Multi Organ Transplant

What is Multi Organ Transplant?

The procedure where the organ is taken from another living being in order to replace the diseased organ by the healthy organ that functions properly. The transplanted organs are those organs that cannot be treated with the help of any medical drugs or with any kind of surgeries.

The different organs that can be transplanted are kidneys, intestine, lungs, pancreas, heart and liver. The different tissue that can be both transplanted and donated are bone marrow, skin, heart, middle ear, tendons and the valves.

Which Human organs can be transplanted successfully ?

Following organs can be transplanted –

Organ Transplant Matching Process

Different factors in considering organ matching and allocation Both logistical and medical characteristics are thoroughly measured for an organ so as to distribute it to the best matched recipient candidate. The matching criterion consists of-

• The relative distance between the recipient and the donor
• The size of the organs needed and blood type
• The time spent awaiting the transplant

Factors to be considered before organ matching

• It is important to know whether the recipient is an adult or a child
• The medical urgency of the recipient
• The degree of the immune system matches between the recipient and donor

Organ Matching Process

• First step is to donate an organ
• Then the UNOS lists the potential recipients
• The third step is to notify the transplant center about an available organ
• Then the transplant team processes the organ for the recipient
• The organ is either accepted or declined

Organ Transplant Waiting List

To be on the national waiting list, the patient is required to visit at a transplant hospital. The physician will examine the patient carefully in order to determine the present condition of health and medical history and thereby deciding that the patient is convincible enough to be listed .

Organ Distribution Policy

The first step to distribute the organs locally and if there are no recipients then the organs are regionally offered and finally they are nationally distributed. The purpose is to place the organs of the donor.

Organ Donation Facts

The organ can be donated by-

• Anyone above 18 years of age can become an organ donor
• If the organ is donated after death, then a detailed medical assessment is done to decide which organ can be successfully donated.
• The conditions that can exclude the organ donation are HIV, severe infections, kidney disease, heart disease and any type of Cancer.

Organ Donors

Both living and brain dead can be organ donors. The person who received an injury either pathological or traumatic to that specific part of the brain that controls the process of breathing and heartbeat, the person is declared as brain dead. The brain dead person is suitable for organ donation.

Bone Marrow Transplant

Bone marrow is a surgical process where the destroyed or damaged bone marrow is switched with healthy bone marrow stem cells. These are basically semi-solid tissues that are found in the spongy portions of the bones and are a site for new blood cell production.

Hair Transplant

It is a surgical technique used to remove or transplant hair from one part of the body (donor site) to a bald part of the body (recipient site). Hair transplant surgery can be opted by both male and female. The donor hair can be used for scalp, eyelashes, beard, chest, and eyebrows.

Heart Transplant

A heart transplant is a surgery to replace a patient’s heart with a healthy heart. The surgery is performed on patients with severe coronary artery disease or end-stage heart failure. Heart transplant treatment is for only those who have tried other surgeries and medication but their health hasn’t recovered.

Kidney Transplant

Kidney transplant is a surgical procedure for replacing the diseased or no longer functional kidney with a healthy one. The kidneys are very vital for the proper functioning of the body as they filter and remove excess water, fluid and minerals from the blood in the form of urine. Also known as a renal transplant, it is opted by those who don’t want to spend their life on dialysis (a machine for filter waste from the blood).

Liver Transplant

The liver transplant, also known as hepatic transplant is a replacement surgery of a diseased or non-functional liver with a healthy liver of another person. The transplant is performed on patients suffering from acute liver failure or end-stage liver disease. However, in such cases, the availability of donor organs can come as a major drawback.

Kidney Transplant

What is Kidney Transplant?

Kidney Transplant or Renal Transplant is a procedure in which a person with completely failed kidneys will receive a healthy kidney from a person who has both the kidneys working in good condition. Thus, after the surgery both the men can continue to lead a healthy and normal life. The person receiving the kidney is called a “recipient” & the person donating the kidney is called a “donor”. After the transplant, the healthy kidney (the “graft”) takes over the functions of non working kidneys in the recipient.

Why do we need Kidney Transplant?

Kidney failure is most often a result of uncontrolled High Blood Pressure or High Diabetes. Untreated kidney failure can have a large impact on the person’s Heart and over all body functions.

