Doctors of Pushpawati Singhania Hospital and Research Institute recently found themselves in a state of flux when three couples turned up to them for kidney transplant. The women requested doctors to transplant their kidneys to their husbands. The doctors, however, had a tough time convincing the women that they won’t be able to do so as their kidneys were unsuitable for their respective husbands. Tests proved them incompatible for the transplants as blood groups of wives were not matching their husbands.
The doctors explained the situation to the couples and suggested them to cross-donate their kidneys to other three men. Once the couples gave consent, the transplants were carried out giving new lease of life to the men. As per doctors, incompatible donor transplant costs more than double than in the case of compatible donors.
The families were unable to afford the high cost. Moreover, it doesn’t provide security of a long life to the recipient. Conducting three concurrent transplant operations wasn’t an easy proposition. Dr Sajiv Saxena, Chairman, PSRI Institute of Renal Sciences, said “A major limiting factor in conducting kidney transplants in India is lack of adequate donor pool, the kidney swap programme not only makes more kidneys available, but also makes them available earlier than otherwise.”
Dr P P Singh, Director and head of kidney transplant surgery at PSRI, said five operation theaters were reserved for the marathon surgeries, which involved retrieving the kidneys from the donors and transplanting them into the three recipients.
A challenging task
· All three transplants had to be carried out on the same day
· 5 operation theatres were run simultaneously for the purpose
· 7 surgeons, six anesthetists, 18 staff nurses and 20 OT technicians worked for 15 hours, from 7 am to 10 pm to complete the task
· Extra care was taken to ensure error-free surgery and outcome
. All three surgeries were successful
The hospital carried out the three transplants on 8 July, 2018. A team of Nephrologist headed by Dr Sanjiv Saxena and a another team of surgeon headed by Dr P P Singh, six anesthetists, 18 staff nurses and 20 OT technicians started the procedure around 7 am and wrapped up the operation around 10 pm.
One of the donors said that her husband was diagnosed with kidney failure in March. “We approached everyone. From the Chief Minister to PMO for financial assistance because my kidney was not compatible with my husband, eventually on doctor’s suggestion we swapped organs with another couple.” The second recipient said that he learnt about his falling kidney when he sought a medical certification to avail a work visa for Dubai. He couldn’t go through an incompatible transplant because his blood showed a high level of antibodies. I would have died if this transplant hadn’t taken place on time.
The third recipient was a government employee in Bihar. He had tried his luck to get a cadaver donor or a live donor but the exercise proved futile. “The hospital then told me to find my own match,” he said.
PSRI doctors claimed to keep a record of all potential donors (Swap transplant Registry) and turn down for incompatibility. If they come across a case where swapping is possible, they advise the two groups accordingly.
Dr Singh said that in a country like India, the expense involved in the antibody removal protocol in case of incompatible kidney transplants is very high. It involves risk of infections. “Transplant centers should work towards a national kidney paired donation programme and frame a uniformly acceptable allocation policy to expand donor pools.”