In India there is a everincreasing pool of patients awaiting renal transplant. On the other hand there is a shortage of organs available for transplant due to various reasons: persons not available/ unwilling for kidney donation , blood group mismatch , religious reasons, familial constraints on the donor etc.
In this scenario , it is vital to encourage cadaver organ donation. In this type of donation , a person admitted in a hospital ICU from severe trauma, stroke or other similar conditions often land up in a situation where in the heart is beating and so the circulation is maintained. However the critical areas of the brain necessary for survival are lost. This is called Brain Stem Death and is a legally accepted form of death where life supports can be withdrawn and organs harvested for transplantation.
It is in this situation that we encountered a donor who was brain stem death and the relatives were keen to donate a kidney.
When both the kidneys were harvested, we found a small tumor in one kidney. The other kidney was normal in appearence.
The biopsy was done from the kidney tumor and it was confirmed as a malignant tumor.
The challenge now was whether to discard both kidneys ,accept the second kidney which was normal but had a small risk of a tumor developing at a later date. Or to simply remove the tumor and use that kidney.
Seeing that the tumor was quite large and the removal of that tumor would not leave much kidney tissue left for the recipient, it was decided to discard that kidney and use the normal appearing other kidney only
As one can imagine this was a challenge then to select a recipient for the kidney.The first concern was to inform all the potential recipients that there is only 1 available kidney and not 2 as was earlier believed. Secondly , the recipient had to accept the fact that the other kidney had a small renal tumor.
Of the 4 recipeints ,2 were ready to be considered, and the elder of the 2 was selected.
The transplant surgery was successful .
The patient is doing well after 3 years of tranpslant.
This case highlights the difficult situations faced during a cadaver transplant, both in selecting the donor kidney as well as selecting the recipent.
However kidneys are precious. No organ is ever allowed to go waste
Please take the opportunity to pledge your organs to donation – you can save many lives with this humane gesture. For more detil visit our website- http://www.drpradhanurologist.com