Kidney transplant does not harm the patient or donor

A fall resulting from a slip in the bathroom in 2008 ruptured then-seven-month-pregnant Mary Mumbi’s right kidney. Her would-be firstborn did not survive.

Prior to that, Mumbi had experienced bleeding and diagnosed with kidney failure. She’d be dependent on dialysis for almost five years at Kenyatta National Hospital (KNH).

Dr Jonathan Wala, a consultant physician and nephrologist at Aga Khan University Hospital (AGUH), says when kidney failure occurs, treatment involves replacing the function of that kidney. He said: “The replacement is temporarily by dialysis but ultimately the best replacement is by kidney transplantation.”

Mumbi was in a group of patients directed from KNH after “a good Samaritan” agreed to sponsor them for transplant. The kidney transplantation programme had restarted at AGUH. Of this group, says Dr Wala, six transplants were done.

“My body was heavily swollen,” Mumbi, 42, recalls. When she was dialysing, getting a machine at KNH was a nightmare. Besides, “I was spending around Sh40,000 per month.” Gratefully, her husband Moses Mwathi stood by her despite being financially drained.

India seemed their destination for further medical attention. But the estimated cost of over Sh2.2 million was prohibitive. The anticipated figure wasn’t realised from fundraising.

Doctors advised her to search for a kidney donor. In Kenya, trading in kidneys is illegal; they can only be donated by the patient’s living relative. In some countries deceased donors are used — patients in the ICU declared brain dead but have their heart beating.

“It wasn’t easy,” Mumbi recollects.

None of her siblings’  — three sisters and a brother — blood group was compatible with hers — ‘O’ positive. Her mother was ruled out. Her nephew Martin Wanjiru, 19, volunteered to donate his kidney. At first, doctors at KNH turned him away because he was too young.

“He was in Form Three. He told me to wait until he completed Form Four.”

Two years later, he qualified.

“Many people were discouraging me, saying, ‘you might donate and then the other one fails; you might be taken to the theatre and you don’t come out alive,’” Wanjiru recalls. “I wasn’t scared. It was successful.”

Mumbi’s lastborn sister Leah Njeri laments about their nephew: “Some people even told him that he’d never have children.”

It’s four years since the transplant. Wanjiru draws his shirt up to expose the scar where surgeons slit his body to extract his left kidney and states: “My health is good.”

Mumbi had helped in bringing up Wanjiru and he couldn’t bear the thought of seeing the woman he regarded as his mother suffer.

WELL-SELECTED DONOR

A donor like Mumbi’s, says Dr Wala, has to be well selected. This involves making sure the potential donor has two kidneys that are 100 per cent functional.

Medical investigations should show that the donors “don’t have problems in their body like diabetes and kidney stones that later on may cause abnormality to the kidney,” he said.

Besides, they should be physically fit to undergo the operation and free of infections that could be transmitted to the recipient.

“The person getting the kidney should not have antibodies that can fight that kidney,” clarifies Dr Wala.

A series of tests were lined up for Mumbi and her donor. Two counseling sessions prepared them mentally on what the procedure entailed and what they would experience.

Mumbi vividly remembers the date of the transplant at AGUH: September 14, 2012. After that, she had to be closely observed to assess how her new kidney was functioning.

“I take tablets everyday. At first they were very expensive. I would spend Sh50,000 per month,” she said. As her body continued to accept her new kidney, the cost kept reducing.

This medication is necessary because, the kidney is from somebody else and “the body’s defence mechanism knows only two things: Either this is me or not,” Dr Wala explains. “To prevent the body from rejecting that kidney, she needs to be on medication all the time.”

Mumbi’s donor said: “I am glad when I see her healthy.” He added: “I have never fallen ill since I donated a kidney.”

Added Dr Wala: “There are few jobs that would exclude you if you have already given a kidney. Joining the military is one of them because a scan would expose that one kidney is missing.

According to Dr Wala, usual activity of daily living is possible within a period of one or one-and-a-half months.

One year after the transplant, Mumbi and her husband requested Dr Wala to monitor her to get a baby. He agreed.

Dr Wala says some authorities would give two years after a transplant as the minimum time for a woman to try and conceive.

“I feel this may be waiting for a long time, especially for someone who may not have many years ahead for productivity,” he said.

This meant changing Mumbi’s medication to those that would be friendly to the baby right from conception until it was nine months.

“She was able to carry this pregnancy as if she’s a sixteen-year-old girl,” explained the nephrologist, with a light touch.

The kidney specialist says Mumbi’s blood pressure didn’t rise a notch. Delivery was by CS. A baby boy, Caleb Mwathi, was born!

“The capacity for sexual activity, conception, carrying a pregnancy as Mary has demonstrated, going to labour or delivering a baby, are not affected by kidney transplantation,” revealed Dr Wala.

Mumbi says regarding her new kidney: “During my pregnancy, it never disturbed me even a minute.”

Caleb is almost turning three. Mumbi has another baby, a girl, who is just above one.

SLIGHT RISK

Dr Wala’s view about Mumbi is: “So far, she’s doing quite well.”

Mumbi’s donor enthused: “I have a child. She’s three years. We got her one year after I donated my kidney to my aunt.”

Dr Wala concedes that, just like any other operation, kidney transplant may lead to death in the theatre. “But this is very rare.” Furthermore, “In future, there is a slight risk that the donor may have a higher chance of developing high blood pressure than one who has never donated a kidney.”

Mumbi was in a group of patients directed from KNH after “a good Samaritan” agreed to sponsor them for transplant. The kidney transplantation programme had restarted at AGUH. Of this group, says Dr Wala, six transplants were done.