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In a rare case in Mumbai last month, the organs of a 59-year-old brain-dead patient, who were removed and transplanted, failed in all three receivers. One of them, aged 32, treated for renal failure, died within 48 hours, while the recipient of the other kidney, aged 60, died in the 15 days. The recipient of the liver, a 73-year-old woman, had to undergo a second transplant shortly after.
The strange and unexpected result has raised a series of questions for the medical fraternity, which is currently conducting a clinical investigation. The case also highlights the lack of outcome records in India that can help understand the quality of life after transplant and the death rate.
Rare example
"These cases are an unusual phenomenon. But they occur and are reported around the world, "says Dr. Avinash Supe, head of the technical committee appointed by the Zonal Transplant Coordination Center (ZTCC) in Mumbai, to investigate the case. "We analyze if something is wrong in the [transplantation] process or there was an immunological problem that went unnoticed. In preliminary investigations, we found that the recovery and grafting was done carefully, with all protocols in place, "says Dr. Supe. "To validate our findings, we call on nearly 12 experts from India, the United Kingdom and the United States."
Hyperactive rejections of organ transplants would occur in the minutes or hours following transplantation of the donor organ into the recipient. But the doctors refrain from qualifying the Mumbai case with hyperacute rejection. "Usually, hyperacute rejection occurs when the recipient is sensitized to donor antigens [molecules capable of producing antibodies in the host]. But this is very unlikely to happen among the three beneficiaries, "said Dr. Bharat Shah, a Mumbai-based nephrologist and ZTCC general secretary. "It's one of the rarest cases."
Joint disease and disseminated intravascular coagulation (IVC) were observed in all three recipients after transplantation, resulting in blood clots throughout the body. Doctors say that when a kidney is rejected, it turns blue and does not produce urine. However, in both cases, the kidney produced urine before the onset of complications.
Dr. Sunil Shroff, of the Multiple Organ Donation Support Network Foundation (MOHAN), said the rare cases of failures should in no way affect the transplantation program of # 39; organs. "There are still some factors in the donor, something inherent, that may not be discovered," he says, citing a case in the United States where all recipients have developed hydrophobia and died rabies after receiving an organ from the same donor. In 2009, in Mumbai, a 33-year-old man died of Guillain-Barré Syndrome (GBS), the same autoimmune disorder at the death of a 17-year-old kidney donor whose brain died.
What data show
In 2017, nearly 800 organ donations from corpses were made in India. Nearly two lakh people need kidneys, but only 8,000 manage to get one. Similarly, more than 85,000 people need a liver, but only about 2,500 manage to get a transplant. The country also records a high number of live organ donations compared to donations from deceased organs. With the creation of the National Organization for Organ and Tissue Transplantation (NOTTO) and the Regional Organ and Tissue Transplant Agency (ROTTO), there may be an incentive to provide survival data to the registers. "The records of results should have been there now. Let's hope the government makes it a requirement, "said Dr. Shroff. "If we start now, we will have reliable data in the next five years." In the West, organ transplants are highly regulated because hospital performance is analyzed and licenses renewed based on these data.
"It is ideal to keep track of the success rates and complications of the post-transplant survival rate. However, this requires resources, "says Dr. Suresh Rao K.G., responsible for critical cardiac care and cardiac anesthesia at Fortis Malar Hospital in Chennai. The hospital maintains useful survival data for various scientific meetings.
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