The committee has made certain suggestions upon this incident. Which are as follows:
- Long-term preservation of donor blood and tissue should be done. This would enable scientific inquiries into unusual outcomes as well as research in the field for better management of transplant patients.
- HLA matching should be preferred even in cadaveric kidney transplants while allocating the kidney
- Any unexplained adverse outcomes should be informed to ZTCC or appropriate authorities as soon as possible. All mortality after cadaver transplant should be notified to ZTCC. Preferably within 24 hours.
- Routine cultures of solution used to preserve the organ fluid. (Not related to the current case) should be performed.
- Research on experimental newer organ preservation techniques like normothemic perfusion in marginal donors should be encouraged.
- Specifically in this case, review of all the three biopsies by an independent expert reviewer with large research experience in transplant histology and immunology may be sought to confirm the findings of the committee.
This rare incidence of multiple organ rejection and two deaths had prompted the Zonal Transport Coordination Committee (ZTCC), which distributes cadaveric organs to order a probe into the incident.
The first kidney transplant recipient passed away 48 hours after the surgery on September 07 at P.D. Hinduja Hospital in Mahim. While the second kidney transplant recipient passed away 13 days post-transplant at Jaslok Hospital in Pedder Road.
The third recipient who had received the liver had to undergo a urgent second liver transplant surgery within 48 hours.
The expert committee said that they did not find any deficiencies in the process of donor maintenance or peri-transplant care. There was no evidence of any bacterial, fungal or other acute infections in any of the recipients acquired from the donor. Blood groups and cross-matching was appropriate.
The adverse outcome appears to be due to an extremely rare immunological phenomenon. Such immunological phenomenon is reported very rarely in literature.
Dr S K Mathur, President of the Zonal Transplant Coordination Centre, Mumbai, said, “Cadaver donations give people a new lease of life. But these two cases which occurred in Hinduja and Jaslok Hospital are a first. It is for the first time that the ZTCC has seen such a case. Consent of the family is taken before the organs are retrieved.”
He added, “In 99 per cent of the cases, people continue to live after a transplant. After a person has been declared brain-dead, a blood test and a human leukocyte antigen (HLA) test is performed, the report of this test takes 24-hours, but the organs have to be transplanted within 6-hours. It will be difficult to implement this suggestion. But we are considering whether to implement the other suggestions made by the expert committee.”