Given the advancements in the surgical methods we have today, organ donation and transplantation are boons to those suffering from failing organs. There are several routes that have emerged for organ transplantation – from animals to humans, from dead persons to living ones, and from live donors to those having defective or malfunctioning organs.
Recently, in Chennai, doctors successfully conducted cadaveric liver transplants from two patients whose families consented to organ donation after they were declared brain-dead. Similarly, the heart of a youth who died in a Vellore hospital was transported to a hospital in Chennai for transplantation.
What organs can be transplanted?
Various parts of the body can be transplanted, ranging from the cornea and the heart to the stomach, hand and intestines, and even skin and bones. But all of these are not equally common.
In Tamil Nadu, one of the States in India known for regular transplants, the most common transplant is of the kidneys, followed by the cornea, a part of the eye. Among solid organs, the next most common are the liver, heart, and lungs. Recently, Rela Hospital, a multi-specialty hospital in Chennai carried out a successful bowel transplant. There have been a few other successful bowel transplants in other hospitals as well. Transplants of the intestine, however, are not so common. There has been only one successful intestine transplant, by the Government Stanley Medical Hospital, Chennai, recorded on the website of the Transplant Authority of Tamil Nadu (TRANSTAN).
Are all States in India equally invested in deceased-donor transplants?
No. The facilities for deceased-donor transplants only exist in some States. These include Tamil Nadu, Gujarat, Telangana, Maharashtra, Kerala, Chandigarh, Karnataka, Delhi, and Rajasthan.
When can an organ be taken from a deceased person?
The rules to be followed while harvesting organs from a dead person and transplanting them are codified by the Transplantation of Human Organs Act (1994) and its subsequent amendments.
For organ removal to be legal, the person should have been declared brain dead, and his or her brain stem should be dead. This rule exists to ensure that a person is truly and irreversibly dead before organ donation is considered.
One of the main criteria for organ donation is two certifications from doctors, with an interval of six hours, that the person is brain dead, before organs may be harvested from their body. Two of the certifying doctors must be those nominated by an appropriate authority of the government with one of them specialising in neurology. The amended act also allows neurosurgeons, intensivists, and anaesthetists to be certifying doctors for this purpose.
Another condition is that the body of the dead person should be connected to a ventilator so that the organs are well perfused, until they are removed to be preserved and used. This ensures that the tissues and organs are not damaged after the death of the person.
Legally, consent must be taken from the next of kin. But the procedure for seeking consent for the removal of organs usually involves the entire family or close relatives.
Why are there relatively few transplants taking place though there are many people in need?
It is not just a matter of awareness, according to Dr Amalorpavanathan Joseph, former member secretary of TRANSTAN and Director of Vascular Surgery at Madras Medical College.
While there is a lot of awareness and appreciation for organ donation, the facilities for harvesting organs and transplanting them are not available easily or everywhere. As mentioned earlier, there are only some States in India that have hospitals authorised to perform transplantations. Additionally, the number of hospitals available for a specific transplant may be even lower than this number.
For example, in Tamil Nadu, 133 (private and government hospitals put together) are approved to perform transplants, but only 91 hospitals across Tamil Nadu are approved for kidney transplants, according to the TRANSTAN website. For heart transplantation, the number falls even lower, to 35.
Does any organisation maintain a list of patients needing organs?
The National Organ and Tissue Transplant Organization (for Delhi and NCR) and the Regional Organ and Tissue Transplant Organizations maintain a waiting list of terminally ill patients requiring transplants. The websites may be found here.
The State-wise list of such authorities may be different – for instance, in Tamil Nadu, the lists are maintained by the Transplant Authority of Tamil Nadu (TRANSTAN). In Maharashtra, the State Organ and Tissue Transplant Organization, which has various Zonal Transplant Coordination Centers in Aurangabad, Mumbai, Nagpur, and Pune, takes care of the coordination of transplants.
Other advances in organ transplantation
Transplants from animals to humans, called xenotransplants, have shown uneven success rates. Recently, doctors in the U.S. attempted a xenotransplant using the heart of a specially reared pig, which had been genetically modified by the removal of pig genes that triggered hyperfast rejection and the addition of human genes. The pig’s heart was transplanted into that of a 57-year-old man in a Maryland hospital. Unfortunately, the patient died two months after the surgery.
According to the latest analysis of this xenotransplant by researchers, the pig had been infected by Porcine cytomegalovirus (PCMV) which wreaked havoc on the organ and the person. An earlier experiment conducted by German researchers on baboons showed that if this virus was present, pig hearts transplanted into the baboons lasted only a couple of weeks, while virus-free transplants lasted more than half a year. Since the pig used in the Maryland surgery had been specially reared for this transplant, it was surprising that it had been infected by the PCMV virus.
A promising technology for the future is to use human stem cells to make the organ needed and to use such organs to replace defective or malfunctioning ones. Bone marrow transplants have already been performed using stem cells.
