Ukufakelwa kwezinso

Isibhedlela Esihamba Phambili Sokufakelwa Kwezinso eHyderabad, India

Ukufakelwa izinso kuyinqubo ikakhulukazi yokushintsha izinso ezingasebenzi nge- izinso ezinempilo kusuka kumnikeli. Inso isitho esimise okwebhontshisi esitholakala ohlangothini ngalunye lomgogodla nangaphansi kwezimbambo. Imisebenzi esemqoka yezinso wukukhipha udoti noketshezi emzimbeni ngendlela yomchamo.

Uma izinso zehluleka ukwenza le misebenzi, imfucuza eyingozi inqwabelana emzimbeni okuholela ekuhlulekeni kwezinso futhi umfutho wegazi ophakeme. Lapho izinso zilahlekelwa amandla ayo okusebenza ngendlela evamile kuholela esifweni sezinso.

Ezinye zezifo ezivamile ezingase zidalwe ngenxa ukwehluleka kwezinso isifo sikashukela, umfutho wegazi ongalawuleki, nesifo sezinso se-polycystic. Lapho kukhona ukuhluleka kwezinso kumuntu imfucuza kufanele ikhishwe ngenqubo ebizwa ngokuthi dialysis.

Izinhlobo Zokufakelwa Kwezinso

Kunezinhlobo ezahlukene zokufakelwa kwezinso okusekelwe emthonjeni wezinso zomnikeli kanye nobudlelwano phakathi komnikeli nomamukeli. Izinhlobo eziyinhloko zihlanganisa:

• Ukufakelwa Kwezinso Zomnikeli Ophilayo:
  • Umnikeli Ophilayo Ohlobene: Onikelayo uyisihlobo segazi somamukeli, njengomzali, ingane yakini, noma ingane.
  • Umnikeli Ophilayo Ongahlobene: Umnikezeli akahlobene ngokwebhayoloji nomamukeli kodwa angaba umngane noma othile ozimisele ukunikela ngokuzinikela.
• Ukufakelwa Kwezinso Zomnikeli Oshonile:
  • I-Cadaveric Deceased Donor: Izinso zitholwa kumuntu oshonile okhethe ukunikela ngezitho zakhe, ngokuvamile ngohlelo olukhethiwe lokunikela ngezitho.
  • I-Expanded Criteria Donor (ECD): Kwezinye izimo, izinso ezivela kubanikeli abashona abadala noma abanikeli abanezimo ezithile zempilo zingasetshenziswa. Lezi zinso zingase zibe nengozi enkulu yokuba nezinkinga, kodwa zisengaba usizo ekwandiseni iqoqo lezitho ezitholakalayo.
• I-Paired Exchange (Ukushintshana Kwezinso): Ezimeni lapho umnikezeli ophilayo engafani yini nomamukeli abahlosile, izinhlelo zokushintshisana ngamapheya zivumela ukushintshana phakathi kwamapheya amabili abanikeli nabamukeli ukuze bathole okufanayo okungcono. Lokhu kungabandakanya amapheya amabili noma ngaphezulu abambe iqhaza ochungechungeni lokufakelwa kwezinso.
• I-Domino Kidney Transplant: Ukufakelwa kwe-domino kuhilela uchungechunge lokufakelwa kwezinso lapho izitho zidluliselwa ohlwini lwabanikelayo nabamukeli. Lokhu kuvame ukuqala ngomnikeli ophilayo futhi kuqhubeke njengoba umemukeli ngamunye ethola izinso ezintsha.
• Ukufakelwa Kwezinso Okungahambelani ne-ABO: Imvamisa, ukuhambisana kohlobo lwegazi kubalulekile ekufakeleni isitho somzimba. Nokho, ukufakelwa okungahambelani ne-ABO kuhilela ukufakelwa ngamabomu izinso kumnikeli onohlobo lwegazi oluhlukile kunomamukeli, ngokusetshenziswa kwemithi yokuzivikela komzimba ukuze kulawuleke izinkinga ezingase zibe khona.
• Ukufakelwa Kwangaphambi Kokugcwalisa: Okunye ukufakelwa kwezinso kwenziwa ngaphambi kokuba umemukeli aqale i-dialysis. Lokhu kwaziwa njenge-pre-emptive transplantation futhi kuhlotshaniswa nemiphumela engcono yesikhathi eside uma kuqhathaniswa nokufakelwa ngemva kwesikhathi sokucofa igazi.

