There are many misconceptions about a transplant which exists among people, even doctors not associated with nephrology.
The most common one being that a kidney is replaced. This is not usually the case. Mostly, a kidney is added to the already existing two. There are some cases where the native kidneys are first removed and the new one then added. But this is very rare. The normal practice is to simply add the new one.
When people get to know that I have a kidney problem, they often ask, "One kidney or both?". If one kidney of an individual stops working, no one would ever know. This is because the other kidney takes on the responsibility of both and performs as well as two kidneys. So, if your renal function declines, it is because both kidneys are impaired.
In fact, an aunt of mine has had one kidney since birth. She got to know when she was around 55 years old when her radiologist son was using his portable ultrasound machine to scan everyone in the house for fun!
Another common misconception is about the role of the urologist versus the role of the nephrologist. The urologist is the person who does the actual surgery. He or she takes the kidney from the donor and places it in the recipient and does all the connections of the various arteries and veins.
The nephrologist is the person who takes care of the medication. Deciding which anti-rejection drugs to use, the dosage of each drug and all the treatment before, during and after the transplant is handled by the neph.
The urologist's work is definitely important but it is quite mechanical. Cut this vein. Cut that artery. Put the new kidney in place. Join this with that. Stitch this here. No novelty. No uncertainties.
It is the nephrologist's work that is more complicated. Keeping in mind the person's history. Zeroing in on the correct combination of immunosuppression. Deciding the dosage. Getting the correct tests done. Reacting appropriately when the results come. Being ready to course-correct at times. Suddenly changing the immunosuppression when something adverse happens. Clearly, the neph's work is more critical.
The outcome of a transplant largely lies in the hands of the neph. Many doctors also do not realize this and they talk about this urologist being better than that one. Or this urologist's success rate is the highest in the city and so on. This is primarily because it is the urologist who does the surgery, the 'main thing', the high point in the treatment, when all the drama happens. The neph works when things are much cooler. Things happen more gradually.
Nephrology is one field which many people, even in the medical field are quite uneducated about. When an individual is brought into casualty, if it is a nephro case, immediately the general medical folks are wary. They will immediately send for someone from the Nephrology department. They don't want to touch the case because they know little about the subject.