• Diabetes mellitus
• High blood pressure
• Glomerulonephritis
• Polycystic Kidney Disease
• Severe anatomical problems of the urinary tract

The need for a Renal Transplant arises when a person’s kidneys have lost all their functions and the Kidneys function is being managed artificially by the help of Dialyzing Machines.

Kidney transplant remains the only cure for chronic kidney disease (CKD) or end-stage renal disease (ESRD).

What is the Candidature for Kidney Transplantation?

To undergo a kidney transplant, the recipient & donor both must be healthy &must NOT have:

• Infections such as TB, hepatitis or osteomyelitis
• Heart, lung, or liver disease
• Cancer

In-case either the recipient or donor has any other medical issue, then they must be treated for the same first before going for the kidney transplant.

Who is Suitable Donor for Kidney Transplant? Suitable Kidney Donors

Many people worry that by donating a kidney they will become unhealthy or be in a dangerous situation. The living donor of the kidney is left with one healthy functioning kidney, which should be more than enough for the rest of the donor’s life. The donor’s activities are not usually limited.

What are the pre-evaluation & tests for Kidney Transplant?

Thorough investigations & evaluations of both the donor and recipient are done to ensure that the donor is perfectly healthy at the time of donation and that he /she continues to remain normal after donation. The potential recipient undergoes evaluation, adequate dialysis and is brought to an optimal state to withstand the major surgery of renal transplant. The tests done include:

• Blood tests or skin tests to check for infections
• Heart tests such as an EKG, echocardiogram, or cardiac catheterization
• Tests to look for early cancer
• Tissue and blood typing to help make sure the body will not reject the donated kidney

What is the complete procedure of Kidney Transplant Surgery? (Recipient)

During the procedure, the surgeon places the new kidney in the abdomen and attaches it to the artery that supplies blood to kidneys and to the vein that carries blood away from the kidney. The kidney is also attached to the ureter, which carries urine from the kidney to the bladder.

What is the complete procedure of Kidney Transplant Surgery? (Donor)

There are 3 ways by which the doctors may take out the kidney from the donor

What is the Post-Transplant Procedure for Kidney Transplant?

Special care is taken post-surgery to minimize the risk of infection. Both the recipient & donor are closely monitored to ensure that the new organ is accepted by the body and to ensure optimum immunosuppressant medication. Post-discharge hospital stay for the recipient is usually 7-8 days &for the donor is about 5 days only.

Follow Up Care Post Kidney Transplantation:

Both the recipient & donor should take due care post-transplant & follow the medicine regime, take anti-rejection drugs as advised, have diet-lifestyle modifications & follow-up consults with the doctor as advised.

The doctors will conduct regular blood and urine tests, monitor blood pressure, temperature, and urine output. Ultrasounds may be done to see if there are any abnormalities with the transplanted kidney.

The period immediately following your transplant may be very stressful. Due care should be taken after your kidney transplantation surgery.

Liver Transplant

What is a Liver Transplant?

It is common knowledge that the liver is the largest internal organ weighing about 3 pounds and acts as a storage house by removing toxic byproducts of certain medications. Liver Transplant is an operation that replaces a diseased liver with a healthy liver or a segment of a liver from another person called the donor.

The most common technique is Orthotopic Transplantation in which the liver is removed and is replaced by the donor organ in the same anatomic location as the original liver. Liver failure can occur suddenly or as a result of complications from certain medications. Liver transplants are the most accepted treatment for end stage liver disease and acute liver failure. After a transplant, the patient will be free from the disease and lead a fairly normal life. Liver Transplants are classified as

• Deceased Donor Liver Transplant (DDLT) : The full liver is used when the donor organ comes from a brain dead but heart beating donor.
• Living Donor Liver Transplant (LDLT) : A half (or hemi) liver is used when the donor organ comes from a living donor.
• Auxiliary Transplantation : In this a part of the liver of a healthy adult donor (living or cadaver) is transplanted into the recipient. The patients’ diseased liver remains intact until the auxiliary piece regenerates and assumes function and then the diseased liver may then be removed.

Criteria for Liver Transplant

When the liver is so diseased that is not able to maintain the normal body functions, then liver transplant is required. There are various conditions that can lead to a liver failure. They are :

Tests Required Before Getting a Liver Transplant

To update previous tests, some of the diagnostic studies are performed during an evaluation. They are Doppler ultrasound to determine if the blood vessels to and from the liver are open.

