cost.

Ethics Committee Approval

In the case of an unrelated donor, prior approval from the Ethics Committee is required before the patient can undergo the surgery. An Ethics Committee is a group of professionals and comprises of doctors, psychiatrists, police officer, and other concerned individuals. The purpose of the Ethics Committee is to ensure that it is not a case of illegal transplantation and that a fair practice is being carried out.

The interview with the Ethics Committee involves the preparation of a certain set of documentation, which is then translated into the local language. It is then presented to the committee. The preparation of documentation and its translation comes at an extra cost.

Singapore and Turkey are the two leading medical tourism destinations that do kidney transplantation from an unrelated donor. In these countries, the Ethics Committee sits twice a month to interview kidney transplant candidates and their unrelated donors.

Other Factors That Control The Cost of Kidney Transplantation

• The overall health of the patient
• Choice of hospital
• Type of accommodation opted for
• Number of follow-up sessions
• Complications management
• Hotel expenses
• Cost of meals
• Cost of extra medications
• Experience of the surgeon

Average Cost of Kidney Transplantation: Top Countries

Country	Kidney Transplantation Cost (Incl Pre-surgery Investigations for Recipient and Donor)
India	$ 13,000
Turkey	$ 21,000
Singapore	$ 67,000
Thailand	$ 35,000

Kidney Transplantation Cost Itemized Breakdown

Pre-surgery Costs	Surgery Cost	Post-surgery Costs
Physical examination Doctor’s consultation Recipient’s work-up Donor’s work-up Blood tests Dialysis Psychiatrist evaluation Cardiac check-up Medications Pre-operative preparation Documentation	Surgery team fees Anesthesia charges OT charges Other consumables and medicines Laboratory charges	Medications cost Other special consumables Any additional service availed Dialysis Any other consultation Complications management Unanticipated care Follow-up sessions DJ stent removal

Tests Conducted Before Kidney Transplantation

Testing to see if you can donate a kidney begins with a blood test. The test will determine your blood type and if it will match the recipient’s blood (compatibility). If your blood type is compatible with the recipient, two more blood tests will be done (tissue typing and cross-matching).

Tests Required for Recipients in Kidney Transplantation:

Tests Required for DONORS in Kidney Transplantation:

Cost of Accommodation, Food, and Local Travel

Patients who travel from abroad to a particular country for treatment have to bear an additional cost of hotel accommodation, local traveling, and food. This additional cost on top of the treatment cost depends on individual preferences. For example, a patient may decide to stay in a 3-star, 4-star or 5-star accommodation and prefer to eat exquisite cuisine during his or her stay. The cost increases with an increase in the level of luxury that a patient looks to have.

The following table highlights the approximate cost of accommodation and food in some of the most popular medical tourism destinations:

Cost (per night/day)	India	Thailand	Turkey	Singapore
Accommodation (3-star)	$30	$25	$20	$60
Accommodation (4-star)	$40	$36	$30	$90
Accommodation (5-star)	$75	$76	$44	$120
Meals for Two Individuals	$20	$26	$42	$90

Internationally Recognized JCI-certified Hospitals For Kidney Transplantation

Country	Hospital
India	Indraprastha Apollo Hospital (Delhi NCR)
	BLK Hospital (Delhi)
	Max Hospital (Delhi NCR)
	Fortis Group of Hospitals (Pan India)
Turkey	Medipol Mega University
	Medicana International Hospital
	Memorial Healthcare Group
	Anadolu Medical Center
Thailand	Vejthani Hospital
	Phyathai Hospital
	Bangkok Hospital
Singapore	Raffles Hospital
	Mount Elizabeth Hospital
	Parkway East Hospital

India:

• Indraprastha Apollo Hospital: The Centres of Nephrology and Urology have a sizeable and comprehensive renal transplant program, having performed both autologous and cadaveric transplants. It has the first organ transplant registry in India. Apollo Group of Hospitals is considered to be the best hospital for Cancer Treatments in India.
  Facilities Available: 
  State-of-the-art procedures for kidney transplantation include:
  • Cadaveric renal transplantation
  • Cadaver-donor kidney transplantation
  • Living donor kidney transplants (from both related and unrelated donors)
  • Laparoscopic donor Nephrectomy
• Artemis Hospital, India: State-of-the-art facilities for renal pathology, with complete biochemical, immunological, microbiological and histological (including immunofluorescence and immuno-histo-chemistry) – back up available under one roof.
  Facilities Available: 
  • Peritoneal Dialysis
  • Continuous Renal Replacement Therapy (CRRT)
  • Plasmapheresis
  • Hemoperfusion
  • Kidney Biopsy and other procedures
  • CAPD Catheterization
  • Vascular Access for Hemodialysis
  • Kidney Transplantation and post-transplant follow up care
  • Focus on preventive aspects of HD and slowing disease progression to dialysis by managing patients under dietary modification and medicines
• Fortis Group of Hospitals: The Department of Urology at Fortis offers advanced urological care at par with international standards. We offer a full spectrum of diagnostics and treatment for urology cancers, prostate diseases, laparoscopic urology, reconstructive urology surgery, stone disease, erectile dysfunction, pediatric urology, pediatric renal transplant, and andrology.

Singapore:

• Gleneagles Hospital: Gleneagles Hospital has a dedicated multi-disciplinary team of specialist doctors which include nephrologists, intensive care clinicians, specialty trained nursing staff, who are experienced and able to work as a seamless team to treat and care for patients during the transplant and post-surgery.
  Conditions Treated: 
  • Acute kidney injury
  • Diabetic nephropathy
  • End-stage kidney disease
  • Fluid and electrolyte disorder
  • Glomerulonephritis
  • Haematuria (blood in the urine)
  • Hypertensive kidney disease
  • Kidney cancer (renal cell carcinoma)
  • Kidney failure
  • Kidney stones
  • Polycystic kidney disease
  • Proteinuria (protein in the urine)
• Mount Elizabeth Hospital: LDKT program offers open and laparoscopic surgeries and surgical interventions including acute and chronic disease management, end-stage disease management and kidney transplantation. They also include undertake complicated transplantations for blood group incompatible and positive cross-match (sensitized) patients and are also the first hospital to offer such solutions in Southeast Asia.