In a rare instance, organs donated by a 59-year-old brain dead patient last week witnessed multiple rejections with a recipient in PD Hinduja hospital in Mumbai dying and another placed on ventilator support in Jaslok Hospital following kidney transplant. A senior citizen who received the liver of the donor in Global Hospitals had to undergo a second transplant after the first one failed.
Officials from the Zonal Transplant Coordination Centre (ZTCC), which coordinates cadaver organ transplants, said a clinical investigation will be necessary to understand how and why the organs were rejected.
This was Mumbai’s 35th cadaver organ donation this year. Owing to growing awareness on organ donation, the city has recorded 37 cadaver organ donations since January. With the help of such donors, 59 kidney, 35 liver, 17 heart and three lung transplants have been conducted.
On September 4, the family of the 59-year-old man had given its consent to donate both his kidneys and liver to the P D Hinduja hospital. While the liver was donated to Global Hospitals for a senior citizen, one kidney was utilised by Hinduja hospital and another sent to Jaslok Hospital as per ZTCC waitlist guidelines.
In Jaslok Hospital, the kidney transplant was conducted on Godavari Singh (60) under nephrologist Dr M M Bahadur on September 5. A day later, the doctors removed the donated kidney from Singh as her body rejected it. The human leukocyte antigen (HLA) test, to assess compatibility of recipient with donor, had, however, shown a match.
“We do not think it could be a case of acute rejection. We are awaiting results of histopathology to understand more and decide further course of action,” a spokesperson from Jaslok Hospital said.
According to Singh’s relatives, while she was on dialysis for the last eight years, she was on a waitlist to receive a kidney for five years. In failed transplants, a recipient’s immune system poses higher chances of rejecting a new organ in the second attempt. Hospital authorities, however, said a second attempt will be successful.
Singh’s son Manvendra said, “She remains on ventilator support, her platelet count has dropped to 3,000.” A normal platelet count ranges from 1.5 lakh to 4.5 lakh. The family has approached the ZTCC for a refund of Rs 50,000 for the failed transplant, claiming that coordination charges levied on them are unnecessary as the organ was rejected by Singh’s body. The ZTCC has rejected the request.
In Hinduja hospital, meanwhile, a 31-year-old recipient, who got the second kidney from the same donor, died hours after the transplant procedure on September 5. The surgery was conducted under nephrologist Dr Jatin Kothari.
When contacted, deputy director for the hospital, Dr Suganthi Iyer, refused to comment. The hospital spokesperson said other authorities are “unavailable for comment”. Hinduja hospital is also where the organs from donor’s body were harvested.
At Global Hospitals in Parel, the liver recipient, a woman aged 73, suffered complications during the transplant procedure on September 5. Hospital officials said the donor liver did not function, following which, it had to be removed. According to a doctor, all necessary tests for liver transplant were found to be normal. “There is no evidence to suggest any infection in the donated liver,” the doctor said.
The patient was re-listed on the waiting list for urgent transplantation. On September 7, a 47-year-old man was declared brain dead in Wockhardt Hospitals and her liver was transplanted into the woman. “The patient is now stable,” a doctor from Global Hospitals said.
Provisions under the Transplantation of Human Organs and Tissues Act mandate two apnea tests must be conducted to confirm a patient is brain dead before cadaver organ donation can be processed. A Human Leukocyte Antigen test is carried to check for compatibility between donor and recipients body. Donor’s body is also clinically examined for any infection such as HIV, hepatitis or tuberculosis that may get transmitted to recipient’s body.
A state health official said that such multiple rejections from a single donor are very rare. “I am not aware of this case. The ZTCC will have to look into it,” said Dr Bharat Shah, general secretary of ZTCC, Mumbai. “The body’s immune system recognises and rejects any foreign organ. That is how our body fights against bacterial or viral infection. In organ transplant, we use immuno-suppressants to facilitate organ transplant, but that does not guarantee the transplant will be successful each time.”
Liver transplant surgeon Dr Ravi Mohanka said that during a brain stem death, donor’s organs may be affected when oxygen supply or blood pressure is reduced. “With medical developments, we have managed to reduce rejections during transplant. But there could be a disease that went undiagnosed and is transmitted to the recipient from donor, say for instance a malignant cancer,” he added.
According to experts, the hyper acute rejection in all three cases will have to be examined to evaluate what went wrong. Experts said that the removed kidney and liver may require pathological tests to assess undiagnosed infection in them. They added that due to time constraints during cadaver organ transplants, conducting all tests on donor body becomes difficult. Usually ultrasound, chest X-ray, HIV, hepatitis, liver function, kidney function and Echo are frequent tests conducted on a donor’s body, based on which organs are donated.