Taking another major step towards easing rules and procedures to encourage organ donation among the masses, the National Organ and Tissue Transplant Organisation (NOTTO) under the Union health ministry has issued draft guidelines for allocation criteria for deceased donor kidney transplant.
The draft guidelines include issues such as recipient registration, listing and scoring system in the waiting list; scoring system for making priority; allocation principles; allocation algorithm, including criteria for urgent listing; and inter-state issues.
On the issue of recipient registration, listing and scoring system in the waiting list, the guidelines state that the patient is to be registered by the concerned hospital through online registration form on www.notto.nic.in and a kidney advisory committee will approve registration and urgency criteria, if any. A kidney advisory committee will confirm need of renal transplant of every newly registered patient. Once approved, only then patient will be put on active list in the system and allocation scoring for that patient will be done on the guidelines formed.
As per the guidelines, the patient should be up to 65 years of age. The patient should be a case of end stage renal disease on maintenance dialysis for more than three months on regular basis. Patient should not have an absolute contraindication for renal transplant, such as advanced untreatable cardiovascular disease, irreversible cerebrovascular accident, inoperable malignancy and untreatable major psychiatric illness.
The guidelines further state that the patient should be registered only in one hospital registered under THOTA with state authority. However, he/she can change the hospital at any stage and his allocation scoring and seniority in central waiting list will not change. However, his seniority in the waiting list of locally available kidney, with the new hospital will be applicable one month after date of change. Patient can be registered for deceased donor even though patient is waiting for living donor transplant. However, his priority of getting deceased kidney will be lower than a recipient who does not have any medically fit living donor.
As per the guidelines, allocation will be done first based on city waiting list. If no recipient is eligible in city waiting list then allocation will be done to state and then to other states in the ROTTO and then to other ROTTO nationally. In order to minimise cold ischemia time, most donated organs should be allocated within the city or at the most state, where retrieval has been done. Kidney from paediatric donor (less than 18 years) first will go to paediatric patient. If no paediatric patient eligible, then to adult patient.
Blood group O kidney will be allocated to recipient with group O, then to next available on waiting list of other compatible blood groups i.e. first group A, then group B and lastly group AB in that sequence. In case of blood group A or B, the organ will be allocated to same blood group failing which to blood group AB. AB will be allocated to AB only
The ministry has invited comments, suggestions or views from the experts as well as from the general public to fine tune the guidelines. The suggestions can be sent to the ministry till January 16, 2016.