Articles on kidney transplantation

Overview of Kidney Transplantation

Dr. Ashwinikumar Khandekar, Nephrologist
Kidney transplantation remains the best form of renal replacement therapy providing better quality of life and  survival compared to dialysis.  Live related donor transplant still remains the solution of choice in End Stage Kidney Disease (ESKD) patients with the promise of deceased donor (cadaver donor) transplantation still not fulfilling its promised growth.Who is eligible for Kidney Transplantation ?Patients whose kidneys have completely failed and no recovery is expected at all ( i.e. Patients with ESKD) have kidney transplant as an option. The other option is to stay on dialysis life-long. These patients are anyways started on dialysis till the transplant workup is done.However, Kidney transplant can also be done prior to dialysis requirement and is called pre-emptive kidney transplant. Dialysis is no longer required after a successful kidney transplant.What are the requirements for a kidney transplant ?A medically fit recipient, a blood group compatible donor, a nephrologist experienced in handling kidney transplant patients, a urosurgeon experienced in performing transplant surgery and most importantly, a multi-specialty hospital recognized for performing kidney transplants.Who can donate a kidney?As per the existing Human Organ Transplant Act  1994, any of the first degree relatives of the recipient     ( parents, siblings, children, grand-parents ) or the spouse can be an organ donor  provided they are blood group compatible.Anyone apart from the above relatives are considered as ‘unrelated’ by law.Blood group [ABO] compatibility is the same as that in relation to blood transfusion except that the Rh compatibility is not required for kidney transplant. Blood group ‘AB’ is a universal recipient while ‘O’ is a universal donor.Who cannot donate a kidney?Following is a list of conditions which preclude kidney donation.AbsolutePsychiatric disease interfering with ability to consentActive drug or alcohol abuseEvidence of advanced kidney diseaseRecurrent or bilateral kidney stonesDiabetes with kidney involvementSevere HypertensionMalignancyActive infectionChronic active viral infection (hepatitis B or C, HIV)Significant chronic liver diseaseCurrent pregnancyRelativeAge <18 or >65 yearsMorbid ObesityMild or easily treated hypertensionBorderline urinary abnormalitiesTo read more - visit www.kidneyadvice.net