Ukufakelwa kwezinso ngokuvamile kwenziwa lapho izinso zingasebenzi futhi imisebenzi ingenziwa. I-Dialysis ingenye yezinketho zokusiza ukunqoba ukwehluleka kwezinso, nokho, kodwa ukuchitha impilo yonke ku-dialysis kungaba buhlungu kakhulu. Ngakho ikhambi elingcono kakhulu nelihlala njalo ukufakelwa izinso. Lokhu kusiza futhi ekwelapheni izifo ezingamahlalakhona noma isifo sezinso.

Izinto eziyingozi zokufakelwa izinso

Ukufakelwa kwezinso kuba okubaluleke kakhulu ukusiza ukwelapha izifo eziningana. Nokho, kunamathuba okuthi ngezinye izikhathi umzimba wesiguli uqale ukwenqaba izinso zomnikeli. Lokhu kwenzeka futhi ngenxa yomuthi. Ngakho-ke, kunconywa ukuthi khuluma nodokotela wakho ezibhedlela ze-CARE ukuze uthole ulwazi oluphelele. 

Kodwa-ke, izinkinga ezingenzeka kanye nezici zobungozi zihlanganisa:

• Ukwenqatshwa: Amasosha omzimba omamukeli angase abone izinso ezitshalwe kabusha njengeyangaphandle futhi afake impendulo yokuzivikela komzimba, okuholela ekwenqatshweni. Imithi ye-immunosuppressive inqunyelwe ukusiza ukuvimbela ukwenqatshwa.
• I-Immunosuppression Side Effects: Imithi esetshenziselwa ukucindezela isimiso somzimba sokuzivikela ezifweni nokuvimbela ukwenqatshwa ingaba nemiphumela engemihle, kuhlanganise nengozi eyengeziwe yokutheleleka, isifo sikashukela, umfutho wegazi ophakeme, nokuncipha kwamathambo.
• Ukutheleleka: Izidakamizwa ze-immunosuppressive zingandisa amathuba okuba izifo. Amagciwane angathinta izinso ezitshalwe kabusha noma ezinye izingxenye zomzimba.
• Izinkinga Zokuhlinzwa: Izingozi ezihlobene nenqubo yokuhlinzwa zihlanganisa ukopha, amahlule igazi, kanye nokulimala kwezitho eziseduze noma imithambo yegazi.
• I-Delayed Graft Function (DGF): Ngezinye izikhathi, izinso ezitshalwe kabusha zingase zingasebenzi ngokushesha ngemva kokufakelwa kabusha, okudinga ukuqhubeka kwesikhashana kwe-dialysis kuze kube yilapho izinso ziqala ukusebenza kahle.
• Ukuphindaphinda Kwezifo Zasekuqaleni: Kwezinye izimo, isimo esicashile esaholela ekuhlulekeni kwezinso kwasekuqaleni (njengezinhlobo ezithile zezifo zezinso) singase siphinde sivele ezinso ezitshalwe kabusha.
• Izinkinga zenhliziyo nemithambo yegazi: Abamukeli bokufakelwa kwezinso bangase babe sengozini eyengeziwe yezifo zenhliziyo, okuhlanganisa ukuhlaselwa yinhliziyo nokushaywa unhlangothi.
• Ingozi Yomdlavuza: Ukusetshenziswa isikhathi eside kwemithi yokuzivikela komzimba kungase kwandise kancane ingozi yomdlavuza othile, njengomdlavuza wesikhumba kanye ne-lymphoma.
• I-Post-transplant Diabetes Mellitus (PTDM): Abanye abantu bangase babe nesifo sikashukela ngemva kokufakelwa kwezinso, ngokuvamile okubangelwa ukusetshenziswa kwemithi yokuzivikela komzimba.
• Izinkinga Zamathambo: Imithi ye-immunosuppressive ingathinta impilo yamathambo, okuholela ezimweni ezifana kwamathambo.
• Izinselele Zengqondo: Ukuzivumelanisa nokuphila ngemva kokufakelwa kwezinso kungase kubangele izinselele ezingokomzwelo nezingokwengqondo. Ukubambelela emithini nasekushintsheni kwendlela yokuphila kubalulekile empumelelweni yesikhathi eside.
• Izinkinga Zezezimali Nomshwalense: Izindleko zokufakelwa kabusha, imishanguzo ye-immunosuppressive, kanye nezinkinga ezingaba khona zingase zibangele izinselele zezimali. Ukufinyelela kumshwalense wokunakekelwa kwangaphambi nangemuva kokufakelwa kubalulekile.

