Treating an Enlarged Prostate: From Medication to UroLift, Rezum and Laser Surgery

Yes, HLA incompatibility alone is not a major problem, even between spouses with no HLA match at all. What actually determines eligibility is the cross match: a negative CDC and flow cross match clears the way for transplant. If CDC is negative but flow is positive, donor-specific antibody testing by the single antigen bead method quantifies the real risk, an MFI reading up to roughly 1,500-2,000 is not a concern, while higher readings call for plasmapheresis first. The key requirement is simply that there should be no antibodies against that particular HLA antigen.

Whenever a brain-dead donor is identified anywhere in Delhi NCR, India's national organ transplant authority (NOTTO) is notified and coordinates two brain stem death declarations roughly two hours apart, made jointly by the primary caregiver and a neurointensivist or equivalent specialist. Once the family consents, NOTTO allocates the organ from its waiting list strictly by turn order across hospitals, no single centre can claim it outside that process. From the first declaration to organ harvest is roughly a 12-hour process, with the recipient's dialysis and cross-match run in parallel so the transplant can proceed within six to twelve hours of harvest.

This is antibody-mediated rejection (AMR), one of two categories of acute rejection alongside cell-mediated rejection (ACR), and a kidney biopsy is needed to tell them apart. Treatment usually starts with methylprednisolone pulses, escalating to anti-thymocyte globulin or plasmapheresis if that isn't enough. In over a decade, hyperacute rejection has not been seen in blood-compatible transplants at this centre, and most rejection today is reversible when caught and treated promptly, the real danger comes from delayed treatment, not from the rejection episode itself.

Donation has to come from love and compassion, never pressure. What actually works is reframing donation as a chance for the donor to become healthier: the thorough medical workup required for donor clearance means any underlying problem gets caught and treated, so donors go on to outlive their peer group rather than being harmed by donating. Where genuine pressure would otherwise be needed, keeping the recipient on dialysis while continuing to look for a willing donor is the ethical path, alongside broader deceased-donor campaigns to reduce reliance on living donors altogether.

It is being tried, but the outlook is not promising because of tissue rejection and the risk of transmitting animal viruses, including parvovirus, into the recipient, so the success of xenotransplantation is still genuinely questionable. Far more promising is tissue-engineered, artificially grown organs: a related technique already in use is tissue-engineered buccal mucosa grafting for urethral stricture, where a small piece of cheek tissue is cultured in a lab and implanted into the urethra, a real, working example of the technology-biology merger that is likely to define the field's near future.

UroLift, a temporary squeezing implant, and Rezum, a water-jet therapy device. All three are minimally invasive, some are daycare procedures, and they are aimed at younger men who want to preserve their sexual function while relieving urinary symptoms.

HoLEP suits men generally above 60 to 70 who are willing to accept retrograde ejaculation as a trade-off for a more definitive procedure; it has been used on prostates as large as 300 to 350 g. Prostates beyond roughly 200 to 300 g are generally treated with robotic simple prostatectomy instead.