Q&a About Kidney Failure, Dialysis and Transplantation

Dr. Arvind C, Nephrologist
What are the functions of the Kidneys?Remove extra water: The kidneys filter extra water, which the body does not need, in the form of urine. This water comes from the liquids you drink and the foods you eat. The kidneys have the ability to concentrate or dilute your urine, as your body needs. As they form urine, it is sent to the bladder through tubes called ureters. The urethra is the tube that drains the urine from the bladder to the outside of the body. Remove waste products: Urea and creatinine are examples of waste products that are found in everyone. Urea and creatinine form as the body breaks down food into energy and performs its routine bodily functions. Waste products are harmful if not removed by the kidneys.Restore needed chemicals: The kidneys work to keep the body’s chemicals (electrolytes and minerals) in balance. Two examples of electrolytes are sodium and potassium. An example of a mineral would be calcium. The kidneys keep a proper balance by saving the chemicals the body needs and passing the excess chemicals into the urine.Regulate blood pressure: The kidneys help the body keep a normal blood pressure by passing extra sodium and water. The kidneys also produce a special hormone called renin that helps to control blood pressure. Help in the production of red blood cells: The healthy kidney produces a hormone called erythropoietin.This hormone helps the bone marrow produce red blood cells.Help with calcium and vitamin balance: The kidneys balance calcium, phosphate and Vitamin D. These three chemicals play a key role in bone formation.What is Kidney failure and what are the symptoms of this disease?As kidney failure begins, the kidneys are not able to clean the blood of waste products. Waste products and excess water collect in the body. A build up of waste products in the blood is called uremia.Extreme tirednessNausea and vomitingItchy skinDifficulty sleepingPuffiness & swelling of the feet, legs hands& faceShortness of breathPoor appetiteHigh blood pressureIt must be stressed that early on, in patients with kidney disease there may be no symptoms at all. A common misconception exists with respect to the volume of urine passed. This unfortunately is not a good measure of kidney function; a patient with advanced kidney failure may still be able to pass more than a litre of urine.Chronic renal failure means that the loss of kidney function is permanent. Kidney function may stop quickly, or slowly fail over a number of years. End Stage Renal Disease or ESRD occurs when the kidneys have reached the point where they can no longer work well enough to maintain the balances needed for life. This is usually when dialysis must be started.What are the common causes of CHRONIC KIDNEY FAILURE?There are many causes of chronic (long-standing) kidney failure in an adult and a few of the most common reasons are listed here: Diabetes Mellitus, Chronic Glomerulonephritis, Hypertension, Chronic Pyelonephritis, Lupus Erythematosus, Polycystic Kidney Disease, etcWhat is the most common cause of Chronic Kidney failure in your practice?Diabetic nephropathy is the leading cause of chronic renal failure here. It is also one of the most significant long-term complications in terms of morbidity and mortality for individual patients with diabetes. Diabetes is responsible for more than 50% of all end-stage renal disease (ESRD) cases in India. Although both type 1 diabetes mellitus (insulin-dependent diabetes mellitus [IDDM]) and type 2 diabetes mellitus (non–insulin-dependent diabetes mellitus [NIDDM]) lead to ESRD, the great majority of patients are those with NIDDMWhat is the Advise that you would give to patients at risk for kidney disease?All patients with Diabetes Mellitus and Hypertension (High Blood Pressure) are at risk for developing kidney disease. Patients with glomerulonephritis (kidney inflammation), recurrent urinary tract infections/obstruction are also at risk of developing develop kidney failure. Such patients are advised to undergo regular follow-up with a nephrologist. Regular checks on urine-protein levels (Proteinuria) and kidney function (urea & creatinine levels) are mandatory. Aggressive Blood Pressure control (aim for BP <120/80 mmHg) and the use of newer medicines (ACEI & ARB) holds the key to the management of such patients with a view to prevent progression of kidney disease.How do you treat End-Stage-Renal Failure (ESRF)?Pts with ESRF can be treated by dialysis or kidney transplantation. Dialysis is of two varieties, Hemodialysis or blood dialysis and CAPD or water dialysis.Kidney transplantation is the best treatment that can be offered to a pt with ESRF.What is kidney transplantation?Kidney transplantation or renal transplantation is the organ transplant of a kidney in a patient with ESRF. The main types of kidney transplant are living donor transplant and cadaveric. In the former, the kidney originates from a deceased (brain-stem-death) person. In the latter, the kidney is being donated by an organ donor. It is possible to transplant a kidney from a living donor because the body can work just as well with one kidney as with two.What are the tests done to evaluate a kidney transplant recipient? A transplant evaluation includes many tests to make sure that the recipient is healthy enough to have a transplant. To make sure that the new kidney will be a good match, tests will be done to find out the blood and tissue type. Other tests include: a check for any active infections, blood clotting profile, a chest x-ray, ECG (electrocardiogram) and cardiac evaluation, and abdominal ultrasound. Women must be cleared by a gynecologist. Other tests may be required depending on the patient’s age and medical history. Can patients with Kidney failure(ESRF) due to diabetes undergo transplantation?Definitely! Infact, patients with diabetic kidney failure form the majority of patients in a Dialysis unit these days. Some diabetics tend to have concurrent heart problems or blood vessel blockages (vascular insufficiency) and this has to be attended to, before they are cleared for transplantationWhat kind of testing does a living donor go through? A person who wants to be a living donor will go through a set of tests. These tests will increase the chances of a successful match. They will also make sure that the donor will not be placed at risk. The tests include blood tests, urine tests, chest x-ray, ultrasound scan of the abdomen and ECG (electrocardiogram). Like the recipient, the donor is also tested for any active infections. Also, a CT/MR scan or arteriogram (an examination of the blood vessels) of the kidneys is done. Potential donors will be examined by a surgeon and a nephrologist (kidney specialist). Anyone with kidney disease, diabetes or high blood pressure would not be considered.Does the transplant recipient have to take special medications after the transplant?Yes, the patient will have to take immunosuppressive medications such as prednisolone, cyclosporine or tacrolimus, mycofenolate, etc indefinitely, but with significant reductions in dosages with time.

