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Organ Transplantation
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Organ Transplatation

Organ Transplantation

Organ Transplantation is a medical procedure in which a failing or damaged organ is removed from patient’s body and replaced with a functioning one. The donated organ may be from a living donor or a deceased donor. In rare cases animal organ or artificial organ is also used.

Organs that have been successfully transplanted include the heart, kidneys, brain, lungs, pancreas, intestine, and thymus. Organ transplantation is often the only treatment for end stage organ failure, such as kidney failure, liver and heart failure.

Organ transplantation is often lifesaving and gives the recipient a wonderful new lease of life. It is also a major surgery that carries potential risks, such as the chances of organ rejection. That is why one needs to gather as much information as possible on organ transplants, before deciding to go for it.

Organ Transplantation in India

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Types of Organ Transplantations

Different types of transplantations are listed below:

Kidney transplantation is a surgical procedure that’s done to treat kidney failure. The kidneys filter waste from the blood and remove it from the body through urine. They also help maintain body’s fluid and electrolyte balance.

If kidneys stop working, waste builds up in body and result in various issues.
People whose kidneys have failed usually undergo dialysis, which mechanically filters waste that builds up in the bloodstream when the kidneys stop working.

In this procedure, one or both kidneys are replaced with donor kidneys from a live or deceased person. It is one of the most common types of transplants that take place.

In Liver transplant patient’s diseased liver is replaced with a healthy liver graft from a donor. Donor liver graft can be obtained from deceased donors, or a family member may choose to donate a portion of his liver to the patient.

In heart transplantation a healthy heart from a donor who has suffered brain death is used to replace a patient’s damaged or diseased heart.

Due to the complexity of this procedure, strict medical criteria is imposed in assessing whether a donor’s heart is suitable for transplant, and whether a potential recipient is suitable to receive the transplant.

In Lung Transplantation One lung or both lungs from a recently deceased donor are used to replace a patient’s diseased lung or lungs.

This type of transplant is commonly done on type 1 diabetic patients whose pancreas doesn’t work properly.

In Cornea Transplant damaged or cloudy cornea can be replaced surgically with a healthy, normal cornea, donated by another individual. It helps restoring vision to those blinded by corneal disease.

Laws and Rules Governing Organ Transplantation

Transplantation of Human Organs Act (THO) passed in 1994, is the primary legislation related to organ donation and transplantation in India. This Act is aimed at regulation of removal, storage and transplantation of human organs for therapeutic purposes and to prevent commercial dealings in human organs.

The amendment to the Act was passed by the parliament in 2011, and the rules were notified in 2014.

The essence of this legislation are :

  • To accept brain death also as a definition of death
  • To stop commercial dealing in organs
  • To define the first relative (father, mother, brother, sister, son, daughter and wife) who could donate organs without permission from the government

The main provisions of the Act (including the amendments and rules of 2014) are as follows:

  • Brain death is identified as a form of death
  • Allows transplantation of human organs and tissues from living donors and cadavers (after cardiac or brain death)
  • Regulatory and advisory bodies for monitoring transplantation activity and their constitution defined.
  • Living donors are classified as either a near relative or a non-related donor.
  • Swap Transplantation : When a near relative living donor is medically incompatible with the recipient, the pair is permitted to do a swap transplant with another related unmatched donor/recipient pair.
  • Authorization for organ donation after brain death
  • Organ retrieval permitted from any hospital with ICU facility once registered with the appropriate authority. Any hospital having Intensive Care Unit (ICU) facilities along with manpower, infrastructure and equipment as required to diagnose and maintain the brain-stem dead person and to retrieve and transport organs and tissues including the facility for their temporary storage, can register as a retrieval center.
  • Cost of donor management, retrieval, transportation and preservation is to be borne by the recipient, institution, government, NGO or society, and not by the donor family.
  • Procedure for organ donation in medico-legal cases is defined to avoid jeopardizing determination of the cause of death and delay in retrieval of organs.
  • Manpower and Facilities required for registration of a hospital as a transplant center are outlined.
  • Infrastructure, equipment requirements and guidelines and standard operating procedures for tissue banks are outlined.
  • Qualifications of transplant surgeons, cornea and tissue retrieval technicians are defined.
  • Appointment of transplant coordinators (with defined qualifications) made mandatory in all transplant centers.
  • Non-governmental organizations, registered societies and trusts working in the field of organ or tissue removal, storage or transplantation will require registration.
  • The central government to establish a National Human Organs and Tissues Removal and Storage Network i.e. NOTTO (National Organ & Tissue Transplant Organisation), ROTTO (Regional Organ & Tissue Transplant Organisation) and SOTTO (State Organ &Tissue Transplant Organisation). Manner of establishing National or Regional or State Human Organs and Tissues Removal and Storage Networks and their functions are clearly stated.
  • The central government shall maintain a registry of the donors and recipients of human organs and tissues.
  • Penalties for removal of organ without authority, making or receiving payment for supplying human organs or contravening any other provisions of the Act have been made very stringent in order to serve as a deterrent for such activities.
step by step process

