Deceased-Donor Organ Transplantation in India: Current Status, Challenges, and Solutions

Kute, Vivek B.; Ramesh, Vasanthi; Shroff, Sunil; Guleria, Sandeep; Prakash, Jai

doi:10.6002/ect.rlgnsymp2020.l6

Cited by 37 publications

(20 citation statements)

References 31 publications

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“…India is currently struck by COVID‐19 with the highest number of COVID‐19 cases in the world, and transplantation activity is at halt in many centers. India has a predominantly living donation program where deceased donation is in its incipient stage 1 . COVID‐19 has been shown to be associated with higher mortality in transplant patients compared to general population across the world 2–4 .…”

Section: Deceased Donor Characteristics Donormentioning

confidence: 99%

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A case report of successful kidney transplantation from a deceased donor with terminal COVID‐19‐related lung damage: Ongoing dilemma between discarding and accepting organs in COVID‐19 era!

Meshram

Kute

Patel

et al. 2021

Transplant Infectious Dis

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Section: Deceased Donor Characteristics Donormentioning

confidence: 99%

“…India has a predominantly living donation program where deceased donation is in its incipient stage. 1 COVID‐19 has been shown to be associated with higher mortality in transplant patients compared to general population across the world. 2 , 3 , 4 In the era of COVID‐19, the safety of transplantation is an area of evolving research.…”

mentioning

confidence: 99%

A case report of successful kidney transplantation from a deceased donor with terminal COVID‐19‐related lung damage: Ongoing dilemma between discarding and accepting organs in COVID‐19 era!

Meshram

Kute

Patel

et al. 2021

Transplant Infectious Dis

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“…There is a dramatic geographic variation in deceased organ donation and transplantation that is related to the state-based organization of health-care services in India. 9 The deceased donations that take place are largely due to the efforts of a few state governments, nongovernment organizations, and hospitals that are highly committed to transplantation. 10 The provision of health care in India is the responsibility of individual state governments.…”

Section: Current S Tatus Of Tr An S Pl Antati On In Ind Iamentioning

confidence: 99%

“…in the state of Tamil Nadu, a dramatic increase in deceased donation and organ transplantations was achieved by establishment of deceased donation procedures, a central waiting list, education and engagement of health professionals, and establishment of the socalled green corridors to facilitate efficient transport of organs. With these simple state government investments, Tamil Nadu had 1338 deceased donors, and performed 4712 lifesaving deceased donor transplants from 2008 to 2019 9. …”

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confidence: 99%

Bold policy changes are needed to meet the need for organ transplantation in India

Shroff

Gill

2021

American Journal of Transplantation

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In 1994 Indians with end-stage heart, lung, and liver disease were doomed to die and only a few wealthy patients with kidney failure could obtain a living donor transplant. In response to embarrassing revelations about the black market in kidney transplants and the absence of extra-renal transplantation, the Indian government passed the Transplantation of Human Organs (THO) Act. [1][2][3][4] The THO Act legalized brain death and made the sale of organs a punishable offense. However, the passage of the THO Act was not accompanied by government-funded initiatives to advance development of deceased donor programs. Unsurprisingly, transplantation in India is predominantly based on living donation. Today, India performs the highest number of living donor kidney and liver transplants in the world but only a small number of deceased donor transplants. In 2019, 88% of 9751 kidney transplants and 77% of the 2590 liver transplants performed in India were from living donors. 5 In comparison, in 2018 only 36% of kidney and 19% of liver transplants performed globally were from living donors. 6 A quarter century after the THO Act, transplantation remains inaccessible for most Indians with end organ failure. An estimated 220,000 persons die of chronic kidney disease in India annually. 7 The burden of extra-renal end organ failure is also undoubtedly large. It is estimated that between 200,000 and 300,000 persons die of liver failure annually with about 25,000 of the deaths among patients who could have been transplant candidates. 8 In this perspective we review the current status and propose national policies to advance deceased organ donor transplantation in India. As the delivery of health-care services in India is complex, this viewpoint does not directly address implementation issues which will vary between individual states in the country.

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“…More than 200,000 CKD patients need renal transplants every year. Despite India being the second largest transplanting country in the world in terms of the absolute number of RTs (~8000 of 95,000 global), there is a huge shortfall leading to the addition of more than 100,000 CKD patients to the transplant waiting list every year [ 1 ]. The deceased donor renal transplant (DDRT) to living donor renal transplant (LDRT) ratio is only 0.24 and compares unfavorably with the developed countries [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Lymphatic Complications Following Renal Transplant: A Prospective Study Involving Predominantly Living Donor Transplants From India

Agarwal¹,

Kumar²,

Rana³

et al. 2021

Cureus

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Introduction Lymphatic complications (LC) are common (up to 33%) and troublesome after renal transplantation. Different studies have established varying medical and surgical risk factors, mostly by retrospective analysis on deceased donor renal transplants (DDRTs). The end-point is mostly lymphocele, with few reports documenting the equally important lymphorrhea. Methods In our prospective analytical study done over three years, most were living donor renal transplant (LDRT) pairs by a single team. The primary outcome measure was lymphocele and/or prolonged drainage for more than 15 days, with a six-month follow-up. The variables recorded were age, gender, hemodialysis duration, etiology, relationship, human leucocyte antigen (HLA) mismatch, induction regimen, acute rejection, warm ischemia time (WIT), and delayed graft function (DGF). Univariate analysis was by chi-square and t-tests as applicable, while logistic regression (both simultaneous and forward stepwise) was used for risk factor prediction. Results Eligible cases were 150, with 145 (97%) LDRT pairs. Donors were mostly female (122/150; 81%) with mean age (~43 years) higher than recipient age (~33 years). The common etiologies were diabetes (31%), hypertension (23%), and IgA nephropathy (11%). Most donors were mothers (37%) and wives (31%), and 28% of LDRT pairs had HLA mismatch >3. Mean duration of hemodialysis was about 18 months, and mean WIT was 52 minutes. Both DGF (B coefficient= -1.69, p<0.000) and WIT (B=-0.038, p=0.024) were significant predictors of the primary outcome, while drain removal before 15 days predicted lymphocele significantly (B=-2.4, p<0.000). Conclusions LDRT has specific risk factors for lymphatic complications, which may be related to extent of recipient vascular dissection, arterial anastomotic time, and early drain removal.

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Deceased-Donor Organ Transplantation in India: Current Status, Challenges, and Solutions

Cited by 37 publications

References 31 publications

A case report of successful kidney transplantation from a deceased donor with terminal COVID‐19‐related lung damage: Ongoing dilemma between discarding and accepting organs in COVID‐19 era!

A case report of successful kidney transplantation from a deceased donor with terminal COVID‐19‐related lung damage: Ongoing dilemma between discarding and accepting organs in COVID‐19 era!

Bold policy changes are needed to meet the need for organ transplantation in India

Predictors of Lymphatic Complications Following Renal Transplant: A Prospective Study Involving Predominantly Living Donor Transplants From India

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