• Is the life saving therapy for end stage organ failure. The most commonly transplanted
organs are kidney, liver, heart, lungs, pancreas and intestine.
• Transplantation is the act of surgical removal of organ from one person and placing it
into another person. Transplantation is needed when the recipient’s organ has failed or
has been damaged due to illness or injury.
• Directorate General of Health Services, Government of India is implementing National
Organ Transplant Programmed for carrying out the activities as per Amendment Act,
training of manpower and promotion of organ donation from diseased person.
• Objectives of National Organ Transplant Programmed:
 To organize a system of organ and tissue procurement and distribution for transplantation
 To promote deceased organ and tissue donation .
 To train required manpower.
 To protect vulnerable and poor from organ trafficking.
 To monitor organ and tissue transplant services and bring about policies and programmed
corrections/ changes whenever needed.
• Brain Stem death is recognized as a legal death in India under the Transplantation of
Human Organs Act.
• After natural cardiac death only a few organs/tissues can be donated (like cornea,
bone, skin and blood vessels) whereas after brain stem death almost 37 different
organs and tissues can be donated including vital organs such as kidneys, heart, liver
and lungs.
Government of India initiated the process of amending and reforming the THOA 1994 and
consequently, the Transplantation of Human Organs (Amendment) Act 2011 was enacted.
Some of the important amendments are:1. Tissues have been included along with the Organs.
2. ‘Near relative’ definition has been expanded to include grandchildren, grandparents.
3. Provision of ‘Retrieval Centres’ and their registration for retrieval of organs from deceased
donors. Tissue Banks shall also be registered.
4. Provision of Swap Donation included.
5. There is provision of mandatory inquiry from the attendants of potential donors admitted in
ICU and informing them about the option to donate – if they consent to donate, inform
retrieval centre.
6. Provision of Mandatory ‘Transplant Coordinator’ in all hospitals registered under the Act.
7. To protect vulnerable and poor there is provision of higher penalties has been made for trading in
organs.
8. Constitution of Brain death certification board has been simplified- wherever Neurophysician or
Neurosurgeon is not available, then an anaesthetist or intensives can be a member of board in his
place, subject to the condition that he is not a member of the transplant team.
9. National Human Organs and Tissues Removal and Storage Network and National Registry for
Transplant are to be established.
10.There is provision of Advisory committee to aid and advise Appropriate Authority.
11.Enucleation of corneas has been permitted by a trained technician.
12.Act has made provision of greater caution in case of minors and foreign nationals and prohibition of
organ donation from mentally challenged persons
TYPES
DEFINITION
Orthotopic
Organ implanted in same anatomic location in the recipient as it was in the donor. Diseased organ
is removed. Eg: Heart, lung, liver, intestine
Heterotopic
Organ implanted in different anatomic location in the recipient as it was in the donor. Eg: Kidney,
Pancreas
Auxiliary Transplantation
Partial tissue from the donor is used which act as temporary support for recipient’s injured organ
which remains in place. Eg: Left Lobe of Liver
Auto Transplant
Transfer of cells/ tissues/ organs within same person. Eg: Auto transplantation of parathyroid in
brachioradialis muscle
Allotransplant
Transfer of cells/ tissues/ organs within same species.
Xenotransplant
Transfer of cells/ tissues/ organs in different species.
Isograft
Transfer of cells/ tissues/ organs within genetically identical individual.
EYE DONATION
• Administration has approved the use of solutions to preserve donated corneas for upto
14days.
• Eyes should be removed 6-12hrs after death.
• Total removal time is about 15-20min.
• Spectacle wearers, hypertensive, cataract operated and diabetics can also donate.
Dead/ Deceased Donors
Brain Dead/ heart beating donors/
Donation after Brain Death (DBD)
Living Donors
Cardiac or Circulatory
Dead/ Non Heart
beating Donors/
Donation after
Circulatory Death Donors
(DCD)
Limited to donation of
• Kidney
• Liver
• Lung Lobe
CATEGORY
DESCRIPTION
1
Dead on arrival at hospital
2
4
Resuscitation attempt unsuccessful
Awaiting Cardiac Arrest after withdrawal of support. (Most common DCD)
Cardiac Arrest while Brain Dead
5
Cardiac Arrest and unsuccessful resuscitation at hospital.
