Previous:Transplant Surgery & Outcomes
Cadaver donated Kidney Transplantation
Kidney Transplantation is the best form of renal replacement therapy (RRT). The minimum basic requirement for this is a compatible kidney donor. All across the world, the demand for kidney is disproportionately higher than its supply.
In India, Living Donors is the predominant source of kidneys. The other source can be from very sick patients who have been declared Brain Dead by team of doctors. These patients are the ‘cadavers’ who can donate their organs for the benefit of other patients.
What are cadavers?
As mentioned above, cadavers are patients who are admitted to ICU and are sick beyond recovery. Usually these are head injury patients or patients with Brain Hemorrhage. They have severe brain injury which will not recover. The other vital organs are functional at that time and capable of donation.
What is Brain Death?
Brain Death is a state where the brain has suffered severe damage and has no chance of a recovery. It is diagnosed by a set of tests that are done by the bedside.
Since brain controls the rest of the activities in the body, all other vital functions go down as well and the patient requires medications to keep blood pressure up in normal range and support of ventilator for respiration. Needless to say, the patient is unable to communicate, since the brain is dead.
For all practical purposes, brain death is same as death.
Who diagnoses Brain Death ?
There is a team of doctors who does this and the team includes Critical Care specialist, treating clinician, neurosurgeon and neurologist. They perform a set of tests on two separate occasions and based on the results, diagnose brain death.
Which organs can be donated ?
Kidneys, Liver, Eyes, Heart, Lungs, Intestines, Pancreas, skin and even bones can be donated !
Who gives consent for such donation ?
There are several ways of doing this.
The best situation is where the patient himself has “pledged” his organs and is carrying the ‘organ – donation’ card with him.
If the person has not pledged his organs and has no donor card, the family can come forward and inform the treating team of their wish to make such donation.
If the family is unaware of the possibility of organ donation, the social worker of the hospital makes them aware of it and inquires if they wish to donate the patients organs.
Is there a Governing Body that oversees cadaver donations ?
The Zonal Transplantation Co-ordination Committee (ZTCC) is a semi-government body with involvement of Senior Government officials, senior transplant surgeons and transplant physicians along with a team of dedicated social workers that governs the entire process of cadaver donated organ transplantation.
How does ZTCC function ?
The ZTCC maintains a list of registered wait-listed patients categorized by blood group. A potential organ donor, once identified, is informed to the ZTCC. The ZTCC then decides on the recipient based on an objective prioritization score based on several parameters.
When is the organ donation surgery done ?
As soon as the consent for organ donation is available. Since cadavers are on intense support systems, surgery should be performed before blood pressure falls too low or heart function ceases.
When is the potential recipient informed?
As soon as the consent for organ donation is available, ZTCC informs the potential recipient who undergoes basic tests and lymphocyte cross match. If the cross match is negative, he can receive the organ.
What are the differences compared to Live Donor Kidney Transplantation ?
Cadaver donated organs may have to be stored for a few hours in a special solution before they are implanted. This is the single biggest difference.
As a result, the kidney may take few hours to few days to be fully functional as opposed to the Living donor transplantation where the kidney is functional even before the surgery site is closed !
Immunosuppression is intense in cadaveric kidney transplant and therefore, opportunistic infections after transplantation are higher in incidence compared to living donor kidney transplantation.