A journey through dialysis, transplantation and living with three kidneys

The Gibraltar Dialysis Patients and Friends Association aims to raise awareness of kidney disease locally. The charity hosted an event at Westside School where science teachers dissected kidneys and students fundraised for the charity by wearing green. The charity’s president Sunil Chandiramani spoke to the Chronicle about his health issues in a bid to raise awareness.

From just four years old Sunil Chandiramani knew that at some point in his life he would need dialysis and a kidney transplant.

He had been diagnosed with polycystic kidney disease and at the time held the local record for the youngest person ever in Gibraltar to be on blood pressure medication.

This began a two decade journey from blood pressure tablets, to dialysis, diabetes and kidney transplantation.

From the age of 13 doctors started planning from transplant and estimating when his kidneys would reach a stage where transplantation was necessary.

Doctors then looked at his parents for possibility of becoming a living donor.

His mum was found not to be compatible, but his dad was a viable donor.

It was decided to delay transplantation for some years so that Mr Chandiramani could continue with school.

“At that time I was leading a normal life, I going out, playing sports and I never really felt ill,” he said.

“My bloods were dangerously high but stable.”

During his A Levels doctors found that his dad had kidney stones.

“There was a decision to be made,” he said.

“Doctors said they couldn’t really give me a kidney with kidney stones and leave my dad with the good one or vice versa.”

At the time Gibraltar was not included in the organ donation register as it is now, meaning that Gibraltarians needing donations would have to reside in other countries such as the UK or Spain in order to sign up to the waiting list.

“It didn’t really stop me, for someone who could have potentially been dead I was still playing cricket and doing as much as I could,” he said.

“My A Levels finished and we decided to go to India to see what could happen there.”

Sunil’s blood type B+ is much more common amongst people of Asian descent, meaning that he would be more likely to find a match in India than in Europe.

He spent three months in India, trialled alternative therapy and even became a vegetarian for six months after a doctor recommended it.

“I was fed up. I spent my 18th birthday in India with none of my friends. Those months were quite sad I had missed out on so much. I said I would come back and face the consequences.”

When he arrived back in Gibraltar a doctor told him the bad news and the good news.

The bad news was he needed to start dialysis.

“So I said what’s the good news? ‘You’re lucky to be alive’. He had been looking at my blood works and said I should have probably been dead at the age of 15.”

After this he needed surgery on his vein to create a “super vein” for dialysis.

“They basically do a union of an artery and a vein,” he said.

A vein is too thin to inject for dialysis and an artery can’t be injected as it would “explode” Mr Chandiramani explained.

“I have to be really careful with that super vein because if something hits it there could be blood everywhere and I would have to go to hospital straight away.”

He started dialysis in 2006 and continued with dialysis for two years and eight months.

During this time he was able to sign up to the Spanish organ donation waiting list.

In October 2008, aged 21 years, he received the phone call that a kidney was ready in Cadiz.

The patient he received his kidney from was brain dead but not clinically dead meaning that transplantation could take place over 24 hours after death.

“So I’ve got three kidneys,” he said.

“I’ve got the two at the back which everyone has and they just stuck one in.”

The third kidney is situated to the front of the body in the abdomen area.

“The two kidneys in the back don’t do anything. They only take them out if they are infected or cause any complications during the transplant.”

Mr Chandiramani remembers waking up in pain and not being able feel his right leg.

“When they cut you open they have to cut a nerve between your waist and your leg,” he said.

He couldn’t walk for days and slowly had to relearn to walk.

After year’s waiting for a transplant he decided to go to university in Cardiff.

In university Mr Chandiramani was diagnosed with diabetes and was 24 hours away from a diabetic coma.

Transplantation can give rise to diabetes, but although he is still diabetic his body is now producing insulin.

Another side effect he has dealt with is osteoporosis, the weakening of bones and is currently on treatment.

He added that skin cancer is also a side effect that could give rise and he is sure to always wear sun cream.

“I lead a pretty normal life the only thing I can’t do is eat grapefruits or have grapefruit juice because it could affect some of my medication.”

Mr Chandiramani thinks more awareness is needed regarding kidney disease and organ donation.

He encourages people to sign up to the organ register on the NHS website.

Last year the UK online register for organ donation was opened for those residing in Gibraltar after an agreement between the Gibraltar Health Authority and Hammersmith Hospital in London.

Some 260 people had signed up in the first six months and local residents can sign up to the UK Organ Donor Register at www.organdonation.nhs.uk.

Currently in Gibraltar organ donation is opt-in and Mr Chandiramani wants to see that change to an opt-out register.

“When someone passes away they could save eight lives and the way I see it is their legacy is still around,” he said.

“If it wasn’t for the person who passed away when I had my transplant I may not be alive today, or I may be alive but hooked onto a machine.”

“I am quite grateful to the organ donor and their family. It’s a hard decision and as a society I don’t think we talk about it as openly as we should.”

“People don’t want to talk about death, but you are giving someone the gift of life. It is a hard conversation even as a living donor. You are giving someone a second chance.”

Mr Chandiramani acknowledged it would prolong the grieving process in Gibraltar as people wouldn’t be buried within hours if donation was involved.

“Sometimes it’s the hard conversations that are the best conversations to have and are the ones that have a lasting impact.”

KIDNEY FACTS
850 million people suffer from kidney disease.

Kidney disease is currently the 11th leading cause of global mortality.

Uncontrolled diabetes and high blood pressure are the biggest causes of kidney disease.

It is estimated 60,000 premature deaths occur in the UK every year due to chronic kidney disease.

Currently 64,000 people in the UK are being treated for kidney failure.

4,820 people are waiting for a kidney, yet only around 3,300 transplants are carried out each year.

3,770 people a year die while on dialysis and five people die every week while waiting for a kidney transplant.

Transplants don’t last for life, they currently last an average of 10 to 15 years.

Kidneys typically weigh around 150 to 170 grams and are around the same size as a computer mouse.

Every minute 1,200ml of blood enters both kidneys.

In one day 1,700 litres of blood is purified.

Adults have seven to eight litres of blood meaning that blood is filtered 400 times per day.

Nephrons – millions of filtering units in kidneys – placed horizontally end to end would reach 16 kilometres in length.

Your body can work normally with one kidney.

Early kidney disease has no signs or symptoms. Blood and urine tests are the only way to know.

Dialysis removes waste products and unwanted water.

When kidneys are transplanted the old damaged kidneys are not usually removed.