How Kidney Transplant Works — From the Donor to Walking Out of Hospital

A kidney transplant does not replace where the kidney sits. The original kidneys — damaged and non-functioning as they are — stay in the body. The new kidney is placed in a different location: the lower abdomen, in the pelvis, where the blood vessels and bladder are conveniently close and accessible. It is a new kidney in a new position, doing the job the old ones cannot.

That is one of the things most patients do not know going in. Here is a complete picture of how the process actually works.

What Triggers the Need for a Transplant

End-stage renal disease (ESRD) — kidneys functioning below 15 percent of normal — is the threshold. At this point, kidneys cannot sustain life without intervention.

The main causes: diabetic nephropathy, hypertensive nephropathy, chronic glomerulonephritis, polycystic kidney disease, and long-standing poorly treated kidney infections. In East and West Africa, hypertension and diabetes are leading causes. Sickle cell disease — prevalent across West Africa and some parts of East Africa — can cause kidney disease that eventually reaches ESRD.

Two replacement therapy options exist: dialysis or transplant. Dialysis maintains life but is physically demanding, limits lifestyle significantly, and carries cumulative cardiovascular risk. Transplant restores closer-to-normal kidney function, eliminates dialysis, and significantly extends expected survival.

Living Donor Kidney Transplant — How the Donor Is Involved

For international patients in India, a living related donor is the route. A close family member — parent, adult child, sibling, or spouse — donates one kidney. The human body functions normally with one kidney; the remaining kidney enlarges slightly to compensate over weeks to months.

Donor evaluation: Blood group compatibility, tissue typing (HLA matching), kidney function tests (to confirm both kidneys are functioning and the donor can safely give one), CT scan of the kidneys (to assess anatomy and blood vessel branching — the anatomy dictates which kidney is easier to remove safely), cardiac assessment, general health evaluation.

The evaluation is thorough because the donor is a healthy person undergoing surgery they do not medically need. India's Transplant Authorisation Committee reviews every case, verifies the donor-recipient relationship, and confirms the donation is voluntary. This process is not optional.

ABO-incompatible transplant: If the donor and recipient have incompatible blood groups, ABO-incompatible transplant is possible with additional preparation — plasma exchange and immunotherapy to reduce blood group antibodies before transplant. Available at select Indian centres. More complex and more expensive than compatible transplant.

Donor Surgery — What Happens

The kidney is removed laparoscopically in most centres — through three to four small incisions using a camera and instruments. The laparoscopic approach means less pain, shorter hospital stay (three to five days compared to five to seven for open), and faster return to normal activity for the donor.

The kidney is disconnected from its renal artery, renal vein, and ureter. Once divided, it is removed through a small Pfannenstiel incision (similar to a Caesarean incision), immediately flushed with cold preservation solution, and passed to the recipient team.

The donor's remaining kidney then has normal blood flow. Recovery for the donor: hospital discharge at three to five days, return to light activity at three to four weeks, full activity by six to eight weeks.

Recipient Surgery — What Happens

The recipient is usually in an adjacent operating theatre. Both surgeries run simultaneously — donor and recipient teams coordinating so the donated kidney spends minimum time outside a living body.

The recipient's own diseased kidneys are left in place — removing them adds risk and complication without meaningful benefit in most cases. The new kidney goes into the right or left iliac fossa — the lower abdomen — where the iliac vessels (external iliac artery and vein) and the bladder are easily accessible.

Vascular anastomoses: The renal artery of the donated kidney is connected to the recipient's external iliac artery. The renal vein is connected to the external iliac vein. These connections are the most critical part of the operation. Any kinking, narrowing, or tension in these anastomoses causes serious complications.

Ureteric connection: The ureter — the tube that carries urine from the kidney to the bladder — is connected to the bladder dome. A small internal stent is often placed temporarily to keep this connection open while it heals. The stent is removed by cystoscopy four to six weeks later.

Once the vascular connections are made and clamps released, blood flows into the new kidney. In most cases, the kidney begins producing urine within minutes on the table — a sign that perfusion is adequate and the kidney is functioning. The incision is closed.

Total recipient surgery time: three to five hours.

After Surgery — What the Recovery Looks Like

Intensive monitoring: Kidney function is checked daily. Creatinine — the main waste product the kidney filters — should fall steadily in the days after a functioning transplant. Fluid intake and output is carefully balanced. The surgical wound is checked. Doppler ultrasound confirms blood flow through the renal artery and vein.

Immunosuppression begins immediately: Tacrolimus, mycophenolate mofetil, and steroids. These suppress the immune system enough to prevent rejection without leaving the patient completely defenceless against infection. The balance is the central challenge of post-transplant management, and the doses are adjusted based on tacrolimus blood levels and kidney function.

Infection prevention: Prophylactic antibiotics, antifungal drugs, and antiviral drugs (cotrimoxazole, fluconazole, valganciclovir) are prescribed for the first months. Patients are educated on the signs of infection and what to do.

Hospital stay: Seven to ten days for uncomplicated cases.

Outpatient monitoring in India: After discharge, two to four weeks of outpatient monitoring before the transplant team clears international patients to fly. Blood tests twice weekly during this period.

After returning home: Blood tests continue monthly. The Indian transplant team is available for remote consultation. Immunosuppressant medications continue indefinitely at gradually reducing doses.

Robotic Kidney Transplant

Several Prime Medical partner hospitals now perform robotic kidney transplant using the da Vinci Surgical System. Smaller incisions, reduced blood loss, lower wound complication risk, and faster recovery than conventional open transplant. Available at Indraprastha Apollo Hospital Delhi and Max Hospital Saket.

Kidney Transplant Hospitals in Prime Medical's Network

MGM Healthcare, Chennai (JCI, NABH, NABL) — Dr. V Chandrasekaran leads transplant. Experience with East and West African patients. Accessible via Dar es Salaam–Mumbai direct flight.

Indraprastha Apollo Hospital, New Delhi (JCI, NABH) — One of South Asia's largest transplant programmes. Robotic transplant. Africa desk.

Max Super Speciality Hospital, Saket, Delhi (JCI, NABH, NABL) — Robotic kidney transplant. Strong post-transplant monitoring.

Fortis Memorial Research Institute, Gurugram (JCI, NABH, NABL) — Kidney transplant alongside broader surgical programme.

Artemis Hospital, Gurugram (JCI, NABH) — Prime Medical partner. Kidney transplant capability.

For patients from Addis Ababa, Kampala, Mbarara, Dar es Salaam, Mwanza, Banjul, or Serekunda who need a kidney transplant: share kidney function reports, dialysis history, and the donor's details with Prime Medical Solutions. Dr. V Chandrasekaran and the transplant teams review within 48 hours.

To book a consultation, call the number on our website.