On August 30, 2025, MOHAN Foundation in collaboration with the Network and Alliance of Transplant Coordinators (NATCO) organized a masterclass on “Due Diligence and Documentation in Non-Near Related Living Donor Transplants” for their employees and NATCO members.
The invited experts for the session were:
• Ms. Vrinda Pusalkar, Senior Manager – General Administration & Transplant Coordinator, Jehangir Hospital, Pune
• Ms. Annu Bharti, Transplant Coordinator, Max Super Specialty Hospital, New Delhi
• Mr. Vishok N, Assistant Nursing Superintendent & Coordinator – Organ Transplant, AIIMS Raipur
The session was moderated by Ms. Trilly Rachel Mathew, Director of Operations – India & Middle East, Alliance for Paired Kidney Donation (APKD).
The objective of the masterclass was to share real-life cases experiences of transplant coordinators and to engage in interactive discussions to address practical challenges and clarify grey areas in due diligence and documentation processes.
Ms. Annu Bharti during her presentation elaborated on the due diligence steps in documentation which included donor-recipient verification, relationship establishment, and medical evaluation. She emphasized that due diligence prevents organ trafficking, protects donor rights, ensures ethical compliance, safeguards donor safety, and provides legal protection for all stakeholders.
Case 1: Donor is Recipient’s Cousin Grandfather (Father’s Paternal Uncle)
Challenges faced:
1. Relationship outside immediate bloodline led to scrutiny of intent
2. Gaps in rural civil records due to unregistered births/deaths
3. Deceased ancestors unavailable to establish linkage
4. Lack of legal documentation for authorization committee
Strategies to overcome challenges:
• Constructed a clear family tree/ family pedigree using government IDs
• Collected generational linkage documents
• Obtained local authority certification of family tree
• Presented medical/genetic evidence
Case 2: Recipient is donor’s niece (Sister’s Daughter)
Challenges faced:
1. Gender identity mismatch (Recipient is Transgender: initially a male after reconstructive surgery a female)
2. Social stigma and discrimination
3. Limited awareness among staff/committee members
4. Psychological stress and inadequate counselling
5. Estrangement from family for years
6. Financial transaction concerns
7. Lack of family photographs/gathering proof
Strategies to overcome challenges:
• Verified legal documents
• Sensitized healthcare/legal teams
• Provided psychosocial counselling and support groups
• Conducted DNA matching
Mr. Vishok N presented a case of a father-in-law donating to his son-in-law, where he faced challenges related to proving the relationship with limited documents (only the daughter’s 10th marksheet available), ensuring the donation was voluntary, and obtaining valid proof of relationship. To address these, he consulted legal authorities and SOTTO for compliance, took video consent from the donor and family to confirm the donation was voluntary and free of coercion, and ensured complete documentation in line with THOA guidelines.
Ms. Vrinda Pusalkar shared two complex cases. In the first, the recipient was the donor’s adopted child, creating challenges such as ambiguity in authorities’ stance on whether the case should be treated as related or unrelated, absence of HLA match due to adoption, and misplaced adoption proof. These were resolved by verifying adoption rights with local centres, obtaining a duplicate adoption deed along with an expert opinion from the adoption centre, and submitting Form 20 with police verification. The case was then referred to the Regional Authorization Committee, which granted permission in Form 19.
The second case involved a donor who was the recipient’s step mother-in-law. Challenges included the donor being widowed, hidden family dynamics with the step relationship revealed later, lack of marriage registration proof, and the donor having no biological children. To address these, additional supporting documents were requested, multiple interviews were conducted by the competent authority, and counselling was provided by the treating doctor with documented proof. The case was then referred to the Regional Authorization Committee, which ultimately approved the transplant.
The session concluded with a vote of thanks by Ms. Pallavi Kumar, Executive Director, MOHAN Foundation, NCR, and President, NATCO. She emphasized the importance of continuous knowledge sharing and recommended that more such non-near related living donor cases be discussed in future forums.
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