Why is organ transplantation required?
Organ transplantation is the only available treatment method to prolong life in end-stage organ failure in liver, heart, lungs. In kidneys, dialysis is available as an alternative but has very poor quality of life compared to transplant.
For liver, transplant is required when the patient has developed complications due to cirrhosis, like blood vomiting, fluid in the belly, kidney failure, complications in the lung (Hepatopulmonary syndrome and aortopulmonary hypertension) and liver cancer.
We specifically assess a number called MELD number, based on 3 tests – Bilirubin, INR, and Creatinine. If the MELD number is >15, the patient should be referred for transplant.
Which of the organs in the body can be transplanted?
Currently, we are able to do corneal transplant, kidneys, liver, pancreas
| Organs that can be transplanted | Indication for transplant |
| Corneal transplant | Corneal blindness |
| Lung transplant | COPD, Idiopathic pulmonary fibrosis, Cystic fibrosis, Pulmonary hypertension |
| Heart transplant | Cardiomyopathy - ischemic and non-ischemic |
| Liver transplant | Cirrhosis with complications (DCLD) from various causes. MELD > 15. Some metabolic illness - Glycogen storage diseases, Tyrosinemia, Maple syrup urine disease, Hemochromatosis, Acute Wilson's disease |
| Renal transplant | End-stage Renal disease with GFR < 20 |
| Small intestinal transplant | For patients with short bowel syndrome |
| Pancreas transplant | Lean diabetic patients with renal failure will benefit from a simultaneous pancreas-kidney transplant |
Is there an age limit or are there medical conditions that can prevent organ transplantation?
There is no specific age limit for transplantation. If the patient is fit to undergo a procedure and would like to have a transplant, he or she will be offered transplant. Tests for assessing fitness will be more rigorous in elderly patients who require transplants.
In general, patients with illness in heart or lungs, in addition to liver or kidney disease will not be offered transplants. Patients with cancer (excluding liver cancer) will have to wait for a minimum period of 2 years before they are offered transplant.
What are the factors that are considered while matching organs and allocating?
Organ allocation is a policy of the government. In an ideal world, every patient with organ failure gets a transplant. But we have a severe shortage of organs in every country in the world. To ensure that organs are distributed on an equal basis, individual governments have made policies to allocate organs. In the USA, this is done according to the MELD number. In Tamilnadu, the allocation is done to individual hospitals and the hospitals allocate the organ based on the waitlist in the hospital.
The most important matching is that the donor and the recipient have the same blood group. There are other parameters that the medical team will consider to see whether the organ is suitable for the patient before they transplant the organ.
What do I need to do to be considered for an organ transplant?
If you are a patient with end-stage organ damage in any of the organs listed above, it is important that you discuss with your doctor about the possibility of transplantation. For liver disease, it is important that you raise the possibility of transplantation when you develop any complications. It is also important to prepare financially and provide adequate time to recuperate from the surgery.
Q & A by Dr. Ilango Sethu, MS (General surgery) M.Ch (GI Surgery), ASTS Transplant Fellowship
Lead Consultant, Surgical services (Transplantation and HPB surgery)
Center for Liver diseases and transplantation
Kauvery Hospital, Chennai