3
Uncontrolled
• Category 1,2,5 are included.
• Warm ischemic time is longer.
• Less predictable.
Controlled
• Category 3,4 are included.
• Death results from planned withdrawal of
Cardiorespiratory support.
• Most DCD donors are Controlled Donors
Used for Kidney and Liver transplant.
Kidney Transplant
• Donor >60 years
• Donor with age 50-59 years with at
least two of the following:
 CVA (Cerebro Vascular Accident)
as a cause of death
 Preexisting Hypertension.
 Terminal Serum creatinine
>1.5mg/dL.
Liver Transplant
• Mild to moderate steatosis.
• Hep C +ve
• Hep B Core Antibody +ve.
Acetaminophen
Non- Acetaminophen
• pH <7.3 (irrespective of grade of encephalopathy) or • PT >100 s (INR >6.5) (irrespective of grade of
all 3 of the following:
encephalopathy) or any 3 of the following:
 Grade 3/4 encephalopathy
 Age <10 or >40 years
 PT >100 s (INR >6.5)
 Etiology: (Non A, Non B Hepatitis, Halothane,
 Sr. Creatinine >300 micromole/L (3.4 mg/dL)
Idiosyncratic Drug reactions, Wilson's Disease)
 Period of Jaundice to encephalopathy >7 Days
 PT >50 (INR >3.5)
 Sr. Bilirubin >300 micromole/L (17.5 mg/dL)
Absolute Contraindication
Relative Contraindication
•
•
•
•
•
•
•
•
• Active chronic infection (Eg: TB, Hep B and C,
parasite)
• Obesity
• Psychiatric disorders (Patient with psychiatric
disorder should be fully evaluated by a
Psychiatrist to establish that the donor
understands and agrees to the procedure).
Age <18 years.
Uncontrolled hypertension.
Diabetes Mellitus.
Proteinuria (>300mg/ day)
Abnormal GFR for age.
Microscopic Hematuria
High risk thromboembolism.
medically significant illness (Chronic Lung
Disease, Heart Disease, recent Malignant tumor
• H/o Bilateral Kidney stones.
• HIV+ve
1)
2)
3)
4)
5)
6)
Un receptivity and unresponsively.
No movements
Apnea 3minties without support.
Absence of elicit able reflex
Isoelectric EEG (Confirmatory value)
Fixed dilated pupil.
• No spontaneous movement
• No spontaneous respiration when tested for period of 4 minutes.
• Absence of brain stem reflexes.
Fixed and dilated pupil
Absent corneal reflex
Absent ciliospinal
Absent dolls eye
Absent gag
Absent vestibular reflex to caloric stimulation
Absent tonic neck reflex
• All above absent after 12 hours.
ORGAN
OPTIMAL STORAGE TIME
(in hours)
SAFE MAXIMUN
STORAGE TIME (in hours)
Kidney
<18
36
Liver
<12
18
Pancreas
<10
18
Small Intestine
<4
6
Heart
<3
6
Lungs
<3
8
All the Organs are stored in University of Wisconsin Solution
• Has cationic composition
• Potassium has higher concentration than Sodium.
• Mimics ICF to minimize Diffusion down electrochemical gradient.
Composition of UW Solution:
• Lactobionate and Rafinose : Minimizes cell swelling.
• HES (Hydroxyl ethyl Starch): Prevention of extracellular space expansion.
• Glutathion: Antioxidant.
• Allopurinol: Free Radical scavenger.
• Adenosine: Precursor of energy metabolism.
• Some people, in dire financial distress, maybe willing to sell one of their kidneys. The
buying and selling of kidneys or any such organ is called ‘Transplant Commercialism’,
and it is illegal almost all over the world.
• Travel for transplantation when it involves organ trafficking or transplant
commercialism or if the resources (organs, professionals and transplant centers)
devoted to providing transplant to patients from outside a country undermine the
country’s ability to provide transplant services to its own population.
Guided By- Dr. Avishek Kumar