Step-wise Process for Undergoing Organ Transplantation

  • Review of reports and case analysis by Transplant Team on the basis of available medical reports.
  • Recipient (Patient) and Donor undergo pre-transplant work up.
  • Donor compatibility assessed by the transplant team based on HLA testing. The No-Objection Certificate issued to the patient by the High Commission of the native country in India is submitted at the hospital.
  • Case forwarded to the transplant committee for approval. Patient submits all necessary documents to the transplant committee for approval of transplant
  • Committee approval (May take 2-4 weeks after submission of all the necessary documents)
  • Patient undergoes transplant after Transplant Committee’s approval

Estimate Cost for different types of Organ Transplantations

Sr.No. Name of Procedure Cost in India (USD)
1 Kidney Transplantation 14000 – 15000
2 Liver Transplantation 35000 – 37000
3 Heart Transplantation 65000 – 70000
4 Lung Transplantation 57000 – 60000

Frequently Asked Questions and patient concerns

1. How are organs from deceased donors distributed?

Generally, donated organs are matched with individuals on an organ waiting list. Matching is based on a variety of factors including blood and tissue types, medical need, length of time on the waiting list and weight of donor and recipient.

2. How long does the donor remain hospitalized?

After their surgery, the donor will typically remain in the hospital for four to seven days.

3. How long before the liver donor is fully recovered?

On average, most donors are fully recovered after three to six weeks. However, every donor’s recovery time is different.

4. Does becoming an organ donor mean that I won’t be eligible to receive the best medical care possible?

Your decision to donate an organ has no effect on the quality of medical care you can receive.

5. How long before the living donor recipient is fully recovered?

On average, most recipients are fully recovered after 3 to 6 months. However, this will depend on the severity of their condition, their age, and their general health.

6. What kind of lifestyle changes do you need to make after organ donation?

The only other lifestyle change we encourage is for transplant patients not to be involved in contact sports. We recommend that you stay active, avoid smoking and alcohol, and stick to a healthy diet.

7. Who can be the donor for transplantation?

There are two sources: cadaveric and living donors.

Cadaveric donors are individuals whose organs have been made available after brain death. As few cadaveric donations take place in India, living related liver transplantation is the only feasible option in our country. For living related transplants, a relative (usually parents) with a compatible blood type donates a portion of their liver to the child. Fortunately, the liver of the donor is able to grow back to full size in 812 weeks.

Living liver donors should be healthy adults, with a near normal body mass index (not obese) who have the ability to understand the procedure. The donor should have no medical, emotional, or psychological condition that could potentially increase the risk of this surgery.

8. What are the risks of transplant surgery?

There are risks with transplant surgery just as with any major surgery. Some immediate complications can include bleeding and blood clotting problems, respiratory problems and malfunction of the donor liver. Long term complications include rejection (when the child’s immune system does not accept the new liver) and infection. Fortunately, most of these complications are treatable.

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