Prevention Of Kidney Stones

Dr. Rajeev Bashetty, Urologist
Kidney stones are known to the mankind since antiquity. Lot of innovations have been done in treating the kidney stones, but there is a very little knowledge regarding the stone formation and how it can be prevented. Daily water intake is one of the important factors in the prevention of kidney stones. Diet is another factor that can promote or inhibit kidney stone formation. Others include environment, body weight and heredity.The dietary advice will be based on the type of kidney stones, which will be recommended by the Urologist. These recommendations mentioned below are general and for the most commonest kidney stone formers.FluidsWater is  inexpensive & easily available. The amount of water a person needs to drink depends on the weather and the person’s activity level. People who have had a kidney stone should drink enough water and other fluids to produce at least 2 litres of urine a day. This can be achieved by drinking about 3-4 litres of water every day. The amount should be consumed on periodic basis about a glass or two every hour. People who work in hot weather need more fluid to replenish fluid they lose through sweat. Drinking enough water helps to keep urine diluted and flushes away materials that might form stones and is the most important thing a person can do to prevent kidney stones. Soft water intake is recommended. Hard water should be boiled and cooled before consumption. Citrus drinks like lemon and orange juice protect against stone formation because they contain citrate, which inhibits stone formation.Fluid like grapefruit juice, colas, beer, wine, coffee, tea should be avoided in excess as they contain substances, which helps in the stone formation. DietThere is a misconception that eating Palak and Tomatoes should be avoided to prevent stone formation. Yes, this is true provided a person consumes them daily in large quantities. Eating palak once in a while or adding tomatoes to the daily food preparation doesn’t really harm or increases the risk of stone formation. Another misconception is to avoid drinking milk as it contains calcium. In fact milk will help in reducing the stone formation. Calcium in the stomach binds to oxalate from food and keeps it from entering the blood, and then to the Urinary Tract, where it can form stones. People who are taking supplementary calcium to maintain the bone density should take the calcium tablets along with the food.Sodium, often from salt, causes the kidneys to excrete more calcium into the urine. High concentrations of calcium in the urine combine with oxalate and phosphorus to form stones. Reducing sodium intake is preferred to reducing calcium intake.The consumption of Meat, fish and egg should be reduced as they contain purines, which break down into uric acid in the urine resulting in uric acid stones.Eating excessive chocolates and nuts like cashew should be avoided as they contain oxalate.Once a person forms a stone, his chances of forming another stone is very high. If the above recommendations are followed, there will be definite reduction in the recurrence. Most of the small stones pass spontaneously, but the larger stone may require treatment. If the stones are not treated at right time, they can cause irreversible damage to the kidney.

When Should You Choose Hair Transplant?

Dr. Harikiran Chekuri
Is hair transplant for you? Now, find it out yourself by getting answers to these questions. Here are a set of common questions that often confuse brains of people aspiring a hair transplant. Having proper answers to these will clear out all the doubts from your mind and help you in your decision making.Now, try and answer these questions.Have you tried other methods of hair regeneration? Have they worked for your?If you have tried different methods of hair transplant like oils, medications, creams etc but they did not work, you are surely in need of a hair transplant.The shave-off does not work for you?Most men try to face their balding phase by shaving off their head. But in most cases they face a setback. Not everybody can slip into Vin Diesel attire by shaving off their head. If your bald reflection in the mirror fails to impress, you need to opt for a hair transplant. Loosing hair too early?Balding is not restricted to age anymore. It can happen anytime. Some men, especially who have a history of early balding running in their family might lose their hair even in early their 20s. If you find yourself in similar situation, where you had a series of failed alternatives along with shaving of your head, opt for a transplant immediately.Is your hair loss hampering your career?People who are in showbiz often have to work hard on their looks. Even some corporate wants their employees to have an attractive appearance. If you too are in a career where your look does play an important role, you cannot take your hair loss with ease. You need to try out hair transplant that can help you regain your natural hair.Is your balding affecting your personal life negatively?Untimely baldness can strike a severe blow to your confidence and cast negative effects on your personal life. Bald people are often subjected to ridicule. They feel low while in the company of their spouses or girlfriends as they look aged and don’t seem to make a pretty pigeon’s pair. This calls in for a hair transplant that can boost not only your looks but your confidence as well.Have you done enough research about the process and feel that you can manage it?Internet is a great store house of resource that can give you all the information about the process. You get an idea about the probable costs, the recovery time and the expected result. If you feel that you can manage all the associated criteria, you make an ideal candidate for the process.However, to know more about hair transplant and your eligibility for the process, get in touch with a reputed and renowned hair transplant clinic around you.

