First cadaveric renal transplantation

First Cadaveric Renal Transplantation

Narrated by – Dr. Pradeep Salgia

Tribute to Mayank MehtaThe measure of life is not in its duration, but in its

donation

Proud parents

Dilip Mehta Sangita Mehta

Donation is not new to India

Maharishi Dadhichi donated his bones to Lord Indra for Making “Vajra”, a most powerful weapon used in war against asuras.

Organ transplantation not new to Indians

SUSHRUTA SAMHITA

The art of transplantation was known in ancient India

सु�श्रु�त सु�हि�त (ca. 500 BC)

Then what holds us back from organ donation?

Knowledge

Desire

Courage

Motivation

Religion

Challenges in Organ donation

Organ shortage

Family consent and negative attitude contribute towards organ shortage.

This could be due to the following reasons –

Misinterpretation of Religion

Fear, ignorance and misunderstanding

Legal aspects

Media reports on scandals involving organ rackets

“Whosoever saves a life, it would be as if he saved the life of all mankind.”Holy Qur’an, chapter 5, vs. 32

One who saves a single life – it is as if he has saved an entire world”Pirke D’Rav Eliezer, Chapter 48

“Of all the things that it is possible to donate, to donate your own body is infinitely more worthwhile.” The Manusmruti

“Where self exists, there is no God. Where God exists, there is no self.”Guru Nanak (founder of Sikh faith, and first of ten Gurus), Guru Granth Sahib (Sikh Holy Scripture)

“In eternity we will neither have nor need our earthly bodies: former things will pass away, all things will be made new.”Revelation 21:4,5

“What loss do I suffer to give an unwanted organ after my death to give another person life?”Dr Desmond Biddulph, Chairman of The Buddhist Society

Don't take your organs to heaven with you. Heaven knows we need

them here

1 person can save 50 peopleJUST

THINK…

We make a living by what we get, but we make a life by what we give.

Legal aspect

Ministry of Law, Justice and Company Affairs (Legislative Department)

New Delhi, the 11th July, 1994 The following Act of Parliament received the assent of

the President on the 8th July, 1994 and is hereby published for general information:- THE TRANSPLANTATION OF HUMAN ORGANS ACT, 1994

No.42 OF 1994 [8th July, 1994]

Transaction of money between Donor and Recipient is against Law

MYTHS

Age – Too young or too old

Single or multiple/Specific organ donation

Religious misbelieve

Favouritism to rich and famous

Organ donation scandals (true only to a

certain extent)

Pre-existing Medical diseases

Facts

Age, Sex, religion, nationality, general medical disability/diseases, financial status, have no bearing for organ donation.

HIV and Hepatitis C are

contraindications. Hepatitis C organs may be

transplanted to a patient of Hepatitis C.

The First Cadaveric Renal Transplantation

A true story narrated by Dr. Pradeep Salgia

22nd April, 2000Mayank Mehta, a 16 year old boy met a severe road accident and was put on ventilator at Suyash Hospital.

23rd April, 2000Neurosurgeon Dr. Rakesh Gupta declared him brain dead. His parents Dileep & Sangeeta were grief stricken and refused to accept the situation.

2:00 PMWhen I got the news, my wife was sitting beside me and she asked about the possibility of organ donation. It was a difficult task to talk about this to the aggrieved parents in the given situation, when they would not accept their son’s sudden demise.

Had it been a Western country this task would have been done by the social workers. 4:00 PMI went to the ICU in Suyash Hospital to inquire about the exact situation. The duty doctor confirmed the news, he said that Mayank’s kidneys were still functioning and he was on respiratory and blood pressure support.5:00 PMI was searching for the parents when the volunteers from Humad Jain Samaaj arrived and I explained them the situation. We felt that it was easier to convince Mayank’s mother than his father, since she was a religious and bold lady.

10:00 PMAs soon as I came to know that the family had agreed for organ donation, I rushed to Choithram Hospital. I informed the Medical Director, Dr. K. L. Bandi, Dr. R. K. Lahoti, Dr. C. S. Chamania, Dr. S. Thatte, Dr. A. Goel, Dr. Satish Pathak, Dr. D. S. Chitnis, Dr. Bhatia and Dr. C. S. Pandit about the possibility of Cadaver Transplant late in the night.

12:00 AM (24th April, 2000) The dialysis unit was opened and the nursing staff was called for immediately. The contact details of the dialysis patients with matching blood group were retrieved from the record book.

1:00 AMI started calling the dialysis patients. The first one said that they would think about it the next morning. The second one refused bluntly. The third and fourth calls went unanswered.

I had started getting anxious that nobody would turn up for the organ transplant. I made the fifth call to Dewas, where the patient’s father received the call and immediately agreed to bring his son. I instructed him to keep the patient fasting and rush immediately to Choithram Hospital.

3:00 AMPatient Ashok Malu arrived in the dialysis unit, his blood sample was drawn for cross match and other tests. His dialysis started without heparin.

3:30 AMThe donor’s blood was brought from Suyash Hospital and Dr. Chitnis and his team started the cross match.

Then, I started searching for the next recipient, the next call was made to a patient staying close to Choithram Hospital and her husband agreed immediately.

