Organ Donation

The process of donating organs or biological tissue to a living recipient, who needs a
transplant.

• Organs that can be donated: Kidney, Pancreas, Liver, Heart, Lung, Intestine.
• Tissues that can be donated: skin, cornea of the eye, heart valve, blood vessels,
nerves and tendon etc.
Registering as a donor:
To be an organ donor, one needs to fill a prescribed consent form, which can either be
downloaded from National Organ and Tissue Transplant Organization (NOTTO) website or
accessed from the medical facility that is approached for organ removal.
In case of deceased donation, a written consent form from the lawful custodian of the body
after the death of the patient is required in a prescribed application form.
The donor medical information is kept confidential by the transplant center. If they are
rejected as a donor during the evaluation process, the donor is told only that their organ
was declined.
Anybody can be an organ donor irrespective of their age, caste, religion, community etc.
Donors having a serious condition like actively spreading cancer, HIV, diabetes, kidney
disease, or heart disease can’t donate organs.
Registering as a recipient:
Similarly, A person in need for an organ transplant needs to be registered in the waiting list
handled by National Organ and Tissue Transplant Organization (NOTTO). Once registered
the recipient has to wait until a matching donor comes in place.
After a suitable donor is identified based on medical compatibility, the recipient is informed
about the donor and that the transplant may take place.
If the recipient is registered within the hospital where the deceased donor is then the organ
is directly given to the patient. If the potential donor is not found within the hospital, the
transplant coordinators of the hospital will notify NOTTO. It acts as the apex centre that
looks after the nationwide coordination and networking for procurement and distribution of
organs and tissues.
This waiting list has several categories depending the on the blood group type. From this
waiting list, the NOTTO will find out the recipient who matches the donor.
REF:
https://sites.ndtv.com/moretogive/donor-recipient-5-step-process-organ-donation-
transplant-stage-india-2036/
https://notto.gov.in/
Types of Donor:

Living Donor: Any person not less than 18 years of age, who voluntarily authorizes the
removal of any of his organ and/or tissue, during his or her lifetime

Deceased Donor: Anyone, regardless of age, race or gender can become an organ and tissue
donor after his or her Death (Brainstem/Cardiac).

Living organ donation Deceased organ donation

Directed donation:
Donor directs the organ to a specific
recipient for transplant. The donor may be a
relative, friend, co-worker or someone else
who has heard about the transplant
candidate's need.
Nondirected donation
Some people become altruistic living donors
by choosing to donate to someone they
don’t know.
A nondirected living donor can participate in
paired organ donation or organ donation
chains to help match incompatible pairs.
Donation after the death (Brain death) of
registered donor or some person with the
approval of their near relatives.
To ensure that the patient is brain dead, a
team comprising hospital doctors and one
civil/government doctor conduct a series
of tests twice in a time frame of 4-6 hours.
A death certificate is issued after no
stimuli are observed.
Then the doctors inform the family about
the functioning organs that can be
donated, after they give their consent to
donate the organs, the process of organ
donation is initiated.
And the doctors inform the authorized
registered Human Organ Retrieval Centre.
The removal and preservation of such
organs/tissues should be ensured in
registered retrieval or transplant center or
tissue bank according to current and
accepted scientific methods in order to
ensure viability for the purpose of
transplantation.

The organs that have been retrieved from

a brain-dead person are stored in a
chemical solution and have limited life
spans, ranging from a few to many hours.

For living donors, the process typically Typical storage times for
involves extensive testing before the
donation, including psychological evaluation • Heart: 4-6 hours
to find out whether the would-be donor • Liver: 12-24 hours
understands and consents to the donation. A • Kidney: 48-72 hours
transplant may take place only after the • Heart-Lung: 4-6 hours
donor's medical compatibility with the • Lung: 4-6 hours
recipient is confirmed by a doctor. After
organ retrieval has taken place, the donor
 will need to stay under medical care for a
few days.
It may be noted that a living donor may only
donate a limited list of organs and tissues.
Living donors can donate:
• One of two kidneys.
• One of two lobes of their liver.
• A lung or part of a lung, part of the
pancreas, or part of the intestines.
Storage times vary because of the relative
speed at which deterioration begins in the
organs' tissues.
The cost for maintenance of the cadaver,
retrieval of organs, their transportation
and preservation, should not be borne by
the donor family and may be borne by the
recipient or institution or Government or
non-Government organization or society,
as decided by the respective State
Government or Union territory
Administration.

