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kidney transplant

Kidney Transplant Crisis: Why 98% of Patients in Delhi Die Waiting

by Dr. Shruthi R March 14, 2025

written by Dr. Shruthi R

In Delhi, the struggle for kidney transplant patients is a dire one. Less than 2% of kidney patients receive cadaver transplants, leaving thousands to rely on living donors or prolonged dialysis. With long waiting lists, low organ donation rates, and significant financial hurdles, many die before getting a second chance at life. Despite medical advancements, the acute shortage of cadaver kidney donations in India forces most transplant patients to depend on living donors—usually family members. However, this is not a viable solution for many, leaving them on dialysis with little hope.

India performs approximately 14,000 kidney transplants annually, but fewer than 2,000 come from deceased donors. This stark statistic highlights the crisis of organ donation in the country. Many patients continue to languish on dialysis for years, with their health deteriorating due to the long waiting period and associated complications. The current system, combined with social stigmas and a lack of awareness, leaves a large number of kidney patients in Delhi and across India without the transplant they desperately need.

The Urgent Need for Cadaver Kidney Donations

Despite India’s vast population, the number of cadaver kidney transplants remains critically low. The preference for living donors persists due to cultural barriers, lack of public awareness, and inadequate infrastructure. In hospitals across Delhi, patients wait endlessly for a cadaver kidney, but most never receive one.

At Aakash Healthcare, for instance, only four cadaver donations have taken place out of over 200 transplants since 2001. Meanwhile, the hospital currently provides dialysis to over 200 patients, yet fewer than 2% ever get the chance for a transplant. In North India, deceased kidney donation remains uncommon, accounting for approximately 1% of total transplants. According to Dr. Reetesh Sharma, Director & Head of Nephrology & Kidney Transplant Medicine at Asian Hospital, “Kidney transplants continue to be predominantly sourced from living related donors.” This stark reality underscores the urgent need for increasing cadaver donations in India.

Barriers to Organ Donation in India

Experts cite several major barriers preventing India from achieving higher organ donation rates, including:

Lack of Public Awareness
The primary barrier to organ donation is the lack of understanding about organ retrieval after brain death. Many people mistakenly believe that organs are taken from naturally deceased individuals, but in reality, they are procured from brain-dead donors—patients in irreversible comas due to accidents or strokes, whose organs remain functional.

According to Dr. Swati Mane, Consultant Nephrologist at Jupiter Hospital, “Families often do not consent to organ donation due to a lack of awareness, particularly in times of emotional distress following the sudden loss of a loved one. Grief counselors play a crucial role in educating families about organ donation during such critical moments.”
Sociocultural Beliefs and Superstitions
Many prospective recipients hesitate to accept organs from deceased individuals due to fear or mistrust. Additionally, cultural and religious beliefs discourage families from donating organs, further reducing the number of available cadaver kidneys.
Lack of Medical Infrastructure
India’s organ donation system suffers from inadequate medical infrastructure. There are not enough trained personnel or dedicated transplant units across hospitals, making the process inefficient and difficult for willing donors and recipients alike.
India’s Opt-in System vs. Spain’s Opt-out Model
In countries like Spain, which has one of the highest organ donation rates in the world, the government has implemented a mandatory opt-out system—meaning all citizens are automatically considered donors unless they choose to opt out. This system significantly increases the availability of cadaver kidneys. In contrast, India follows an opt-in system, where individuals must actively register as organ donors, leading to lower participation.

The Financial Burden of Kidney Transplants

Even when a transplant is possible, financial constraints often prevent patients from undergoing the surgery. Many remain on dialysis simply because they cannot afford the one-time cost of a transplant.

At Aakash Healthcare, the cost of a kidney transplant from a living donor is approximately ₹8 lakh, covering surgery, post-operative care, and immunosuppressive medications. For the first three months post-transplant, immunosuppressive drugs cost around ₹15,000 per month, eventually decreasing to ₹4,000–6,000 per month after six months.

According to Dr. Soubeer Ghosh, Consultant at PSRI Hospital, “The overall cost of a kidney transplant depends on the type of transplant. If the blood group is compatible, the cost is around ₹6-8 lakh. If not, it is higher—around ₹10-15 lakh—depending on various factors.”

Many patients and their families struggle to arrange this amount, forcing them to continue dialysis, which becomes a lifelong financial burden. Dr. Reetesh Sharma explains, “While transplantation is a one-time expenditure, dialysis requires continuous financial investment. However, if financial support can be secured, transplantation remains the more effective and medically beneficial option.”

