Advances & Challenges In Organ Transplantation

Organ transplantation is a critical medical procedure that involves replacing a failing or damaged organ with a healthy one from a donor. This life-saving treatment has revolutionised modern medicine, offering hope to patients suffering from severe organ failure due to various causes, including chronic diseases and traumatic injuries. Kidney, liver, heart, lungs, pancreas, and intestines are among the most commonly transplanted organs, with corneas and tissues also commonly donated

What are the critical factors in successful organ transplantation

For successful kidney transplantation, it is important to have a healthy donor organ which can come either from the relative in case of paired organs like kidneys. Part of the liver is also taken out for transplantation from a living relative. Otherwise, the rest of the organs like the heart, lungs, pancreas, intestine, eyes, can only come from the person who is dead, either brain death, or cardiac death. Apart from the availability of successful organs, there is a need to have a good infrastructure, experienced doctors, good ICU care and availability of investigations, imaging facilities as well as immunosuppressive drugs. A good ICU facility is a must so that once the operation is done, the patient can get good perioperative care for a successful outcome, . Operation alone is not only important. After the operation, once the patient is discharged, long-term good patient follow-up is mandatory, otherwise the transplanted organ may be lost.

Challenges in organ transplantation and how to address them

The main challenge is that there is a big gap between demand and supply. Just to give an example, we need approximately 200,000 kidney transplants in a year to take care of all the people who are suffering from renal failure, but we could do only 13000 to 14,000 kidney transplants in a year, so many patients are dying, or they remain on Dialysis to survive? The same thing is true for other organs—there is a huge demand of livers, hearts, lungs, intestine, and pancreas cornea but the availability of organs are limited. That is because organ donation rate is very low in our country. This demand cannot be met, unless more donations happen. There is a lot of opportunity —unfortunately, many people are dying after roadside accident, brain haemorrhage or thrombosis or brain tumours or some other suicidal or accidental death. Once it is confirmed that the patient is brain dead, at least 6-7 organs can be taken out and to be given to the people who need it , so that their life can be saved. But this is not happening because of the various factors like lack of awareness in society, hesitation in the family members to donate the organ, some of the wrong beliefs and religious myths and social stigma in the community. There are many myths which are not true, and they can be spelt out.

What is the role of technology in organ donation, any innovation?

Technology has a big role in making transplants very successful. Now we have many good immunosuppressive drugs and induction agents which can make the argon to live long for many years which was not possible 20–30 years ago. 2–because of the so many Imaging developments like MRI, CT scan, PETS scan and Doppler ultrasound, we can diagnose the problem and can take care of them. Many drugs now which can be assessed so that we can prescribe appropriate doses. The new technologies like Robotic have come into Transplantation and we can do the Transplantation without cutting up the abdomen. We have to give a small incision so that argon can be dropped inside, and Transplantation can be done. So such a complex operation can be done with less pain and morbidity. Now we can keep the organ alive with the Machine Perfusion for at least 24 to 48 hours. Some of the sub-optimal organs can be transplanted with the help of machine perfusion. So there are a lot of technological advances happening, which has improved the results of transplantation whether it is kidney transplantation, liver transplantation, heart transplantation or lung transplantation.

The author is Chairman, Urology, Robotics & Renal Transplant, Max Super Speciality Hospital, Saket

Dr Anant Kumar

Guest Author Chairman, Urology, Robotics & Renal Transplant, Max Super Speciality Hospital, Saket