Deceased donor kidney transplantation (cadaver donor transplantation) is transplantation in which the source of an organ(s) is heart beating cadaver (brain dead person) getting treatment in a hospital approved by the Government for organ harvesting.
Deceased donor transplantation (cadaver donor transplantation) is transplantation in which the source of an organ(s) is heart beating cadaver (brain dead person) getting treatment in a hospital approved by the Government for organ harvesting.
Death is defined as cessation of heart activity. Brain death is complete and permanent cessation of brain activity despite the presence of heart beat; with mechanical and medical support, the lungs and heart can be made to continue function and circulation to various organs can be sustained.
A panel of four doctors that includes a neurologist and the Medical Superintendent of the hospital carry out a series of standard tests that are accepted medically and ethically all over the world to confirm that a patient is “brain dead”.
For deceased donor transplantation, you should complete the recipient evaluation first. Then you will have to fill up a registration form, get it signed by your consultant and submit it to Zonal Coordination Committee of Karnataka for transplantation (ZCCK) office at National Institute of Mental Health And Neurosciences, Bangalore. The enrollment is complete with the payment of registration fee.
Apart from psychological evaluation, the recipient should undergo evaluation for a) the cause of the kidney disease if it is possible, b) lower urinary tract to rule out abnormal urinary outflow, c) blood-borne viruses and d) cardiac disease including coronary angiogram especially in patients who have diabetes mellitus and prior heart disease. Some of these issues will have an impact on the timing of transplantation and post-transplantation complications and it is better they are taken care of before transplantation.
Approximately two weeks.
ZCCK is a non-profit medical service working with centers recognized by the Government for cadaver donor transplantation and co-ordination for the same. It registers and maintains a list of eligible potential recipients (please be aware that demand always exceeds supply and it may be even years before you get a call for transplantation from ZCCK).
On receiving information about potential donors, ZCCK will assess brain dead person for suitability for organ donation. If suitable, a team of surgeons will perform the removal of organs from the donor. ZCCK will short list the potential recipients depending on the blood group, the grounds of need, wait list and if necessary, by tissue characteristics and inform the consultant taking care of the short listed recipients for further action.
Once the brain dead person’s family has given consent for organ donation, the organ donor will be maintained on a ventilator and stabilized with fluids and medications until organs are harvested. Numerous laboratory tests will be conducted to make sure that there is no chronic illness that involves the organs to be harvested; patients with age above 70 years, severe hypertension, advanced cancer, and blood-borne viral and bacterial infection will not be considered for organ harvesting. Cessation of the heartbeat is likely to happen within two to three days in brain dead individuals and organs will be harvested within 24 hours of diagnosis. Because of these measures, we can hope that the harvested organs will have a good function after transplantation.
What will the consultant do once he is intimated of the selection of his patient for deceased donor transplantation ?
The consultant will get the patient’s consent for the procedure. The patient will be called to the hospital and basic tests and clinical examination will be done to make sure that he/she does not have current/active infection. An extra session of dialysis will be arranged if there is a need and immunosuppression will be started. The patient will then be sent for tissue cross match to make sure that there are no preformed factors in the recipient’s blood that can damage the graft. The report of the cross match will be available 8 to 10 hours later.
The harvested organs will be perfused and kept in cold storage under ZCCK’s custody until the tissue cross match report is ready. They will then be transported to the center wherefrom the chosen recipient had registered with ZCCK.
It does not mean that you will be allotted the organ if you are called for cross match; several patients sharing the same blood group will be called simultaneously for the two kidneys. You will undergo transplantation only if you are among the first two who had tested negative on cross match.
The recipient will undergo central vein catheter insertion (to monitor central venous pressure), urinary catheter insertion (to monitor urine output) and catheter insertion into the back (for injecting pain relieving agents) prior to surgery in the Operating Room (OR) before transplantation. Space will be created in the abdomen of the recipient in the area above the thigh to keep the new kidney. The kidney from the cadaver will be connected to the recipient blood vessels.
In almost all patients (95%), the transplanted kidney (graft) will start its function over a period of two to three weeks. The improvement in graft function will be evidenced by brisk urine output and progressive decline in serum creatinine. Improvement in graft function does not mean that everything will be all right thereafter. Kidney function may decline any time and that is why, constant and regular monitoring of kidney function using blood and urine tests is needed.
The cause for defective graft function will be analyzed by blood, urine and ultrasound tests and appropriate corrective action will be taken to improve graft function. In that process, additional procedures like graft exploration in OR and graft biopsy may be required and you may continue to require dialysis till there is improvement in graft function.
There is a possibility that the graft may not function at all (because of complications in the blood vessels or severe rejection) and you will have to continue dialysis till you undergo transplantation again. Such grafts may require removal in OR to avoid serious life threatening complications like rupture of blood vessels or the graft itself.
The diseased kidneys will be removed only if they are seriously infected or the cause of severe hypertension or massive bleeding.
Living donor transplantation is well planned whereas the deceased donor transplantation may happen anytime; mostly the waiting time for deceased donor transplantation will be years. Graft function is most often immediate in living donor transplantation whereas in deceased donor transplantation, it will be weeks before the graft functions adequately. Therefore the requirement for dialysis will be longer in patients waiting for deceased donor transplantation. As tissue match is likely to be less, the graft survival is likely to be less with cadaver donor transplantation and more powerful immunosuppression (with the associated risks of infection) at higher cost (not less than INR 1.5 lakh at the time of transplantation and INR 10000 every month) will be required to minimize the risk of rejection.