The Harsh Reality of Life on Dialysis

For those who remain on dialysis, life becomes a never-ending cycle of hospital visits. Patients typically undergo two to three dialysis sessions per week, each lasting four hours. The procedure is not only time-consuming but also significantly reduces life expectancy.

Health Complications Associated with Dialysis:

Infections and Vascular Access Issues – Repeated dialysis sessions increase the risk of infections and complications at the vascular access site.
Cardiovascular Disease – Dialysis patients are at a higher risk of heart attacks and other cardiovascular problems.
Malnutrition and Muscle Wasting – Over time, prolonged dialysis can lead to nutritional deficiencies, bone weakness, and muscle disorders.
Reduced Life Expectancy – Data suggests that the 10-year survival rate for dialysis patients is only 15–20%, meaning over 80% do not survive beyond ten years.

In contrast, kidney transplant recipients enjoy a near-normal quality of life and significantly longer survival rates.

Policy Reforms and the Path Forward

Experts agree that a multi-pronged approach is needed to address India’s organ donation crisis. Key solutions include:

Stronger Awareness Campaigns
The government must launch nationwide awareness drives, particularly targeting schools, colleges, and workplaces. If young individuals understand the importance of organ donation, they can influence their families to make informed decisions.
Mandatory Organ Donation Education in Schools
Introducing organ donation education in school curriculums can help demystify the process, encouraging more people to sign up as donors.
Incentivizing Organ Donation
Countries like Singapore provide financial aid to families of organ donors, covering medical and funeral expenses. A similar system in India could encourage more donations.
Improving Hospital Infrastructure
Investing in specialized transplant units, trained counselors, and efficient organ retrieval systems will ensure a smoother donation and transplantation process.
Implementing an Opt-out System
Shifting to an opt-out system (like Spain) can significantly increase cadaver organ donations. If all Indian citizens were considered donors by default, the waiting list for kidney transplants would shrink dramatically.

A Race Against Time

For thousands of kidney patients in Delhi and across India, every day is a fight against time. The 2% lifeline is simply not enough. A radical shift in public perception, policy reforms, and financial assistance is required to save lives.

If India fails to address these challenges, countless patients will continue to die waiting for a kidney that never comes. However, with the right interventions, hope is not lost—India can transform its organ donation landscape and give kidney patients the lifeline they desperately need.

March 14, 2025 0 comment

Five Kidneys, One Miracle: The Incredible Story of Devendra Barlewar’s Third Kidney Transplant

by Dr. Shruthi R February 26, 2025

written by Dr. Shruthi R

A groundbreaking medical achievement has been made in Delhi, where 47-year-old scientist Devendra Barlewar underwent a successful third kidney transplant, defying the odds and demonstrating extraordinary resilience and determination. Despite battling chronic kidney disease (CKD) for years and enduring two failed kidney transplants, Barlewar’s latest surgery has given him a new lease on life. His remarkable case is particularly unique, as he now carries five kidneys, though only one is functioning. His journey, however, was fraught with challenges, both medical and logistical, and serves as a beacon of hope for patients with complex kidney diseases.

The Challenges of Chronic Kidney Disease and Multiple Transplants

Devendra Barlewar’s health challenges began in 2008 when he was first diagnosed with hypertension, which eventually led to CKD. The progression of the disease required frequent dialysis, almost three times a week, severely impacting his professional life and overall well-being. He underwent his first kidney transplant in 2010 and a second one in 2012. Both transplants ultimately failed, leading him back to dialysis. In 2022, his second transplanted kidney failed after he contracted COVID-19, worsening his health further and making a third kidney transplant necessary.

For Barlewar, a kidney transplant had always been the best long-term treatment option, despite the failure of his first two transplants. After his second kidney transplant failed, he registered for a donor transplant at Amrita Hospital in Faridabad in 2023. On January 7, 2025, an opportunity arose when a cadaveric kidney from a 50-year-old farmer, who was declared brain-dead, became available. The National Organ and Tissue Transplant Organisation (NOTTO) prioritized his case, given the urgency, and the medical team had only a few hours to optimize him for surgery.

The Complexities of a Third Kidney Transplant

Performing a third kidney transplant is highly rare, as it presents multiple challenges. One of the major hurdles is finding a suitable donor. Kidney donors are in limited supply, and the likelihood of finding a match for a third transplant is extremely low. Additionally, managing the risks of organ rejection is a constant concern. Each successive transplant increases the likelihood of the immune system attacking the new organ, making pre-operative planning crucial. The surgical team must also account for the physical limitations of the recipient’s body, especially when they have previously undergone multiple surgeries.