Some Devastating Statistics About Chronic Kidney Failure in India

Dr. Prashant C Dheerendra, Nephrologist
Even as we speak chronic kidney failure is taking a huge  toll on  lakhs of families in India. This is unfortunate because kidney failure is the easiest of all organ failures  to manage.  We have dialysis which can replace kidney function to a significant extent and kidney  is the easiest solid organ  to  transplant. This sad situation is because of a number of factors, the most important of which is the lack of awareness at all levels of the society. Compared to similar patients in the developed world or even some other developing countries, kidney failure patients have extremely poor outcomes in India. As things today we are not even addressing the tip of the iceberg. Given below are a few devastating statistics about chronic kidney failure in India.17% of Indians have some form of chronic kidney disease. This figure was reached that in a study conducted by Harvard Medical School in partnership with 13 medical centres  all over India. One third of the above people have advanced stages of the disease. There are  60 million people with diabetes in India, more than any other nation on the planet. Sadly, the majority of them are either  not diagnosed or poorly treated.At least 30% of diabetics will develop chronic kidney disease because of diabetes. People with the last stage of kidney failure (technically called Chronic Kidney Disease Stage 5 or CKD-5) require dialysis and/or kidney transplantation as a life sustaining treatment. 40 % of such patients would have developed kidney failure because of diabetes.2,00,000 new patients need dialysis treatment every year in India.  but the unfortunate reality is that only 10 to 20% of them get proper treatment.  The remaining are either not diagnosed or unable to continue proper treatment.Statistics suggest that there should be almost 20,00,000 people on dialysis in India a sof today. The reality is that there are only about 1,00,000. The rest have been lost due to non-diagnosis and non-treatment.The majority of chronic kidney failure patients are diagnosed in the last stage. Though proper statistics are not available, it is accepted that almost 50%  first see a nephrologist (kidney specialist) only in the last stage.There are 0.4 dialysis centers per million population in India. By contrast, Japan has 20 dialysis  centres  per million  population.Only 4,000 kidney transplants are  performed every year in India. The United States  with one fourth the population of India performs 16,000 such operations per year.Kidney failure can affect people of any age group. While in the west, the majority of patients are elderly, in India kidney failure patients are much younger and affects predominantly the working population.