• Pulmonary function studies to determine the lungs’ ability to exchange oxygen and carbon dioxide.
• Echocardiogram to help evaluate the patient’s heart.
• Computed tomography which uses X-rays and a computer to generate pictures of the liver and showing its shape and size.
• Blood tests examine blood type, biochemical status of blood, clotting ability and to gauge liver function. AIDS and Hepatitis tests are also included.

Donor for Liver Transplant

• Living-Donor : This process involves removing a segment of liver from a healthy living donor and implanting it into a recipient. Both the donor and recipient liver segments will grow to a normal size in a few weeks.
• The donor must be a blood relative or spouse. Blood type and body size are critical factors in determining an appropriate donor.

Liver Transplant Procedure

The procedure involves few steps :

• The surgery usually takes 5 to 6 hours
• Liver Transplantation is performed under a general anesthesia.
• Prior to surgery a tube is placed through the mouth of the patient into windpipe to help breathing during the operation.
• A Y-shaped incision in the abdomen is made and the diseased liver is removed. Donated liver is then inserted and attached to the major blood vessels and to the bile ducts. The incision is then closed at the end of the surgery.

Advantages of Liver Transplant :

• Provides a chance for a longer active life.
• If the transplant is performed before the recipients’s health deteriotes then they are able to tolerate the surgery and recovers more quickly.
• The recovery can sometimes become difficult but the anti – rejection makes the process easy.
• The donors will discharge in a week and recipients in 2 to 3 weeks.

Post Liver Transplant

The process involves carrying out daily life activities and recovering to the level of health. The process can be slow which includes simple activities like walking, deep breathing to ensure the lungs stay healthy to prevent pneumonia, well balanced diet and exercise to build up the muscles weakened by illness.

Guidelines for Live Donor Liver Transplantation ( LDLT )

Recipient’s evaluation:

1. Patients must carry a prescription or a letter from his physician/ gastroenterologist / hepatologist that suggests a Liver Transplant as the treatment of his liver disease. As we wish that you should stay under the care of your physician once you go back, this is important for us.
2. Once you reach your preferred hospital in India, the requirement of the liver transplant will be re-diagnosed and confirmed.
3. In case you wish to seek an opinion through e-mail about regarding the possibility of a Liver Transplant, you can please send a mail attaching the following reports:

Urine protein creatinine ratio and Urine routine/microscopy

• Anti HCV, HIV I & II, Liver Function Tests (LFT), P time / INR, Urea ,Creatinine, CBC / Hemogram, Sodium , Potassium, AFP, HbsAg
• Triple phase CT angiography of the liver (Patients with normal ceratinine levels, urea and no contrast allergy can get this test done safely)
• Your Medical Summary prepared by your doctor carrying information about your past medical history / symptoms.
• Recent Upper GI endoscopy report

All these reports are required to confirm the requirement and cost of a Liver Transplant. Nevertheless, once the patient reaches the preferred hospital in India.The liver transplant candidate would be examined again and would have to undergo certain other essential tests such as ABG, PA pressure measurements, PFT, Stress Echo for checking his fitness before undergoing the transplant surgery.

Evaluation of Donor

• He/She should be a relative of the patient and should be happy to donate his liver on selfless basis.
• It is preferable that the donor must be between the age group of 18 and 45 years. He/she should be fit, strong and have a matching or compatible blood group
• Though liver looks like a single organ but in reality it consists of 8 different lobes and thus can be separated into these lobes. Generally the donor’s right half of the liver is donated during an adult – to – adult liver transplant. Liver’s bloodless division into right and left has now become possible because of latest techniques and gadgets. A living donor can now easy donate his liver safely as the remaining left side grows back to around 80 percent of liver’s original size in few weeks and quite close to the original size within few months. The ratio of risk in liver donation is even lower than 1:200.
• It is mandatory that the donor should be a psychologically-sound adult who is well aware to take any sort of decision.
• If the transplant is being done by an unrelated liver donor for financial reasons, it is illegal and punishable under Indian laws. No queries in this regard would be entertained.
• In case, you want to start the evaluation of the donor on an immediate basis, you can get done the Level I and Level II tests in your own country and send the reports to us by mail

This scan is a crucial part of the donor work up

• Tests at Level III and IV for the donor and all tests for the patient can be done within 48 hrs of arrival at a hospital in India. If the test reports are fine, liver transplant can be done quickly once permission from Government of India Transplant Authorisation Committee is taken. All this might take a week’s time.