In Barlewar’s case, his thin build and existing incisional hernia made it difficult to find enough space in his abdomen to accommodate a fifth kidney, in addition to the two native kidneys and two non-functioning transplanted kidneys. The surgeons had to navigate these complexities carefully to ensure that the new kidney could be successfully transplanted without causing additional health complications.

Dr. Anil Sharma, Senior Consultant Urology at Amrita Hospital, Faridabad, and Dr. Ahmed Kamaal, Senior Consultant Urology at the same hospital, were the surgeons who performed the surgery. Dr. Sharma explained that the transplant was a delicate procedure due to Barlewar’s heightened immune response, which increased the risk of organ rejection. As a result, careful planning was needed to ensure the transplant would be successful. Dr. Kamaal noted that third kidney transplants are rare not only due to donor scarcity but also because of the challenges associated with recipient fitness and existing surgical complications.

Why Non-Functioning Kidneys Are Not Removed

In kidney transplantation, it is common practice to leave the original, non-functioning kidneys in place. The reasons for this are primarily due to the risks associated with removing them, such as bleeding, infection, and other surgical complications. Dr. Nishchay Bhanuprakash, an MD and DM Nephrology & Kidney Transplant Consultant at KAUVERY Hospital, Marathahalli, Bangalore, elaborated on this process. He explained that the removal of shrunken and scarred kidneys often provides little benefit and can increase the risk of complications. By leaving the non-functioning kidneys in place, surgeons reduce the risk of further damage and focus on ensuring that the new kidney functions optimally.

In cases like Barlewar’s, where multiple transplants have been performed, each new kidney is placed in a different part of the abdominal cavity. This careful navigation ensures that there is adequate blood supply to each kidney and minimizes the risk of complications. Surgeons must account for existing structures and previous surgical sites while ensuring that the new kidney is positioned in the most suitable location.

The Groundbreaking Nature of the Surgery

The uniqueness of Barlewar’s case lies not only in the fact that he underwent a third kidney transplant but also in the exceptional complexities involved. The procedure required highly advanced surgical techniques and a well-coordinated effort between the medical team and the transplant coordination network. Barlewar’s case is a reminder of the advancements in medical technology and the importance of donor organ availability in saving lives. The success of this transplant has paved the way for further research into improving the success rate of multi-transplant surgeries.

Dr. Sharma and Dr. Kamaal highlighted that the procedure was especially challenging due to the limited space available in Barlewar’s abdomen, as well as the presence of multiple non-functioning kidneys. Despite these challenges, the surgery was successful, and Barlewar’s recovery has been promising. He is now in the early stages of his postoperative period, showing good signs of recovery and potential long-term success.

Long-Term Health Outlook for Barlewar

After the surgery, Barlewar will need to closely monitor his health to ensure the new kidney remains functional and to manage any potential complications. He will continue to take immunosuppressant medications to prevent organ rejection, and he must adhere to a strict regimen to keep his hypertension under control. Dr. Sharma and Dr. Kamaal emphasized the importance of regular follow-up visits and monitoring to ensure the long-term success of the transplant.

While Barlewar will need to make some dietary changes, his quality of life should improve significantly compared to his previous experience on dialysis. The ability to manage his health more effectively, coupled with the successful transplant, offers him a chance at a better future. However, the journey ahead will still require careful management and consistent medical attention.

The Impact of Organ Donation and the Importance of Awareness

Barlewar’s story highlights the critical importance of organ donation. Organ donation rates remain low in many parts of the world, and Barlewar’s case underscores the need for increased awareness and the importance of registering as an organ donor. Without the availability of a deceased donor kidney, Barlewar’s life would have been at risk, and his remarkable survival and recovery were only made possible by the generosity of the donor and their family.

The success of this transplant is also a testament to the incredible advances in medical science and the surgical expertise that made it possible. It demonstrates that even in the most challenging cases, there is hope for patients with kidney disease, and that with the right medical care and a suitable donor, lives can be saved.

Devendra Barlewar’s third kidney transplant is not just a medical triumph, but also a testament to the human spirit and the potential of modern medicine. His case, though extremely rare, offers hope to countless patients suffering from chronic kidney disease and showcases the immense potential of organ transplantation. While Barlewar’s road to recovery is far from over, his success story serves as an inspiration to both the medical community and patients worldwide. As science and medicine continue to evolve, stories like Barlewar’s highlight the critical role that organ donation plays in saving lives, and the groundbreaking progress being made in the field of transplant surgery.