Hair Transplant - How to Decide for or Against

Dr.MK AGARWALA, Dermatologist
Hair Transplant industry is the next big financial revolution happening in our country. The profits involved are large and the risk minimum as compared to most of the other organ transplant. It has made every Tom, Dick and Harry thinking that it is in their domain and when a complication happens such unlicensed clinics get the limelight as the recent death of a medical student post hair transplant in Chennai. The prospective patients should utilize their wisdom before making such an important decision. DO NOT FALL PREY TO CHEEKY HEADLINES AND BIG ADVERTISEMENTS.  The cause of hair fall needs to be established before proceeding for a hair fall therapy and it is easily done by a clinical examination alone most of the times. In a minority of cases, where clinical dilemma happens, a skin biopsy should be performed to prognosticate the success of hair transplant. Hair transplant is mainly performed for a condition called pattern baldness. There are certain things to understand before deciding for or against the procedure. Most of us would have done a basic research before thinking of the procedure. If you have done your research & understanding and are willing to step ahead with surgery, then the surgical options of FUE and FUT has to be discussed with your doctor. There are minor modifications done in these two techniques in an attempt to increase end results but technically they fall into FUE or FUT. You can take opinion from the hair transplant surgeon or there are various websites to make you understand the same. FUE and FUT are good standard protocols with independent merit and demerits; you should discuss this during your consultation. Coming back to pre-transplant decision stage, hair transplant is not a treatment to the core cause of male pattern baldness and you must understand this. The hairs from the back of your scalp are redistributed to the front and sides to cover those bald areas. The hairs from the back of the scalp have an advantage that they are not affected by hormones which cause hair loss in form of male pattern baldness. However they do have a natural life and will die out eventually. Second the hair follicles removed from the back will not re-grow. You may have apprehensions that the areas from which hair have been plucked will appear bald but this is not true as your hair transplant surgeon does the art that even after removing a few thousand follicles, the baldness is not evident. Third, the standard medications for baldness will still have to be continued for many reasons- to increase the life of transplanted hair, to preserve other hairs and the most obvious reason that hair transplant is not a cure for the underlying pathology. It is good to have a few sessions of platelet rich plasma (PRP) treatment along with a hair transplant as they increase the likelihood of graft survival. Certain centers offer them in package and you can strike a bargain. Hair transplant centers have mushroomed in our country, so be careful in your choice of a hair transplant surgeon. It also involves good amount of cost, so discuss and understand all pros and cons. Having said all that, cases where hair transplant is needed and if done perfectly, final results are encouraging and make a huge difference to the personality. Complications in hair transplant can happen in any part of the operative procedure, during anesthesia or later but that is so for all other transplant operations as well. Discuss the same with your doctor.

Understanding Kidney Stone Analysis

Dr. Anish Kumar Gupta, Andrologist
Did you recently get your kidney stone removed ?Kidney stones come in many different types and colors. How you treat them and stop new stones from forming depends on what type of stone you have.  Get the stone analysis done to know the type of stone you are having. And, then go back to your doctor to ask for more detailed advise to prevent the same.There are 4 main stone types, discussed below.Calcium stones (80 %)Most common type of kidney stones. They can be calcium oxalate and calcium phosphate. Calcium oxalate is by far the most common type of calcium stone Some people have too much calcium in their urine, raising their risk of calcium stones Even with normal amounts of calcium in the urine, calcium stones may form for other reasons Uric acid stones (5–10 %)Uric acid is a waste product that comes from chemical changes in the body.Uric acid crystals do not dissolve well in acidic urine and instead will form a uric acid stone. Having acidic urine may come fromObesityChronic diarrhoeaType 2 diabetesGoutA diet that is high in animal protein and low in fruits and vegetablesStruvite/infection stones (10 %)Uncommon type of stones. Related to chronic urinary tract infections (UTIs). Some bacteria make the urine less acidic and more basic or alkaline Magnesium ammonium phosphate (struvite) stones form in alkaline urine.These stones are often large, with branches, and they often grow very fast.People who get chronic UTIs, such as those with long-term tubes in their kidneys or bladders, or people with poor bladder emptying due to neurologic disorders are at the highest risk for developing these stones Cystine stones (<1 %)Cystine is an amino acid that is in certain foods; It is a building block of protein  Cystinuria (too much cystine in the urine) is a rare, inherited metabolic disorder. It is when the kidneys do not reabsorb cystine from the urine When high amounts of cystine are in the urine, it causes stones to form Cystine stones often start to form in childhood Stone analysis is only one part of understanding why stones form. For a detailed advise for prevention the patient will also need to undergo urine and blood tests to help decide the need for any specific advise for the same.Ask your Urologist about it in in your next visit.