REF:
http://www.neurologyindia.com/article.asp?issn=0028-
3886;year=2018;volume=66;issue=2;spage=316;epage=322;aulast=Srivastava
https://www.thebetterindia.com/75687/organ-donation-india/
https://www.mayoclinic.org/

Kidney Transplantation:

A kidney donor can be living or deceased, related or unrelated to the recipient. The health
care team will consider several factors, such as blood and tissue types, when evaluating
whether a living donor will be a good match for the recipient. Family members are often the
most likely to be compatible kidney donors. But many people undergo successful
transplants with kidneys donated from people who are not related to them.

If a compatible living donor isn't available, the recipient name will be placed on a waiting list
for a donor kidney. Because there are fewer available kidneys than there are people waiting
for a transplant, the waiting list continues to grow. The waiting time for a deceased-donor
kidney is usually a few years.

Blood typing is the first blood test that will determine if the recipient blood is a compatible
match with the potential donor's blood.

• Recipients with blood type O… can receive a kidney from blood type O only
• Recipients with blood type A… can receive a kidney from blood types A and O
• Recipients with blood type B… can receive a kidney from blood types B and O
• Recipients with blood type AB… can receive a kidney from blood types A, B, AB and
O (AB is the universal recipient: recipients with AB blood are compatible with any
other blood type)
Donor Evaluation Process

The following process is used to determine if someone can be a donor. This is a general
description of the testing process, and may vary from center to center:

• medical and surgical history.

• physical exam.
• psychosocial exam.
• Compatibility tests:

Tissue (HLA) typing is a first blood test that matches the number of antigens the
donor and recipient share. Each person has six basic tissue typing antigens (or
markers) shared equally from their parents. The markers help tell which donor will
be the best match between the recipient and donor. It is not necessary that donor
match their antigens for a successful transplant. Even matching one antigen may
make for a more successful transplant than matching five or six antigens from a
deceased donor kidney.

The second blood test measures antibodies to HLA; this test is done for the
patient only and is repeated frequently (sometimes monthly but less often dependent upon
the transplant program policy). HLA antibodies can be harmful to the transplanted organ
and they can increase or decrease over time so they must be measured while waiting for a
transplant, immediately before a transplant surgery, and sometimes following
transplantation. If a patient has HLA antibodies in their blood, they are considered HLA
“sensitized” and it is best to find a donor with HLA types that avoid the HLA antibodies in
the patient’s blood.
Serum Crossmatch: In this test, cells from the donor are mixed with the recipient
serum. If the recipient serum has antibodies against the donor's cells, the antibodies will
bind the donor cells and be detected using a fluorescent detection method. If these
antibodies are at high levels, the donor cells will be destroyed. This is called a positive
crossmatch and it means that the transplant cannot take place. To do so would result in
immediate rejection of the transplanted kidney.

Other tests in the donor evaluation include:

• blood tests
• 24-hour urine collection
• electrocardiogram, if donor is age 50 or older to tell if their heart has a normal
rhythm
• chest X-ray
• CT (computed tomography) of donor abdomen (to see the blood vessels and
structure of donor kidneys)
• follow-up blood test three to seven days after the CT scan.
• Cardiac stress test.
• Cancer screening.
• Colonoscopy. A flexible camera is used to check the colon for polyps, tumors, and
any unusual growths that might indicate cancer or other medical problems. If donor
 is over age 50 or have a personal or family history of colon cancer, this test will be
included.
• Gynecological examination. Women will need a pap smear, mammography, and
checked for pregnancy (if appropriate).
• Prostate exam. Men may need a prostate exam.
• Dental evaluation.

After reviewing the results, the doctors will decide if donor can donate. It is up to the donor
to decide what information will be shared with the recipient.
Expanded criteria donation

Expanded criteria donors (ECD) are deceased kidney donors who are age 60 or older, or who
are between the ages of 50 and 59 and meet two of the following criteria:

• Had high blood pressure

• Had less than normal kidney function, based on a creatinine test
• Died because of having a stroke

Kidneys from expanded criteria donors may not last as long as kidneys from standard
criteria donors (SCD). However, ECD kidneys may be available sooner than SCD kidneys, and
can still extend the recipient life.

If one ECD kidney is not working well enough to keep the recipient alive by itself, they may
be able to get two ECD kidneys transplanted. These two kidneys with less than normal
function can work together to function as well as one healthy kidney. This type of kidney
transplant is called a dual kidney transplant.

REF:

https://www.kidney.org/atoz/content/BloodTests-for-Transplant

https://www.allinahealth.org/health-conditions-and-treatments/health-library/patient-
education/kidney-transplant/for-the-kidney-donor/tests-you-need-before-surgery

https://www.kidney.org/atoz/content/kidney-transplant-evaluation

Thank you!