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| Domino Kidney Transplantation |
Organ
transplantation means changing an organ from one body to another
for the purpose of replacing the recipient's damaged or absent organ.
Organs that can be
transplanted are the heart, kidneys, liver, lungs, pancreas, intestine and
thymus. Tissues include bones, tendons (both referred to as musculoskeletal
grafts), cornea, skin, heart valves, and veins.
Worldwide, the kidneys are the
most commonly transplanted organs, followed closely by the liver and then the
heart. Organ transplantation may be living
or brain dead.
Domino kidney transplant can be
done When a patient requires or requests a nephrectomy for therapeutic reasons,
they may choose to donate that kidney to a patient awaiting a transplant.
Domino donation is uncommon and equity of access to
such kidneys is unlikely to be affected by local rather than national
allocation.
Domino donation carries a potentially higher risk of
uncertainty about the viability of the retrieved kidney for transplantation in
comparison with other living donor kidney scenarios the retrieval surgery may
be complicated by the patient's underlying condition.
Legal issues are involved in organ donation cases whenever
the organ donor and recipient are not related. Since the transplant was to be
conducted in Mumbai — at Hinduja Hospital, Bombay Hospital and Hiranandani
Hospital — and since four of the five donor-recipient pairs are from
Maharashtra, permission of the State Authorisation Committee was necessary and
has been obtained. This permission for the four donor-recipients has been
assured and will be granted formally next week.
Dr Billa, who is also
a member of Apex Swap Transplant Registry (ATSRA), said that the first domino
chain that the team tried to put together failed when one of the patients died
in November 2011. "We had worked hard to prepare the chain but our efforts
were brought to naught when one patient died. This is the second domino chain
we worked on, and it has turned out a success," said Dr Billa, adding that
such swap transplants are a life-saver for patients with incompatible donors.
In fact, ASTRA has created a database of such patients who have family members
willing to donate kidneys but cannot go ahead due to incompatible blood groups.