Everything You Wanted to Know About Corneal Transplants

Dr. Quresh Maskati, Ophthalmologist
Q. What is the CORNEA?A. This is a clear piece of tissue that fits like a watch crystal (outer glass cover of the watch) over the coloured part of the eye called the iris. Unlike the watch glass, which is flat, the cornea is dome shaped. Light passes through the transparent cornea, just like it would through a window, to the back of the eye. The parallel rays of light passing through the cornea gets bent so as to focus on the retina which is the inner lining of the back of the eye, like the film of the camera.Q. How does the cornea get cloudy?A. Clouding or irregularity of the cornea may be caused by many different kinds of problems. When the cornea becomes cloudy, similar to the frosting of glass, light is not able to pass through the eye and poor vision results. Some of the causes are:· Infection and injury to the eye· Nutritional disorders such as Vitamin A deficiency · Reaction to drugs, e.g. Stevens–Johnson Syndrome· Degenerations and dystrophies of the cornea (inherited conditions which may cause clouding of the cornea in adult life· Keratoconus (an irregularity of the shape of the cornea, where there is progressive ‘coning’ of the cornea) In this condition even though the cornea is clear the quality of vision gradually deteriorates. Clouding only occurs in the very late stages.· Corneal clouding as a complication of cataract or glaucoma surgeryQ. In such cases, how is vision restored?A. The only way to restore vision is to replace the cornea with donated healthy corneal tissue by a surgery called corneal transplant or keratoplasty. This consists of removal of a central disc of the abnormal cornea and replacing it with a similarly sized piece of normal cornea obtained from a donor eye. The cornea is the only part of the eye that can be transplanted.Q. How successful is cornea transplant surgery? Is it true that most corneal transplants become opaque in a few years?A. The corneal transplant or corneal graft as it is also called, is devoid of blood vessels. Hence out of all transplants done in the body such as heart, liver, kidney etc, it has the least chance of rejection. I amend the previous statement – it would come second in terms of success rates to hair transplants! Even if rejection does occur, it can be successfully treated by eye drops in most cases without having to take recourse of systemic immunosuppressive medication, as is the case with rejected transplants elsewhere in the body. I have seen several grafts done 30 and 40 years ago, remaining crystal clear to this day! Grafts done in eyes where the cornea is already vascularised naturally, have a poorer long-term prognosis (expected outcome, in layman’s terms). However, in case a graft does fail or get rejected for some reason and the rejection is not reversed by timely treatment, all is not lost. If the rest of the eye has no other complications, it is possible to do a re graft i.e. one more graft (naturally after removing the previous opaque graft!) and restore vision once more.Q. When does rejection usually occur?A. Statistically speaking, rejection occurs most often in the first year after transplant and following any major or minor surgery to the eye there after i.e. a patient of corneal graft who now undergoes cataract surgery or even removal of his corneal sutures (commonly done a year or so after the corneal graft surgery) is at increased risk of graft rejection in the month immediately following the surgical procedure.Q. How does the patient know that there is early rejection and he should rush to the nearest eye doctor?A. If the patient suddenly experiences increase in redness, pain, watering of the operated eye or a drop in vision in the same eye, he should immediately see his nearest eye doctor, preferably on the same day. He should avoid the temptation of taking telephonic advice for his symptoms. This is because these same symptoms can occur in graft rejection as well as in graft infection. The treatment for the former is very frequent instillation of topical corticosteroid drops while this will make the condition worse if it is a graft infection and not a rejection.Q. Can all opaque corneas be successfully transplanted to restore vision?A. I did mention a few paragraphs ago that those corneas already having blood vessels growing into them have a poorer prognosis (Meaning of Prognosis also explained in a previous answer). Besides these, eyes which have a history of previous grafts rejected are more at risk to develop rejection again as the body now knows that there is an intruder and sends its defence forces (white blood ‘killer’ cells) to destroy the invader! Besides, eyes with an inadequate tear secretion or with poor quality tears are not good candidates for corneal grafting. Any condition that has destroyed the “limbus” i.e. the factory that constantly replenishes the cells on the surface of the cornea, which is situated at the junction between the black and the white of the eye, makes a corneal transplant surgery doomed to failure. Some of these conditions are chemical burn injuries, drug reactions such as Stevens Johnson syndrome, which destroy the stem cells at the limbus and certain congenital conditions such as Aniridia, in which there is a very poor quota of stem cells to begin with. For more information on stem cells, read the chapter on “Ocular Surface disorders”.Q. What is the ‘new’ development