NEW DELHI: Can organs, say a kidney or the liver, retrieved from a deceased donor with a history of diabetes or hypertension be used for transplantation?
In a first of its kind factual assessment and report, the Indian Society for Organ Transplantation (ISOT) has said the benefits far outweigh the risks involved and, therefore, such donations should be considered subject to the viability of the organ.
According to the ISOT, while Indian data are lacking, international registries report hypertension in 15-20% and diabetes in 2-8% deceased donors. “Evidence from the US Renal Data System (USRDS) and the United Network of Organ Sharing (UNOS) databases suggests minimally increased risk of primary non-function, acute rejection, or delayed graft function (DGF) and marginally lower graft survival from such donors, particularly in kidney transplantation,” the ISOT statement published in the Lancet Regional – South-east Asia says. It has been co-authored by doctors from 32 top medical institutions in the country, including AIIMS Delhi, Safdarjung hospital, Kokilabnen Dhirubhai Ambani hospital Mumbai, Max Saket and Madras Medical College Chennai among others.
Over time, diabetes that isn't well controlled can damage blood vessels in the kidneys that filter waste from the blood. This can lead to kidney damage and cause high blood pressure. High blood pressure can cause more kidney damage by raising the pressure in the filtering system of the kidneys, according to the Mayo Clinic.
Dr Dinesh Khullar, a leading nephrologist and co-author of the ISOT statement, said they have suggested a screening criterion to decide whether kidneys donated from a diabetic deceased donor can be considered or not. “Outright rejection is wrong. In my view, doctors should carry out individualized risk assessment of the donor organ and recipient profile to reach a conclusion,” he said.
Dr Shiv Sarin, director of the Institute of Liver and Biliary Sciences (ILBS) also said that organs from deceased donors with a history of diabetes, hypertension or for that matter cancer can be used on a case-to-case basis. “A liver biopsy should be done to see the extent of fibrosis and fat in liver from a diabetic donor, as one-third may be unfit. Similar caution for hypertensive donors for kidney donation needed. Organ from a donor cured of cancer for more than two years, should be acceptable,” Dr Sarin said.
More than two lakh Indians require transplantation annually. Not even 10% get it. This is because organs donated from deceased donors are scarce. That’s why, earlier, preference was accorded to younger patients – those below 65 years of age – for receiving the organs.
Recently, the govt did away with the age bar. Doctors say the demand for organs has, therefore, gone up further.
A living person can donate only for immediate blood relations (brother, sister, parents and children). He or she can donate kidney (as one kidney is capable of maintaining the body functions), a portion of pancreas (as half of the pancreas is adequate for sustaining pancreatic functions) and part of the liver (as the few segments that are donated will regenerate after a period. A brain-dead person, on the other hand, can donate more than 20 organs and tissues including the heart, lungs, liver, kidney, intestines, pancreas, eyes, heart valves, skin, bone marrow, connective tissue, middle ear and blood vessels.
In a first of its kind factual assessment and report, the Indian Society for Organ Transplantation (ISOT) has said the benefits far outweigh the risks involved and, therefore, such donations should be considered subject to the viability of the organ.
According to the ISOT, while Indian data are lacking, international registries report hypertension in 15-20% and diabetes in 2-8% deceased donors. “Evidence from the US Renal Data System (USRDS) and the United Network of Organ Sharing (UNOS) databases suggests minimally increased risk of primary non-function, acute rejection, or delayed graft function (DGF) and marginally lower graft survival from such donors, particularly in kidney transplantation,” the ISOT statement published in the Lancet Regional – South-east Asia says. It has been co-authored by doctors from 32 top medical institutions in the country, including AIIMS Delhi, Safdarjung hospital, Kokilabnen Dhirubhai Ambani hospital Mumbai, Max Saket and Madras Medical College Chennai among others.
Over time, diabetes that isn't well controlled can damage blood vessels in the kidneys that filter waste from the blood. This can lead to kidney damage and cause high blood pressure. High blood pressure can cause more kidney damage by raising the pressure in the filtering system of the kidneys, according to the Mayo Clinic.
Dr Dinesh Khullar, a leading nephrologist and co-author of the ISOT statement, said they have suggested a screening criterion to decide whether kidneys donated from a diabetic deceased donor can be considered or not. “Outright rejection is wrong. In my view, doctors should carry out individualized risk assessment of the donor organ and recipient profile to reach a conclusion,” he said.
Dr Shiv Sarin, director of the Institute of Liver and Biliary Sciences (ILBS) also said that organs from deceased donors with a history of diabetes, hypertension or for that matter cancer can be used on a case-to-case basis. “A liver biopsy should be done to see the extent of fibrosis and fat in liver from a diabetic donor, as one-third may be unfit. Similar caution for hypertensive donors for kidney donation needed. Organ from a donor cured of cancer for more than two years, should be acceptable,” Dr Sarin said.
More than two lakh Indians require transplantation annually. Not even 10% get it. This is because organs donated from deceased donors are scarce. That’s why, earlier, preference was accorded to younger patients – those below 65 years of age – for receiving the organs.
Recently, the govt did away with the age bar. Doctors say the demand for organs has, therefore, gone up further.
A living person can donate only for immediate blood relations (brother, sister, parents and children). He or she can donate kidney (as one kidney is capable of maintaining the body functions), a portion of pancreas (as half of the pancreas is adequate for sustaining pancreatic functions) and part of the liver (as the few segments that are donated will regenerate after a period. A brain-dead person, on the other hand, can donate more than 20 organs and tissues including the heart, lungs, liver, kidney, intestines, pancreas, eyes, heart valves, skin, bone marrow, connective tissue, middle ear and blood vessels.
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