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| INOS GUIDELINES FOR ORGAN SHARING | |
| ESSENCE OF INOS | |
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“Organs should be treated as national resource and No Organs should be wasted” |
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| ORGAN SHARING – GENERAL GUIDELINES | |
| A common waiting list of recipients wishing to undergo cadaver transplant should be maintained. | |
| Before putting patients on waiting list the consultant should ensure | |
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a) |
Should inform him/her that no guarantees that organ will be available within a period of time. |
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b) |
Counsel the patient about cadaver kidney transplant |
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c) |
Should tell the patient that the kidney may not function immediately and may take up to 4 to 6 weeks to work and a few dialysis may be necessary. |
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d) |
Should tell the patient and relatives that 90% of all kidney transplants are done from cadaver kidneys abroad. |
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e) |
The long-term success and graft outcome though not as good as live related transplants, however the difference is only 5-10%. |
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f) |
The cost of treatment may be less or more than live related transplant depending on the immediate outcome of the transplant graft. |
| A small registration charge of Rs.1000/- is recommended from the patient of which Rs. 500/- should be refundable if the patient fails to get a cadaver transplant or if the patient wishes to be taken off the list. However this decision to charge is entirely up to the local INOS committee. | |
| Before putting the patient on waiting list for cadaver transplant the consultant should ensure | |
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a) |
The patient has adequate access for dialysis |
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b) |
The patient is relatively fit to undergo surgery. |
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c) |
Has obtained cardiac clearance, dental checkup and gynaecology examination if necessary |
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d) |
A full urology assessment. |
| Periodic assessment of these patients is essential. If the patient is found unfit for some reason they should be deactivated from the list. | |
| If a hospital has a Brain dead donor who is going for organ retrieval, one kidney and one cornea should stay in the hospital and the other kidney and cornea should go to the common pool of waiting list patients. | |
| The INOS follows simple principle for prioritization of organ on the common waiting list. For Kidneys the guidelines followed at present are as follows: | |
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a) |
It gives priority to the patient who is the longest on waiting list to get the organ. If the patient is unfit or refuses, the second patient is called for and so on. If possible serum should be kept and a historical cross match should be done before calling the patient. After this a second cross match is undertaken when the patient arrives. |
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b) |
‘O’ organs should go to O recipients. Organs from A or B can go to their respective blood group or to AB |
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c) |
If other INOS groups wish to evolve their own guidelines on organ sharing they should send one copy to Mohan Foundation. |
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d) |
The heart stays in the hospital of organ retrieval if there is a patient available. |
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e) |
If no patients are available for heart in the hospital of retrieval it should be offered to other hospitals. Heart valve retrieval should only be done if there are no recipients available in the city. |
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f) |
The same principle as heart applies for livers too. |
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g) |
Other criteria’s for sharing heart, liver and kidneys can be evolved in the future once the cadaver programme stabilizes in the region. However in the initial stages (first 100 cadaver organs) simple principles of sharing should be evolved. |
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h) |
A computerized web based registry is now available. If the hospital wishes to join they can write to Mohan Foundation, Chennai (www.mohanfoundation.org/inos) |
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i) |
One consultant from each specialty should be made in charge and should be the first person to be informed if an organ is available. He or she should then consult the waiting list and make organ allocation for that region. |
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j) |
If no recipient is available in the region the organ can be offered to other regions. First preference should be given to INOS hospitals in other regions. |
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k) |
The updating of the waiting list is the responsibility of the hospital concerned. This can be done by each hospital by using the web-based registry. Otherwise this information should be passed to the consultant in charge during the monthly INOS meeting. |
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l) |
The graft outcome should be discussed in the INOS meeting. |
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m) |
Organ sharing protects the hospital against any accusation by the press or the public. It also creates goodwill for the hospital in the community and helps with the progress of the programme. |
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n) |
Any differences in organ sharing should be resolved during INOS meeting and in the larger interest of the programme these differences should not be made an issue. There is no place for individual egos clashing in the whole INOS organ-sharing network. Everyone should be treated equally and their views should be respected even if they are not in agreement with the consensus view. As far as organ sharing is concerned, the last word in any dispute should be from the consultant in charge of that organ. However if the grievance continues to haunt the aggrieved member; the INOS Governing council Chairman should appoint a three members committee and the decision of the committee should be respected by all. |
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