17 February 2011
By Malathy Iyer
For another, authorities from his home state of Tamil Nadu took over two months to get convinced that Jackson’s father, Don Bosco, could donate a kidney to his son even though they had different blood groups. Jackson’s group was A+ and his Tuticorin–based fisherman father’s was AB +. "The Chennai authorities initially told us that one of us would die if such an incompatible transplant was done," said Jackson, who was discharged from Jaslok Hospital a couple of days back.
Instances of incompatible kidney transplants or transplants between people with different blood groups have been growing across the world, particularly in the US and Japan. Less than 50 such transplants have been carried out in India, mainly at Jaslok Hospital on Pedder Road and CMC in Vellore. Many doctors believe that such incompatible transplants, though expensive, are an option because of the dearth of kidney donors.
"There is a 98% chance of successful kidney transplant if both the donor and recipient have the same blood group. If they don’t have the same group, then the chances drop to 90%," said nephrologist Rushi Deshpande, who has been treating Jackson since he was transferred to Jaslok Hospital in October.
Dr Deshpande believes that Jackson’s experience with the Chennai authorities shows that knowledge about incompatible transplant is poor even among the medical fraternity. "Jaslok Hospital had to send a detailed reply to the Chennai authorization committee about its 25 previous cases of incompatible transplants before the approval was given," added Dr Deshpande.
The Human Organ Transplantation Act requires various clearances before a transplant is approved. As Jackson is domiciled in Tamil Nadu, he needed a clearance from his home state before doctors in Mumbai operated upon him. Jackson was detected with kidney failure in September in a hospital in New Orleans.
He was transferred to Jaslok Hospital on October 3 for an urgent transplant but there was no match in any of his relative. Thereafter, Jackson had to undergo a special plasma exchange to ensure that his blood’s antibodies didn’t react to the donor organ. He was then given a drug called Rituximab to reduce the antibody production.
"These procedures add about Rs 90,000 to the entire operation. Moreover, an incompatible transplant is better than dialysis," said Dr Deshpande. While a standard transplant would cost between Rs 2 and 3 lakh, an incompatible costs double.
There are, however, a section of doctors who are not convinced about the incompatible transplants. "There are short–term complications. Moreover, the longterm results of such transplants are just not on a par with the normal transplants," said a doctor attached to a public hospital.
New technique helps transplant
Transplants are usually done between donors and recipients with the same blood group. If not, the antibodies in the recipient’s blood will reject the donated kidney. But now, a new method has been introduced to remove these antibodies. With this new technique, the antibodies can be removed by either giving the patient a Rituximab tablet or removing his/her spleen. The patient then has to undergo a plasma exchange, in which the old blood plasma is removed and replaced with a new one. After this procedure the transplant can take place.