February 26, 2025 0 comment

First human recipient of Genetically Modified Pig Kidney transplantation

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First Recipient of Genetically Modified Pig Kidney Who Marked An New Era in Transplantation Died On May 11th

by Dr. Shruthi R May 13, 2024

written by Dr. Shruthi R

Xenotransplantation involves transplanting animal organs into humans to address organ shortages, exemplified by Richard Slayman, the first recipient of a genetically-modified pig kidney. Despite its potential, the procedure carries risks such as organ rejection and cross-species infections.

Richard “Rick” Slayman, the first recipient of a genetically-modified pig kidney, passed away on May 11, approximately two months after the transplant surgery. According to statements from Massachusetts General Hospital and Slayman’s family, his death was not connected to the procedure. This case sheds light on xenotransplantation, a medical approach that involves transplanting animal cells, tissues, or organs into human bodies.

What is Xenotransplantation?

Defined by the U.S. Food and Drug Administration (FDA), xenotransplantation can include anything from the transplantation of live non-human cells, tissues, or organs to the use of human tissues that have been in contact with animal cells. This method is primarily explored to alleviate the significant shortage of human organs available for transplantation. For instance, a 2024 article in Nature highlighted that nearly 90,000 people in the U.S. are on the waiting list for a kidney transplant, with over 3,000 dying each year while waiting.

Why Pigs had been selected for Xenotransplantation?

Pigs have been chosen frequently for these procedures because their anatomical and physiological properties closely resemble those of humans. Additionally, the extensive farming of pigs makes it feasible to obtain organs at a lower cost and with controlled breeding to match human needs. Pig heart valves, for example, have been used in human surgeries for over five decades.

The Case of Richard Slayman

In Slayman’s pioneering procedure, the pig kidney underwent 69 genomic edits using CRISPR-Cas9 technology to enhance compatibility with the human immune system. These modifications included removing specific pig genes and incorporating human genes to minimize the risk of organ rejection. Despite these precautions, xenotransplantation carries inherent risks like immune reaction, infection, and the transmission of animal viruses to humans, which can result in complex health issues years later.

Ongoing Challenges and Ethical Considerations

The field of xenotransplantation not only faces scientific and medical challenges but also ethical and regulatory hurdles. The potential for cross-species infections and the ethical implications of using animal organs for human transplants continue to prompt significant debate within the medical community and society at large.

Looking Ahead

While Slayman’s operation did not directly lead to his death, his case and others highlight the urgent need for ongoing research, improved safety protocols, and thoughtful consideration of the ethical dimensions of xenotransplantation. As technology and genetic engineering continue to evolve, the potential for these transplants to save lives grows, but so does the complexity of the decisions involved.

This emerging field holds promise for addressing critical shortages in human organ transplants, but it also requires careful navigation of its risks and ethical concerns to realize its full potential in medicine.

May 13, 2024 0 comment

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34-Year-Old Woman was saved by First-In-The-World Medical Interventions In Kidney Transplant

by Medically Speaking February 23, 2022

written by Medically Speaking

Dr. Madan Bahadur, Director, Department of Nephrology and Kidney Transplantation, has published a first-in-the-world medical research that found life-threatening antiviral side effects in patients with a genetic defect that is frequent among Indian transplant patients. This research was carried out at Jaslok Hospital and Research Centre, which is the pioneer of kidney and liver transplantation in western India.

Following a kidney transplant, valganciclovir is commonly administered to prevent viral infection. Patients with NUDT15 enzyme deficiency have severely low blood counts after using valganciclovir, according to Dr Ashay Shingare, Consultant Nephrologist at Jaslok Hospital, making them exposed to life-threatening infections.

In one recent kidney transplant recipient, a genetic test revealed NUDT15 deficiency, and after quitting valganciclovir, his blood numbers improved, and the infection went away.

First Case Of To Find The Link Between Valganciclovir And Genetic Variation

The prominent transplant journal Transplant Infectious Disease has published the first case report of a link between valganciclovir and genetic variation. In the instance of Mahima Ralli, 34, who was hospitalised to the ICU in January 2022 with a urinary tract infection following a kidney transplant, this genetic association report saved her life.

Mahima was diagnosed with the renal illness in 2002 and began hemodialysis in 2004. She was taken to Jaslok Hospital’s ICU after experiencing a dramatic rise in her blood pressure that was uncontrollable despite seven blood pressure medications and the removal of both of her damaged kidneys. She was given a combination of sodium nitroprusside and sildenafil for blood pressure control, which was a new, first-in-the-world intervention that saved her life.

