History was made twice in Rajasthan in February 2015. On 6 February, the first organ donation and abdominal organ recovery was performed at Mahatma Gandhi Hospital in Jaipur, resulting in the first deceased donor kidney transplant in Rajasthan and sharing of the liver with the Institute of Liver and Biliary Sciences in Delhi via a green corridor for urgent transplant of a 6 year old.
On 25 February 2015, the first abdominal organ recovery was performed at a Rajasthani Government Hospital (Sawai Man Singh--SMS--in Jaipur) resulting in two successful kidney transplants and sharing of the liver with Army R&R in Delhi for a successful liver transplant. The SMS Hospital achievement is particularly important because it demonstrates proof of principle that organ donation and transplantation can be available to all strata of Indian society.
On 23 February, a young girl was admitted to SMS after falling from a height. When impending brain death was recognized by Dr. Jitendra Hingonia in the Poly Trauma ICU, he immediately notified me and the MOHAN Foundation Jaipur Citizen's Forum (MFJCF) Transplant Facilitator. In the future, it really shouldn't happen this way (the transplant ball is supposed to get rolling only after brain death is declared), but we were the only ones who could teach them how to resuscitate the girl and maintain her in optimal condition should organ donation be considered.
We came in the middle of the night and stayed several hours. After stabilization, the SMS Brain Death Committee performed the first brain death exam and confirmatory apnea test. The girl was brain dead. The family was consoled. What brain death really means (the brain is dead, there is no longer any blood flow to the brain, she can never get better because brain death is different from coma) was compassionately explained to the family.
Bhavna Jagwani and Dilip Jain of MFJCF then joined Kamlesh Verma, the SMS Transplant Coordinator, to speak with the family about the notion of organ donation. As is usual with such sensitive and intense discussions, the decision to consent to organ donation by the entire family took several hours. But they said yes. They said "yes we consent to donating life saving organs from our deceased daughter in order to save the lives of others" even at a time of extreme emotional duress. This decision continuously impresses on me the miraculous kindness and Daan of the Indian people and donor families all over the world.
We started organizing the immunologic crossmatch testing that is imperative before proceeding with a kidney transplant (if the crossmatch test is "positive" this means that the recipient will immediately reject the new kidney, so another "crossmatch negative" patient must be identified). We had all agreed to share the organs in Rajasthan in a transparent and fair fashion using the Rajasthan Network for Organ Sharing (RNOS) web registry "waiting list". The top two blood type compatible, crossmatch negative patients would be offered the organs. This is no small task. There could be crossmatch positive results, there could be certain patients on the list who would not be ready for transplant because they were too sick or they were simply out of station, there could be people on the list who wanted to continue waiting. In order to figure this out, we needed to test at least 4-6 top candidates and get the results back as soon as possible.
Jaipur at that point did not have the capability to do such testing (despite my identifying this as a major problem back in November 2014). We turned, once again, to Dr. Vimarsh Raina from Medanta HLA Lab in Gurgaon. Dr. Raina had graciously provided his services back on 6 February for the first history-making event at MGH and he was prepared to do so again for SMS. So we waited until we could collect enough representative blood samples, then sent them up by road (5 hour drive) to Gurgaon.
The second brain death exam was performed and confirmed. We were ready to go to the Operation Theater (OT) for the recovery surgery for kidneys and liver. Army R&R Hospital in Delhi had a recipient waiting and Dr. Sanjay Sharma trusted me to perform the liver recovery on their behalf.
The organ recovery surgery proceeded flawlessly. It was as if they had all done it before. The liver was shared with Army and one life was saved. The kidneys were transplanted into recipients at SMS and two more lives were saved. We made history again.
So Rajasthan is now on the map as a green corridor player, but there remain many challenges ahead, particularly when trying to do organ transplantation in a Government Hospital setting. In my next post I will outline the issues of professional transplant training, infrastructure deficiencies and social/cultural idiosyncracies of hospital bureaucracies. All are surmountable challenges, as demonstrated by Rajasthan's incredible success.
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