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Bone Marrow Transplant

What is Bone Marrow Transplant ?

A special type of therapy for those patients who are suffering from certain diseases or cancers is known as bone marrow transplant (BMT). Bone marrow transplant, also known as hematopoietic stem cell transplant or stem cell transplant, includes taking of cells that can be found in the stem cells (bone marrow).

These cells are filtered and are then given back to either other person or to the donor (patient). The aim of BMT (bone marrow transplant) is to transfer healthy bone marrow cells in a patient when their unhealthy bone marrow has been treated for destroying the abnormal cells. Following are the diseases that can be successfully treated by BMT that include –

• Some solid tumor cancers
• Leukemias
• Multiple myeloma
• Severe aplastic anemia
• Immune deficiency disorders
• Lymphomas

Requirement of a Bone Marrow Transplant

A bone marrow transplant is required when high doses of radiation therapy or chemotherapy treatment has damaged the bone marrow stem cells. BMT may also be required when a disease has destroyed the bone marrow. A BMT is used for –

• Replacing of a bone marrow with a genetically healthy functioning bone marrow. This is done for preventing more damage from a genetic disease process such as adrenoleukodystrophy and Hurler’s syndrome.
• Replacing of non-functioning and diseased bone marrow with a healthy functioning bone marrow. This is done in specific conditions like sickle cell anemia, leukemia and aplastic anemia.
• Replacing the bone marrow for restoring its normal functioning after being given high-doses of radiation therapy and chemotherapy for treating a disease. This procedure is known by the name of rescue for conditions like neuroblastoma and lymphoma.
• Regenerating a new immune system that will help to fight off other cancers that are not destroyed by the radiation therapy or chemotherapy used in the transplant, or residual or existing leukemia.

Different Types of Bone Marrow Transplants

A number of bone marrow transplants are there that primarily depends on the donor that include –

• Allogeneic Bone Marrow Transplant : This implant requires a genetic type of the donor similar to the patient. The stem cells are then taken by apheresis or bone marrow harvest from a genetically-matched donor. This generally involves a sister or brother. Some of the other donors are-
• Unrelated Bone Marrow Transplants : An unrelated donor provides genetically matched stem cells or marrow. National bone marrow registries can provide these types of donor.
• A Parent : When the genetic match is minimally identical to the recipient and a parent is the donor then it is known as a haploid-identical match.
• Umbilical Cord Blood Transplant : Right away after the delivery of an infant, the stem cells are then taken from an umbilical cord. They then reproduce into functioning and mature blood cells that more effective as compared to those stem cells taken from the bone marrow of other adult or child.
• Autologous Bone Marrow Transplant : A patient is itself a donor. In this transplant, stem cells are taken from a patient by apheresis or bone marrow harvest. These cells are then given back to a patient after they have been frozen. Rescue is the name given to this process.

When do people need stem cell transplants?

A bone marrow transplant is required for certain reasons. A normal bone marrow transplant can be provided to those –

• Patients who are suffering from a genetic disease that may affect different body organs.
• Patients whose bone marrow has been damaged by radiation therapy and chemotherapy for treating cancer.
• Patients whose bone marrow stem cells are defective or abnormal.
• Patients who are relatively in good health in spite of their associated condition.

Bone Marrow Transplant Procedure

A bone marrow transplant depends on following conditions such as a patient’s ability to tolerate certain medications, the type of transplant and the disease that requires a transplant. The procedure includes the following –

• The preparation of a bone marrow transplant involves high doses of radiation therapy and/or chemotherapy. This is required for treating a specific disease and also to create a sufficient room in the bone marrow for the new cells to develop. Myeloablative or ablative is the name given to this therapy due to its effect on the bone marrow. Majority of blood cells in the body are produced by the bone marrow. The marrow becomes empty when the ablative or Myeloablative therapy stops the cell production. The new stem cells require an empty marrow so that they can grow and simultaneously establish themselves as new blood cell production system.
• The marrow transplant is given from the central venous catheter in the bloodstream after administering radiation therapy and/or chemotherapy. This process is not considered as a surgical procedure. The stem cells start to grow into healthy blood cells by making their way into the bone marrow.
• A supportive care is offered after the transplant for preventing complications, infections and side effects. This care involves providing a clean environment, frequent blood tests, and daily weigh-ins, strict measurement of fluid input and output, and monitoring of vital signs.