The process of transplantation
Dr Shreyash Agrawal,
Intern at VMMC & Safdarjung Hospital, New Delhi
Contrary to the popular belief and myths surrounding the world of organ donation and transplantation, the process around the world is very well regulated. It consists of various steps and protocols, and the transplantation can be done only once all the pre- requisites are fulfilled.
There are two sides of the process – The Donor and the Recipient. On the side of the donor, the cycle begins when one registers as an organ donor or even opting to donate once an irreversible brain injury has occured or when a healthy individual chooses to donate an organ to a relative or a friend. Whether a case of a road traffic accident or someone who has been fighting a long term illness, all efforts are made to save the life first irrespective of donor status. Once deemed brain dead (irreversible damage), the option to donate organs opens up.
A discussion is set up with the family of the patient and the process is explained, on agreeing to donate, a medical examination is done for the purpose of determining the viability of the organs. The system is notified about the potential organs available and according to the urgency and various other factors, they are allocated to potential recipients. Organ recovery, transportation and transplantation follow thereafter.
On the recipient end, once diagnosed with a disease or injury which can not be cured or repaired, organ transplantation may be the only option for such individuals for extending life. They are screened according to government guidelines and put on a “Waiting List”. This list places the potential recipients in the order of preference considering various factors such as increase in the life expectancy, chances of rejection etc.
Once a potential donor and recipient match according to the list, the next step is the matching of the organs. Since transplant rejection is a highly common complication ranging from on the table rejection to delayed rejection, use of various genetic modalities (ABO & HLA genes) to ensure maximum match is done. In case of a healthy donor, a good match is the primary goal.
The process of transplantation is done by expert surgeons, since time is the key in such procedures. Each organ has a specific time for which it can be kept viable once out of the body. Thus, transport as well as the procedure both need to be as quick as possible.
Complications other than rejection are rare per se and mostly of surgical nature like pain, infection, hernia, bleeding, and clots.
Post operative care is mostly done in an Intensive Care Unit. Transplant recipients are started on immunosuppressants to reduce the chances of transplant rejection from before the surgery which makes the immune system highly susceptible to any infection. Thus, close monitoring of vitals is of utmost importance in the postoperative period.
Even though rejection is the number one problem in the postoperative period, other life threatening conditions like hemodynamic instability and arrhythmias need to be kept in mind and monitored closely for the overall outcome of the procedure.
“Organ Donation is not a tragedy, but it can be a light in the midst of one.”
- NOTTO – National Organ and Tissue Transplantation Organisation