An expert committee formed to investigate how, in an extremely rare case, an organ donation in September led to multiple rejections and death of two recipients, has said “immunological factors may have contributed to the organ rejection”. The committee has recommended that the liver and two kidneys of the deceased donor be sent to the University of Birmingham for further immunohistology study.
The report, submitted on Saturday, to the Zonal Transplant Coordination Centre (ZTCC), also clarified that the organ transplant was not a case of hyper acute rejection as earlier suspected by transplant coordinators.
On September 4, a 59-year-old patient was declared brain dead at the PD Hinduja Hospital following which his family consented to donate his organs for cadaver transplant. While the liver was donated to the Global Hospital for a 73-year-old woman, one kidney was utilised by the Hinduja Hospital for a 31-year-old man and another was sent to the Jaslok Hospital for a 60-year-old woman as per ZTCC waitlist guidelines.
On September 15, The Indian Express reported about the sudden death of the 31-year-old Bhuleshwar resident on September 7 following the failed kidney transplant at the Hinduja Hospital. His family claimed he was undergoing dialysis for the last 14 years after both his kidneys failed and he was on the ZTCC waiting list.
In a rare instance, the same donor’s second kidney led to the death of the 60-year-old woman recipient in the Jaslok Hospital on September 19. According to her family, the Kandivali resident was put on ventilator support after the transplanted kidney failed. Doctors removed the kidney two days after the transplantation procedure. A fortnight later, she succumbed to multiple complications. She was on dialysis for eight years before the organ transplant procedure was initiated.
“In both kidney transplants, the human leukocyte antigen (HLA) test showed 94 and 95 per cent match between donor and recipient respectively,” said Dr Avinash Supe, who chaired the technical expert committee. He said there was no hyper acute rejection of donated kidney in recipient’s body.
The HLA test is mandatory before a kidney transplant is carried out to match compatibility between the donor and recipient’s body. While the test came as per standards, the committee said the death could have been caused by ‘Shwartzman phenomenon’, rare reaction of a body to a particular type of toxins.
In this case, the committee claimed the donor’s blood samples were not available to carry out further tests. “We are not sure if the donor’s body was infected, it does not seem so,” a member of the committee said.
Medical records of the third transplant – of donated liver – that also failed in the Global Hospital showed the blood group of the donor and recipient were compatible for transplant. The failed liver was removed from the senior citizen’s body and an urgent second transplant was conducted to save her life.
The committee report claims all standard procedures were followed for the three organ transplants. “It seems immunological factors led to coagulation,” the report observed.
The committee stated that further tests of both kidneys and liver may be required in UK’s University of Birmingham, for detailed histopathology and histology test, a facility not available in India. “We are not sure what went wrong. My mother’s platelet count dropped to 3,000 after the transplant failed and donated kidney was removed. We were hoping for a second chance at transplant but she could not make it,” said Manvendra Singh, son of the 60-year-old recipient.