Izinzuzo Zokufakelwa Izinso

Ukufakelwa kwezinso kunikeza izinzuzo eziningi kubantu abanesifo sezinso sokuphela kwesigaba (ESRD) uma kuqhathaniswa nezinye izindlela zokwelapha ezifana ne-dialysis. Ezinye zezinzuzo ezibalulekile kanye nezinzuzo zokufakelwa kwezinso zihlanganisa:

• Ikhwalithi Yempilo Ethuthukisiwe: Ukufakelwa kwezinso okuphumelelayo kungathuthukisa kakhulu ikhwalithi yempilo yabantu abaneESRD. Ibavumela ukuthi baphinde bathole umuzwa wokujwayelekile, inkululeko, kanye nokuvumelana nezimo uma kuqhathaniswa nemikhawulo ebekwe yi-dialysis.
• Ukusinda Kwesikhathi Eside: Ngokuvamile, abamukeli bokufakelwa kwezinso banezinga elingcono lokusinda lesikhathi eside uma kuqhathaniswa nabantu abaku-dialysis. Ukufakelwa okuphumelelayo kunganikeza impilo enwetshiwe futhi enempilo.
• Ukuqedwa Kokuncika Kwe-Dialysis: Ukufakelwa kwezinso kususa isidingo sokwelashwa okuqhubekayo kwe-dialysis. Lokhu kungaba impumuzo enkulu, njengoba i-dialysis idla isikhathi, idinga ukubambelela ngokuqinile esimisweni, futhi ingaba nzima ngokomzimba.
• Impilo Engokomzimba Ethuthukisiwe: Ngezinso ezitshalwe kabusha ezisebenzayo, abantu bavame ukuzwa impilo engokomzimba ethuthukisiwe, okuhlanganisa amazinga akhuphukayo wamandla, isifiso sokudla esingcono, kanye nekhono lokuhlanganyela emisebenzini eminingi yomzimba.
• Ukujwayela Kwebhalansi Yamanzi Ne-Electrolyte: Izinso ezitshalwe kabusha ngokuvamile zenza imisebenzi yemvelo yokulawula ibhalansi yoketshezi kanye ne-electrolyte ngokuphumelelayo kune-dialysis. Lokhu kusiza ekugcineni ukulingana okuphelele komzimba emzimbeni.
• Impilo Yenhliziyo Ethuthukisiwe: Ukufakelwa kwezinso kuhlotshaniswa nengozi encishisiwe yezinkinga zenhliziyo nemithambo yegazi uma kuqhathaniswa ne-dialysis yesikhathi eside. Lokhu kungaba nomthelela omuhle empilweni yenhliziyo futhi kunciphise nengozi yezinkinga ezihlobene nenhliziyo.
• Ukulawula Kangcono I-anemia: Izinso ezitshalwe kabusha ngokuvamile zikhiqiza i-erythropoietin, i-hormone ekhuthaza ukukhiqizwa kwamangqamuzana abomvu egazi. Lokhu kungaholela ekulawuleni okungcono i-anemia, inkinga evamile kubantu abanenkinga yezinso.

Inqubo Yokufakelwa Kwezinso

Ukufakelwa kwezinso kwenziwa ngokunikeza i-anesthesia evamile, okusho ukuthi, awuvukile ngesikhathi senqubo futhi awuzwa lutho. Ithimba le-CARE Hospitals lizoqapha isilinganiso senhliziyo, umfutho wegazi kanye nezinga le-oxygen kulo lonke ukuhlinzwa.

Udokotela ohlinzayo uzosihlinza ukuze athathele lowo onikelayo esikhundleni senso endala. Imithambo yegazi yenso entsha inamathele emithanjeni yegazi engxenyeni engezansi yesisu. I-ureter yenso ixhunywe esinyeni.

Ezinye zezinkinga ezingase ziphakame phakathi nenqubo kungaba amahlule egazi kanye ukuphuma, ukuvuza epayipini, ukutheleleka futhi kungase kube ithuba lokwenqatshwa kwezinso ezinikelwe. Nakuba kwenzeka ezimweni ezingavamile kakhulu, ungakwazi njalo ukuxoxa ngezingozi ezihlobene nokufakelwa nodokotela wakho ngaphambi kokuhlinzwa. 

Ngaphambi kwenqubo

Ukufuna umuntu onikela ngezinso ofanelekayo kuhilela ukucabangela izici ezihlukahlukene, ukuthi lowo onikelayo uyaphila noma ushonile, nokuthi bahlobene yini nawe noma abahlobene nawe. Ithimba lakho lokufakelwa lizohlola izici ezimbalwa ukuze linqume ukuhambisana kwezinso ezingaba ngumnikeli.