4:30 AMThe second recipient also arrives in the hospital.The atmosphere of the hospital was thrilling at that moment. Then came a sudden blow, as per the organ transplant act, the organ retrieval had to be carried out in Choithram only. Thus, Mayank was to be shifted from Suyash Hospital and his father refused to the shift the patient in this condition.

5:00 AMI rushed to Suyash Hospital and explained Mayank’s parents about the technical difficulties and was finally able to convince them to shift Mayank to Choithram Hospital.

5:30 AMI shifted the patient in an ambulance on Ambu bag and dopamine drip along with a duty doctor and rushed to Choithram Hospital.

6:00 AMThe donor was taken straight to the ICU in Choithram Hospital and put on life support.

6:30 AMMembers of the brain death committee Dr. J. S, Kathpal, Dr. V. Haridas and the Medical Director were called to verify brain death.

9:30 AMThe first recipient Ashok Malu is ready for the transplant.

10:00 AMDespite using vasopressor, Mayank’s B.P. was falling and serum creatinine had started rising. If the patients kidney goes into Renal failure, then the transplant outcome would be poor.

10:30 AMThe tissue cross match is reported negative.

11:00 AMThe brain death committee verifies the brain death for the second time as per law.

11:30 AMThe donor was shifted to the operation theatre. Kidney transplant team began kidney retrieval Dr.S.Pathak took the Biopsy for frozen section, Dr. Mrs. Shobha Chamania. and the team started retrieving the skin from the back Dr.S.Parwani, Dr. Shreya Thatte took out the corneal grafts.

In the meantime Dr. S.Pathak announced that the tissue architecture in the Biopsy was O.K., so the second team started to transplant the kidney in to the first recipient Ashok Malu.

12:30 PMThe ventilator was disconnected after the organ removal and Mayank was finally declared dead. The body was handed over for the post-mortem. I requested the administration of M.Y.H. to expedite the post-mortem formalities. The second recipient developed high grade fever while preparing for the transplant and the surgery had to be cancelled. Dr.Pandit packed up the second kidney in saline and double packed it and buried in the ice.

3:00 PMThe first cadaver transplant was carried out successfully. The patient started making some urine and was shifted to kidney transplant room.

Since the second recipient was cancelled, I started looking for other dialysis patients. On my second attempt, the response came again from a patient from Dewas.

Yajuvendra Rajput's mother, who was a nurse volunteered immediately for the second surgery, but expressed her inability for the surgery due to financial constrains. The only option left was to discuss the situation with the management.

5:00 PMI reached the office of Managing Trustee, Shri Motiani and told him that we have a Donor Kidney and a recipient, but it could not be transplanted due to financial constrains and the donor’s kidney would go waste. He asked for the budget and after hearing my reply, gave me immediate sanctioning and told me to go ahead with the second transplant without any deposit.

6:00 PMDr. Chitnis started second patients tissue cross match and we started dialysis, to make him fit for surgery.

11:00 PMSecond Cadaver transplant began.2:00 AM (25th April, 2000) Yajuvendra was shifted to the kidney transplant room. The entire surgical team was satisfied with whatever had been done. Dr.Pandit and myself were under great stress because the second recipient did not make any urine, but we were hopeful that sooner or later it would function.

8:00 AM (27th April, 2000)I left for home after two days and two nights, without sleep and food, but with great satisfaction that we could make Choithram Hospital, the first one in Central India to start cadaver transplant.

Mayank Mehta's name became immortal in the history of Indore.

25th April, 2005 Five years later, I am sitting at my home and writing the account of the event for the History book of Choithram Hospital. Both recipients Ashok Malu & Yajuvendra Rajput were healthy, happy and enjoyed good life for five years.

• Another case of cadaver transplant done in 2001.

• Mr. Mathew donated the kidneys his daughter Shijo after her brain death and the recipient still living after 11 years.

• The link to the vedio of this patient can be watched at:

• https://www.youtube.com/watch?v=3T3zMwLgZns&feature=youtu.be

10 years survival of cadaver transplant

History of the First’s

The first kidney transplantation in the United States was performed on June 17, 1950.

The first kidney transplants between living patients were undertaken in 1954 in Boston and Paris.

In 1967 – First successful cadaveric renal transplant was done in KEM Mumbai.

In 1982 - First-ever live-related kidney transplant was performed at Osmania General Hospital. 

In 1985 – First live related kidney transplant was performed at CH&RC, Indore.

In 1994 – First successful heart transplantation was done at AIIMS, New Delhi.

In 1995 - First successful multi organ transplantation was done at Apollo, Chennai.

In 1998 – First Successful Lung transplant, Madras Medical Mission Hospital, Chennai.

In 1999 – First Pancreas Transplant, Ahmadabad.

In 2000 – First Cadaveric transplant performed at Choithram Hospital.

History of the First’s

Dr. K. L. Bandi

Dr. A. Goel

Dr. S. Thatte

Dr. C. S. ChamaniaDr. R. K. Lahoti

Dr. S. Bhatia

Surgical Team

Surgical team working on Donor

Harvesting the Kidney

Surgical team working on Recipient

Perfusion of kidney before transplantation

A perfect gift to mankind

Surgical Team working on Recipient

Vascular anastomosis

Dr. Pradeep Salgia http://www.drpradeepsalgia.com/

Thank You