in cornea transplant surgery – the ‘lamellar’ corneal transplant or keratoplasty?A. Most corneal transplants done in India and even the world over are ‘full thickness’ corneal transplants (technically called penetrating keratoplasty). The diseased cornea is removed with all its layers and replaced by a similar or slightly larger sized, donor cornea also of ‘full’ thickness. However, in certain diseases, such as ‘Keratoconus’ or conical cornea or in superficial corneal scars, the innermost lining of the cornea, called the endothelium is intact and healthy and therefore need not be changed. In these cases, approximately 90% of the thickness is changed, i.e. the innermost layer, the endothelium is left unchanged. Since it is the donor endothelium which is chiefly responsible for the rejection response by the patient’s immune system, the chances of rejection of this ‘lamellar’ graft are reduced dramatically. However, this procedure requires a little more skill than the usual penetrating keratoplasty and has a rate of operative complications (necessitating conversion to penetrating keratoplasty) of about 5-10% in the best of hands. Also, DALK (deep anterior lamellar keratoplasty as it is also called) cannot be used in patients who have unhealthy endothelium. It therefore requires careful patient selection.Q. I have heard of another procedure called “Endothelial Keratoplasty”. What is this?A. I congratulate you for your hearing abilities. This procedure, which is even more technically demanding than DALK, requires special instruments and is still not routinely done. This is transplantation of only the inner lining of the cornea – the endothelium, after stripping off the patient’s own inner lining. It is also known as DSEK and DSAEK and posterior lamellar keratoplasty. You need not bother your head with the full forms of these acronyms. You probably will forget them after reading them anyway. It can be done for those whose corneal inner lining only is dysfunctional and the rest of the cornea is OK. Sutures are generally not required in such cases, so visual recovery is much faster and suture related complications are eliminated.Q. Is there any hope of restoring vision for those unfortunate patients who cannot have or will not benefit from a cornea transplant but have a diseased cornea?A. Yes, they can be fitted with an artificial cornea or Keratoprosthesis, for which you are advised to read the chapter especially devoted to the subject.Q. What are the expenses involved in corneal transplantation?A. These vary considerably depending on the geographical region of the country you get the surgery done. In many places inIndia, these surgeries are done only in government, municipal or trust hospitals where there is no charge or a minimal cost. In the larger cities, it is done in the private sector as well. Though the eyeball is donated free of cost, most eye banks run extensive tests on the donated tissue as well as test the blood of the donor for AIDS, Hepatitis and other communicable diseases. They also employ highly qualified staff that evaluates the eyeball to decide suitability of its use. All this costs money, which is levied by the eye bank as “processing charges”. In Mumbai for example, this cost is around Rs.6000/-per patient at the time of writing this edition. This charge is only levied upon patients in the private sector, which forms only 30% of all patients receiving donated corneas in Mumbai. The remaining 70% of cornea is distributed practically free of cost to the municipal and free hospitals of Mumbai.Q. What about surgical fees?A. These also vary from state to state. In states where there is private sector corneal grafting surgeries performed, the professional fees charged by an eye surgeon is usually around what he would charge for modern day cataract surgery.Q. Is this morally justified? After all he is receiving a donated eyeball free from the deceased donor!A. Morality is a relative issue. No surgeon charges for the eyeball or cornea (eye banks may however charge a processing fee – refer to previous answer). However, surgeons trained in corneal grafting surgery have spent a lot of money to acquire this expertise. Also, they do need good surgical microscopes, disposable trephines and other costly tools to do good corneal grafting surgery. Most corneal surgeons would like to do only corneal surgery to earn their livelihood. However as tissue availability is low, they end up doing cataract and other surgeries as well to earn their daily bread. Practically no eye surgeon in the private sector survives on the income from corneal transplant surgery alone. Most eye surgeons who do a fair number of transplants use the income from affording patients to subsidise the surgery for those that cannot afford.Q. Can every blind person have his sight restored by an “eye transplant”?A. No, corneal grafting or corneal transplant surgery can only benefit those who are blind due to the cornea becoming opaque. The rest of the tissues of the eye cannot be transplanted. As of today, retinal transplants are being tried on an experimental basis but it will be many years if at all, before this procedure can be done successfully to restore vision to those having diseased retinas.Q. Can a person who has received a corneal transplant himself donate his cornea after death?A. Yes. If the cornea is clear, it can be re-used to give sight to one more corneally blind person. It would be a truly noble gesture!