• Ukuhlolwa okwenziwe ukuhlola ukufaneleka kwezinso ezinikelwe zihlanganisa:
• Ukuthayipha igazi: Okufanelekile, uhlobo lwegazi lomnikeli kufanele lufane noma luhambisane nelakho. Ukufakelwa kwezinso okungahambelani ne-ABO kungenzeka kodwa kudinga ukungenelela okwengeziwe kwezokwelapha ukuze kuncishiswe izingozi zokunqatshelwa kwesitho.
• Ukuthayipha kwezicubu: Uma izinhlobo zegazi zihambisana, isinyathelo esilandelayo sibandakanya ukuhlolwa kokuthayipha kwezicubu, okwaziwa ngokuthi ukuthayipha kwe-human leukocyte antigen (HLA). Lokhu kuhlolwa kuqhathanisa izimpawu zofuzo ukuze kwandiswe amathuba okuthi izinso ezitshaliwe zibe nempilo ende. Ukulinganisa okuhle kunciphisa ingozi yokwenqatshwa kwesitho.
• I-Crossmatch: Ukuhlolwa kokugcina okufanayo kuhlanganisa ukuxuba isampula elincane legazi lakho negazi lomnikeli elebhu. Lokhu kuhlola kunquma ukuthi amasosha omzimba egazini lakho angase asabele yini ngokumelene nama-antigen athile egazini lomnikeli.
• I-crossmatch engalungile ikhombisa ukuhambisana, kunciphisa amathuba okuthi umzimba wakho wenqabe izinso zomnikeli. Ukufakelwa kwezinso ezinhle ze-crossmatch kungenzeka kodwa kudinga ukungenelela okwengeziwe kwezokwelapha ukuze kuncishiswe ubungozi bokuthi amasosha omzimba wakho asabela esithweni somnikeli.

Ngesikhathi senqubo

Ukuhlinzwa kokufakelwa kwezinso kwenziwa ngaphansi kwe-anesthesia jikelele ukuqinisekisa ukuthi iziguli azazi ngesikhathi senqubo. Phakathi naso sonke isikhathi sokuhlinzwa, ithimba labahlinzayo liqapha ngokucophelela izimpawu ezibalulekile njengokushaya kwenhliziyo, umfutho wegazi, kanye amazinga e-oxygen egazini.

Ngesikhathi sokuhlinzwa

• Udokotela ohlinzayo wenza imbobo ohlangothini olulodwa lwesisu esingezansi bese efaka inso entsha. Ngaphandle kwalapho izinso ezikhona zesiguli zibangela izinkinga ezifana nomfutho wegazi ophakeme, amatshe ezinso, ubuhlungu, noma ukutheleleka, zigcinwa endaweni yazo yasekuqaleni.
• Imithambo yegazi yenso entsha ihlanganiswa nemithambo yegazi engaphansi kwesisu, ngenhla nje komlenze owodwa.
• I-ureter yenso entsha, ishubhu elixhumanisa izinso esinyeni, ixhunywe esinyeni.

Ngemva kokufakelwa izinso

Ngemva kokufakelwa izinso, uzobe usesibhedlela izinsuku ezimbalwa lapho odokotela bezoqapha isimo sakho. Uma odokotela sebebona ukuthi isimo sizinzile uzobuyiselwa ekhaya. Udinga ukuza ukuzohlolwa njalo futhi ulandele imiyalelo kadokotela ngokunembile.

Imithi kufanele iphuzwe njalo kukho konke ukuphila. Ukufakelwa izinso ngempumelelo ngeke kusadinga noma iyiphi i-dialysis. Kungokwemvelo ukuthi umuntu angase azizwe ekhathazekile noma ejabule kakhulu futhi angase abe nohlobo oluthile lokwesaba mayelana nokwaliwa. Ezimweni ezinjalo, abangane namalungu omkhaya bayasiza ekubhekaneni nezikhathi ezinzima.

Ezibhedlela ze-CARE, sikulethela ingqalasizinda yesimanje ehambisana nobuchwepheshe obuphambili. Odokotela bethu nabo bonke abasebenzi balwela ukunikeza ukunakekelwa okungcono kakhulu ezigulini zethu. Uma uhlushwa yinoma yikuphi izimo zezinso, vakashela izibhedlela ze-CARE eziseduze nawe namuhla. 

Chofoza lapha ukuze uthole imininingwane eyengeziwe ngezindleko zalokhu kwelashwa.