Transplantation is an established and standard therapeutic tool in the management of end stage organ dysfunction. Transplantation of kidneys, liver, heart, lungs, cornea, bone marrow, pancreas and small bowel is now standard practice. However, in India, organ transplantation has had a checkered history. Problems of high cost, limited expertise and inability to sustain long term care has prevented the establishment of transplantation programs. Multiple scandals over organ donation and retrieval have brought the whole field into disrepute. This situation is unsatisfactory and scores of patients with end-stage organ dysfunction are being deprived of a life saving intervention.

It is against this background that we have setup “ Asha Dinesh Institute for Advanced Surgeries” under the sponsorship of Mrs. and Mr. K. Dinesh, co-founder of Infosys, to create a center of excellence for organ transplantation.  Our aim is to develop a program to provide an efficient, ethical and affordable organ transplantation service

At Narayana Hrudayalaya we cater to needs of patient who require the following transplants.

At present, the liver transplant program in India is in its infancy. Only a few centers perform the procedures regularly and the cost is very high-to the tune of 15-30 lakhs. End stage liver failure is common and usually a result of cirrhosis, congenital anomalies such and biliary atresia, infections and alcohol abuse. The liver may be transplanted from a cadaveric (brain dead) donor or from a matched living relative. Cadaveric and living related hepatic transplantation have a success rate of more than 75% at 5 years. It is difficult to estimate the number of patients who will need a liver transplant in India as there is insufficient data available. Rough estimates indicate that any one Institution treating patients with chronic liver disease would perform approximately 50 cases per year.

Patients will have to take immunosuppressive medications usually lifelong to prevent graft rejection. These medications including investigations can cost up to Rs 8000/- per month. In the case of liver, unlike the other organs, some patients who become immuno-tolerant over time can stop immuno-suppression. All patients lead normal productive lives after transplantation. We will be able to do a liver transplant operation at a cost of 10 lakhs at Narayana Hrudayalaya.

Organ transplantation is the only option in children with end stage liver disease. Even in children with kidney failure, transplantation is perhaps the most effective therapy. Unfortunately, the penetration and acceptability of this modality of treatment in India has been poor so far.

Against this background, The solid organ transplantation program was set up at NHWCI about three years ago. Since then, the program has grown into the largest such dedicated pediatric transplantation program in the country. The group has carried out transplantation of liver, kidney and multiple organ transplants. The program is primarily a Live Donor program-that is a near relative or parent donates the organ to the child.

The program has several distinguishing features. Some of these are listed below:

• dedicated pediatric team that carries out the transplantation and cares for the child before and after the transplantation
• the largest experience with liver transplantation in young children(< 10 kg.) and in infants in India.
• well established protocols for donor selection, in line with the Governmental regulations and guidelines
• well established Institutional Ethics Committee that screens every patient and interviews all the donors and the families. This Committee consists of non-medical personnel, including a legal expert. Patients are accepted for transplantation only after the Ethics Committee clears the donor-recipient combination.
• as per Governmental regulation, donors who are not first degree relatives and all foreign nationals are referred to the Appropriate Authority set up by the State for clearance.

The results of transplantation -both liver and kidney , have been at par with contemporary standards and are improving further as the team gains more experience in handling smaller and sicker children.

Liver transplantation is the last resort for a variety of diseases that cause progressive liver failure, when all other treatment options are no longer effective. The commonest cause for progressive liver failure is cirrhosis most often due to chronic infections with Hepatitis B or C virus, or due to alcohol abuse. Other diseases that may need this treatment are Fulminant Hepatitis, certain liver cancers and a variety of metabolic diseases in children. World over the survival figures after liver transplantation are 90% at 1 year and 70% at 5 years for patients who would not survive more than a year without transplantation.

In this operation the patient's diseased liver is removed and replaced with healthy liver from a donor. Traditionally the liver is taken from a 'brain dead' cadaveric donor, although now, with operations on the liver becoming increasingly safe in expert hands, a living donor may donate part of their liver to the patient. Although cadaveric liver transplantation is the safest form of transplantation because it does not put a donor at risk, living donor transplantation is being increasingly performed for children who need a small portion of the donor liver, in societies where cadaveric donation is not possible either for religious or social reasons, and when urgent transplants are necessary for Fulminant hepatitis or cancers.

At Narayana Hrudayalaya we offer living donor liver transplantation from related donors for adults. Each patient and donor is cleared by the hospital Ethics Committee. A stringent set of tests is necessary to determine whether the donor will be able to tolerate removal of part of their liver, so as to minimize the risk of operation. We are in the process of collaborating with a variety of organizations and hospitals to procure organs from cadaveric donors so as to make the process of liver transplantation safer and more widely available

Kidney is the most common solid organ to be transplanted. In India roughly 1 million new cases of End Stage Renal Disease (ESRD) are added each year. Of these, only about 7% receive some form of renal replacement therapy-dialysis or transplantation. The rest simply die. Renal transplantation from either a cadaver (brain dead) donor or a relative will transform the life of any adult of child allowing then to lead normal productive lives.

1. Pediatric Liver Transplant – Dr.Ashley D’Cruz
2. Adult Liver Transplant – Dr.Kenneth

1. Dr.Isthiaque Ahmed
2. Dr.Lyold Vincent
3. Dr.Nithin Hegde

BONE MARROW TRANSPLANT:

Dr.Sharth Damodar