Kidney Transplantation From Unrelated Donor: Things You Need to Know

Kidney disease kills millions of people around the world. It is estimated that 31 million people in the US alone are suffering from chronic kidney disease (CKD), which accounts for almost 10 percent of the adult population. Kidney Transplantation From Unrelated Donor is a reality in today’s world.

Patients suffering from CKD often need dialysis or kidney transplantation to survive. However, it is estimated that only half of the people across the world who need hemodialysis or kidney transplantation actually end up receiving treatment. Nearly 2 million people die prematurely every year because of the absence of treatment for kidney failure.

One of the main reasons why so many people die is the unavailability of donors in the immediate family. Additionally, the quality of life of people who wish to remain of dialysis for the rest of their lives and not go for a transplant also continues to deteriorate.

However, another major problem is ignorance about the laws pertaining to kidney donation and kidney transplant across the world. When people do not have a suitable donor in their family, they usually think that there is no way to undergo a transplant. This is because most of the countries only allow kidney transplant from a blood relative. However, this is not true about all countries.

Patients who do not have a blood-relative and who can donate a kidney can still get transplantation done. This is possible through an unrelated, yet emotionally attached donor. However, there are only a handful of countries that allow that and Singapore and Turkey are two of them.

Kidney transplantation in Turkey is available at some of the best JCI-certified hospitals in the country. Kidney transplantation in Singapore is equally popular among renal patients.

Patients and families who know that it is possible to get kidney transplantation done from an unrelated yet known donor are often confused about the procedure, how things work out in this case, the documents they need, and the legal implications. The purpose of this blog is to empower the end-stage renal patients by imparting them knowledge about unrelated kidney transplantation.

Section 1: Qualifying Criteria for Unrelated Kidney Transplantation

The most important thing that matters in the case of unrelated kidney transplantation is that the donor and the patient should be known to each other for years. However, it is equally important for them to be emotionally attached.

It is important to have a donor who is known and emotionally attached but not someone who is:

• Known to the patient but is willing to donate in return for financial help
• Known to the patient but has any other interests in return
• Not mentally stable
• Is not an adult
• Not independent enough to make his or her decision

The donor in the case of unrelated kidney transplantation should also fulfill the following criteria:

• Within the age group of 18 and 50
• No history of any surgery before
• No history of any disease or underlying conditions such as hypertension or diabetes

Section 2: Ethics Committee Meeting and its Purpose

All case of unrelated kidney transplantation has to undergo Ethics Committee Interview for the final approval on the surgery. The purpose of the Ethics Committee Meeting is to identify that the donor is genuine or whether he or she is actually known to the patient and his family or not.

The Ethics Committee Meeting is usually held twice a month in the country that allows kidney transplantation from an unrelated donor. The committee comprises police offers, psychologists, and doctors.

During the meeting, the patient and the donor are asked distinctive questions. Based on their answers, body language, attitude, and the level of confidence with which they answer, the committee decided whether the case is genuine or if there is organ trafficking involved.

For this reason, the patient and the donor should not try to hide any information from them. If any discrepancy is found or if the committee gets to know that it is a case of paid organ donation or organ trafficking, then there can be serious penalties or even imprisonment under the law of that particular country.

Before the Ethics Committee Meeting takes place, the concerned hospital gets all the investigations done for the patient and the donor. A copy of the reports is submitted to them along with other documentation mentioned later in this article.

In the case of patients from a different country who are not comfortable with the local language, a translator is given to facilitate the Q&A session. The patient and the donor are given different translators (approved by the Ministry) to maintain transparency and to rule out foul play during the entire process.

There are no set questions that the Ethics Committee asks every patient and that totally depends on the patient and the donor and their comfort level in responding to questions. However, as per our previous patients, the following are some of the areas that the Ethics Committee asks questions around:

• Names of the immediate children, siblings, or family members
• Family background, residential location, etc.
• How do you know each other and since when?
• How is their house, number of rooms, number of family members, etc?
• Why are you donating the kidney?
• Are you aware of the risks of kidney donation?
• Are you under any stress of donating your kidney?

You can also check the Patient testimonial of a patient who had undergone a Kidney Transplantation in Turkey. He explains to you how the process of Kidney Transplant takes place, what kind of questions are asked in the Ethics Committee and his review of the same process in a Foreign Medical Destination.

Section 3: Tests Required

For a technical approval on the case, the following reports of the patient and the donor must be submitted for review before the case proceeds any further:

• Blood group and other work-up
• Serology tests (HIV, Hepatitis B, and Hepatitis C)
• Urinalysis
• Kidney function test
• Liver function test
• Electrolytes
• Renal ultrasound
• Whole abdomen ultrasound
• Doppler ultrasound of the kidney vessels
• Tissue compatibility tests (HLA mapping)

The concerned hospital may or may not decide to repeat all the tests when the patient arrives. In addition to these tests, a cardiac and psychiatric evaluation is also carried out. Once everything is done and approved, all reports are submitted to the Ethics Committee for their review, a few days in advance of the meeting.

Section 4: Documentation Required

Hospitals that conduct kidney transplantation in Turkey from an unrelated donor usually require the following set of documentation:

• Birth certificate for the patient and the donor
• Family records and proof of relationship (old photographs, documented records, etc.)
• Passport copies of the patient and donor
• Written notary verified consent of the husband/wife if the donor is married

All of these documents must have Apostille authorization and later are translated into the Turkish language for submission to the Ethics Committee. Hospitals that conduct kidney transplants in Singapore from an unrelated donor require an extra set of documentation. Some of the documents include the following:

• Family tree of the recipient along with the name, age, blood group, and health status
• Family tree of the donor along with the name, age, and occupation
• Official proof explaining why can’t a blood relative donate a kidney
• Donor’s consent in the presence of The Commissioner of Oath in Singapore
• Financially independent donors to submit bank passbook or statement for the last 6 months, educational certificates, income tax return, appointment letter, and/or a copy of health or life insurance among other documents

A kidney transplant in Turkey can be done from a donor who is aged above 18. But kidney transplant in Singapore is usually done from a donor aged above 21.

Section 5: Cost Implications

The cost of kidney transplantation in Turkey at a JCI-certified hospital starts at around $15000 (pre-investigation excluded). The cost of kidney transplantation in Singapore at a JCI-certified hospital starts at about $40000 (pre-investigation excluded).

The overall kidney transplantation cost in either of these countries, however, may depend on several factors, including the following:

• Pre-surgical investigations for the patient and donor
• Accommodation
• Food expenses
• Cost of document translation
• Follow-up cost after discharge
• Cost of flights
• Visa fees

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