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 Medical Charity

March 2012
Organ Transplant:Overcoming limitations
Dr K Subramanyam
 
Amajor source of human organs for transplantation in the western countries is heart-beating deceased donors known as brain dead donors. This is the way forward in India too especially in the context of the large number of patients in need of organs and the scarcity of live related donors.

Clinically, one major factor in the success of cadaver/ brain dead human organ transplants is the time between the harvest from the donor and the transplantation into the recipient.

Our Organ Transplant Act has defined brain death. The legal process to follow while harvesting the organs from such donors and the methodology of harvesting the organs in time to ensure that they are functional in the recipients too are detailed in it. Limitations of infrastructure and transport facilities have however meant that cadaver organ transplants in India are limited to patients registered in the network of transplant teams among neighborhood hospitals in a city or a place. Seen in this context, the recent case of a cadaver kidney transplant at our Apollo Health City, Hyderabad is an achievement that holds hope for many.

It all started on at about 4.30 am on 17th January when our hospital came across a flash query for transplant teams at hospitals in Hyderabad. The query was from MOHAN foundation – a NGO for facilitating organ donation. They wanted to know if any of us had recipients for a pair of kidneys they were harvesting from a 67-year-old brain dead patient Organ Transplant: Overcoming limitations Dr K Subramanyam at Christian Medical College Hospital, Vellore. The kidneys looked set to go waste in the absence of suitable kidney patients in their local limits and suitable patients were absent with the transplant teams in nearby Chennai too, they said.

At Apollo Health City, our team took quick stock of the situation including a variety of problems. Among them was also the age of the donor – 67 years. It is a bit elderly by the classical standards of cadaver donation and we had our doubts on whether the kidneys would function normally once transplanted. The question of logistics was how to physically move the kidneys from Vellore to Hyderabad in minimum time or with least delay. The third issue was the identification of suitable recipients from among our patients.

Our single-minded determination was to ensure that the available kidneys are put to best use and not be allowed to go waste. The initial search in our pool of dialysis patients showed three to four possible recipients. Three of them were reluctant to receive it. The worry and the doubt on the age of the donor and the distance from which the kidneys were being sourced played on their minds too.

Our fourth patient – JR, was a 48-yearold man who had been on dialysis for over three years. He seemed to see the value of the kidneys that were available and was readily willing to receive it.

While I handled the organ transplant side of the issue, my colleague Dr Tarun Kumar Saha handled the nephrology side of the case. Together we explained to our patient the case and its risks: Due to the delay in harvesting and transplantation, the kidneys may not work well immediately, but as medical professionals we were confident that the kidneys will work in about two weeks time.

One major challenge was to get the kidneys to Hyderabad from Vellore. The Apollo Hospitals Group’s well organised network of hospitals, sense of purpose and dedication to patient welfare were instrumental in achieving the nearly impossible. A flurry of calls from Hyderabad to Apollo Hospitals, Chennai and to CMC, Vellore followed. Effectively a person from CMC Vellore carried the icebox containing both the kidneys to the Chennai Airport from where a representative of Apollo Hospitals, Chennai collected it and boarded a flight to Hyderabad. Simultaneously our patient JR was prepared by dialysis. Keeping the advanced age of the donor in mind, our team decided to transplant both the kidneys into one patient only. (Normally, in kidney transplants, only one kidney is transplanted to a transplant patient. Meaning a pair of harvested kidney goes to two different patients.).

Our wait for the arrival of the harvested kidneys felt like a lifetime. It finally ended that night at 11 pm. The good part of the night or the next three hours went in laboratory testing to check the match between the harvested kidneys and JR the recipient or patient. The transplant surgery per se started the next morning – early at 4 am. It was a six-hour-long operation.

Just as we medical professionals had expected and explained to our patient – the kidneys did not function immediately. And just as we had assessed it, our effort and patience yielded fruit in two weeks when JR started passing urine with increasing volumes by the day. The kidney function was normalised in him in about three weeks.

It was a triumph of human perseverance and hope on our professional side. On the other side was the faith the patient placed in the team of his doctors.

(Note: The full name of the recipient and the donor parties are withheld to maintain confidentiality. Pictures are for representaion only. They are not related to people mentioned here)


    
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