GOVERNMENT - CKD SCHEMES

The Kidney Transplant, Indian Law and Medical Management

Kidney Transplant

India’s response to kidney failure has been largely through living donor transplants.

Living Donor Transplants:

Normally a family member or a friend offers to donate a kidney to save their loved one. The donors who get approved belong to these categories:

a. near relatives - spouse, parents, children, siblings, grandparents, grandchildren

b. other than near relatives - requires additional verification about their intent to donate.

Donor must be an adult with sound mind, willing to donate voluntarily, without expectation of any financial gain in cash or kind.

Refer to the THOTA Law to know your rights as a patient.

https://notto.mohfw.gov.in/act-end-rules-of-thoa.htm

If a person does not have a suitable donor, there’s an opportunity to get a Cadaver Transplant.

Cadaver Transplant:

With the help of the doctor, hospital, social worker a person can get listed for a kidney transplant after starting dialysis.

Tests Required to be Added to the Cadaveric Transplant Waiting List:

You will be asked to undergo a comprehensive medical evaluation at your transplant hospital to confirm your diagnosis, assess fitness for surgery, and ensure that a transplant is safe and beneficial for you.

Typical tests include:

• Blood tests: Blood group typing, complete blood count, liver and kidney function, electrolytes, coagulation profile.

• Infection screening: HIV, Hepatitis B & C, Tuberculosis, and other transmissible diseases.

• Tissue typing: HLA (Human Leukocyte Antigen) typing and cross-matching to improve compatibility.

• Imaging tests: Ultrasound, X-ray, CT or MRI scans to assess organ condition and overall health.

• Cardiac evaluation: ECG, echocardiography, or stress tests to check heart fitness for surgery.

• GFR, dialysis records.

In addition, a psychosocial assessment and financial counseling are usually done, since transplant requires long-term medicines and follow-up.

Once all reports are complete and reviewed, the hospital uploads your details into the state waiting list.

Determining the Compatibility of a Cadaveric Organ:

When a deceased donor organ is available, doctors check:

• Blood group match (ABO): Your blood type must be compatible with the donor’s.

• Tissue match (HLA typing): Shows how closely your immune system matches with the donor’s.

• Crossmatch test: Ensures you don’t have antibodies that would attack the donor organ.

If the organ is considered safe and suitable it will be offered to you.

When a cadaveric organ becomes available:

The transplant team will contact you as soon as a matching organ is available, usually by phone.

Always keep your phone nearby and inform your family so you can reach the hospital immediately when called.

Cadaveric organs must be transplanted quickly, so prompt communication and response are essential. Therefore, avoid long travels, stay reachable, carry your medical records, medications, and contact information for your transplant team.

Brain Death: Understanding the Process

Introduction:

Informing a family that their loved one is brain dead is one of the most difficult and emotional tasks for healthcare professionals. It can be confusing for families because the ventilator keeps the heart beating even though the person will never regain consciousness or breathe independently.

During this time, families need to make important decisions about continuing ventilator support and the possibility of organ or tissue donation. It is important for them to understand that the individual is brain dead, and removing the ventilator does not cause death.

What Is Brain Death

In India, brain death is defined under the Transplantation of Human Organs and Tissues Act (1994) as the “stage at which all functions of the brainstem have permanently and irreversibly ceased”.

The brainstem connects the brain to the spinal cord and controls vital activities such as breathing, heart rate, and blood pressure.

Common causes for brain death include severe head injuries, stroke, cardiac arrest leading to lack of oxygen to the brain, infections, hemorrhage, or drug overdose.

Once brain death occurs, although machines can keep the heart beating for a short time, there is no chance of recovery due to the permanent loss of vital functions, and the person is considered clinically and legally dead.

Who Declares Brain Death:

A set of 4 doctors from the hospital’s empanelled Committee are authorized to declare brain death after performing certain tests.

The panel includes:

• the doctor in charge of the hospital

• a doctor nominated from a panel by the appropriate authority

• a neurologist or neurosurgeon

• the treating doctor

The tests are to be repeated after a minimum interval of six hours to be certain that brain death has occurred. If brain death is confirmed after both these tests, the family is informed.

The ventilator continues to keep blood circulating through artificial respiration, which can help preserve the person’s organs if the family wishes to consider organ donation.

Counsellors guide the family and coordinate with authorities based on the information shared by the family.

Call MOHAN Foundation’s 24x7 Helpline: 1800 103 7100, or government agencies such as NOTTO / ROTTO / SOTTO and other NGOs working in this field within 1–2 hours of death.

The hospital informs the state level nodal agency (ZZTCC, SOTTO, etc. based on the state).

Allocation of organ is done by the nodal agency that maintains a waiting list of patients waiting to receive organs.

Allocation is done as per the law, based on blood/tissue match, medical urgency and wait list priority.

Become an Organ Donor:

Sign up for a donor card with NOTTO or MOHAN FOUNDATION and indicate the organs that you wish to donate.