Cadaver transplantation

It has been correctly pointed out by Harsha Deshmukh inher article Cadaver transplants: ground realities (1) that very few cadaver transplants have been performed even after the Human Organs Act 1994 removed a major legal hurdle by recognising brain death.

As suggested by Ms Deshmukh, a central body with a transparent protocol for putting patients on a waiting list and distributing organs would work wonders if help is taken from the information technology drive sweeping the world.

In this respect I would like to refer the readers of Issues in Medical Ethics to a report by R.V. Petrov in Me or not me, a book on immunology, in which countries cooperate and use computer technology to save lives (2). The selection of the donor-recipient pair is accomplished not by choosing a donor for a recipient but by selecting a recipient for a donor.

Dr Van Rood, an immunologist from the Dutch city of Leiden, describes the functioning of the international organisation Eurotransplant: Data on patients in need of a renal graft, their leucocyte and blood groups and other relevant information, are stored in a computer. Every month printouts listing recipients according to their blood cell groups are sent to centres affiliated with Eurotransplant. If one of the centres has a potential donor, it telephones the closest most suitable recipient. The doctor in charge of the donor contacts the doctor supervising the patient. Sixty-seven patients have already obtained kidneys through Eurotransplant’s card indices. The organs to be grafted were on an average two to five times more suitable than those chosen by other means.

Of course it is difficult to find a kidney, to say nothing of a heart. But a patch of skin to cover a burnt surface, bone marrow for treating radiation sickness, or blood, can be supplied by virtually any healthy person. In these cases success is based on overall typing. Many countries have started typing antigens vis-a-vis compatibility among large groups of people. In the not so distant future, passports will carry, in addition to blood group and Rh sensitivity, information on the four basic tissue compatibility antigens.

To treat radiation sickness by means of bone marrow transplantation, Professor Good from Sloan-Kettering Institute, New York, uses a card index containing data of 20,000 typed donors. Radiation sickness develops because leukaemia or blood cancer can be treated only by irradiating a patient with X- or Gamma rays. It can be cured only by grafting bone marrow compatible in all known antigens. This requires screening several thousand donors to find a compatible one. However, bone marrow transplantation does away with the need to suppress immunological responses with medicines toxic to the entire body.

But what is to be done for heart transplantation? A compatible donor for this cannot be found even through Eurotransplant. A heart for transplantation can be taken only from a patient who is dying in a most sophisticated equipped hospital, dying, for instance, of a cranial-cerebral trauma: the brain is already dead, while breathing and heart beat are sustained artificially. Transplantation should be effected immediately. To get a donor under these circumstances is an extremely rare event.

Dr Petrov’s article was published in 1987. Much has developed in the field of medical technology since then. In order to tackle a medical problem such as cadaver transplantation, such approaches could be the subject of serious debate. There is scope for getting the data required for kidney transplantation centrally located and made available to needy patients in spite of our social and political problems.