Patients Got A Kidney Transplant A Second Time

Later that year, in 2004, she received a living donor kidney transplant from her mother, which has been functioning successfully for more than 16 years. Her kidney function deteriorated as a result of urinary bladder difficulties, and she was forced to return on dialysis in 2021. Mahima’s maternal aunt gave her kidney to her for a second kidney transplant at Jaslok Hospital in November 2021.

A new urinary bladder was surgically built prior to the donation. Because the blood types of the donor and recipient did not match, she underwent plasmapheresis operations. She got an extremely low blood count two months after the transplant, which led to a bacterial infection that necessitated ICU care.

Mahima also has a deficit of the enzyme NUDT15, according to genotyping research. She improved after the antiviral was stopped, and she was discharged from the hospital. It’s a miracle that this young child lived to see another day at Jaslok Hospital, where she received unique, first-in-the-world medical treatment.

February 23, 2022 0 comment

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Relation between COVID vaccine and Kidney Disease

by Medically Speaking Team March 10, 2021

written by Medically Speaking Team

Dr. Sunil Prakash, Senior Director & HOD, Nephrology & Renal Transplantation, BLK Super Speciality Hospital on relation between COVID vaccine and Kidney Disease:

Q1. There is a rising concern in the community of patients with Chronic Kidney Disease (CKD) on getting Covid vaccination as raised levels of blood and use of immunosuppressive agents can potentially hamper vaccination responses, do you think these fears are true?

Ans1. This is true that patients with Chronic Kidney Disease (CKD) will be less responsive to the drugs, but this patient also has more susceptibility to get very bad infection. They must get the vaccine. If a normal person gets vaccinated, 70% will get a good/immune response. In CKD patient, immune response will be less but they should take it, as the benefit is more and the risk is less.

Q2. Will vaccination help lower infection rates and reduce morbidity and mortality rates?

Ans2. Absolutely, it will. Although it may not be as effective as in normal people but will certainly help a CKD patient. In India, 2-3% of normal people die because of Covid. But in my own experience, if a CKD patient gets Covid then the mortality is 8-10%, more on the higher side and if a transplant patient gets it then it is as high as 25%. So, CKD patients must take vaccine and that is why they are given priority.

Q3. Should patients with Chronic Kidney Disease (CKD), including those on dialysis or living with a renal transplant take Covid-19 vaccination?

Ans3. Absolutely, because they have very high chances of mortality. Although, immune conversion will be less but whoever gets vaccinated can still be saved.

Q4. How should transplant candidates go about getting the vaccine?

Ans4. Transplant patients should get the vaccine in the same way as non-transplant patients, but the conversion will be less as in CKD because they are taking immunosuppressive medicines so that immunity is hampered and their chances of that is less.

Q5. Has the morbidity and mortality rate in patients of CKD been higher due to Covid vis-à-vis the rest of the population?

Ans5. Yes, mortality in CKD patients has been much higher. Because if they get Covid, their immune system is not so competent to fight it away and they have many other comorbidities as well like diabetes, high blood pressure, they are taking other medicines. All this is also there and that is why they should get the vaccine.

Q6. Is the vaccine especially important for kidney transplant patients and other immunocompromised patients? Are they at greater risk of severe complications of Covid -19?

Ans6. Yes, 25% mortality in transplant patients which is extremely high –which is an important point.

Q7. Are Covid vaccines safe to be given to transplant recipients Are Covid vaccines safe to be given to kidney donors?

Ans7. With Covid vaccine there is a lot of worry that some side effects are coming but my take on this is a little philosophical. I believe that there is nothing in this world which is 100% safe. If you leave home for work, there is fear of road accident, our food may contain pollutants, there are so many things. With Covid vaccine the side effects may be there, but the benefits are also there. It is a situation of 70% benefits and 10% side effects, but these side effects are not very severe.

Q8. After getting the vaccine, will patients of CKD be totally protected from contracting the infection?

Ans9. No, the conversion rate is 70% but still some people can get Covid even after getting vaccinated. Suppose 100 people get the vaccine, 30 will get the infection, 70 will not. In CKD patients, if 100 get the vaccine, 70 can get the infection, 30 will not. Such is the ratio. The benefit is in taking the vaccine.

https://www.blkhospital.com/doctor/sunil-prakash

March 10, 2021 0 comment