(As established by the Advisory Committee in its First to Third Meetings)
All private transplant hospitals wishing to join the Tamil Nadu Transplant Network will pay an admission fee of Rs.10,000. There will be no annual fee. The fees will be paid to the Tamil Nadu Medical Services Corporation, who will keep a separate account of funds received and spent or given to the Convenor to meet coordination expenses. No fees are payable by government hospitals.
All transplant hospitals will appoint a Transplant Coordinator (TC), preferably full time, preferably with social work background. The TC will keep in contact with the Convenor, Cadaver Transplant Program, Tamil Nadu (CCTP) and will provide him full contact particulars of himself / herself and two other medical officers of the hospital who can be contacted any time. The TC will ensure that each transplant team in the hospital makes a list of patients assessed by them as needing organ transplant and posts them online or by email on a regular basis in the format required by the CCTP and will ensure that it is kept constantly updated when the patient information changes. The hospital will ensure that the password access to the registry maintained by the CCTP is restricted to only one or two key persons in the organization and the access is handled with full responsibility and confidentiality.
The TC will keep in touch with the ICUs in the hospital and when a brain death is suspected, will swing into action to organize brain death certification, grief counseling of the relatives, handling police liaison in cases of death by accident, seeking organ donation from the relatives and alerting the CCTP if donation looks feasible. She will also coordinate transfer of relevant patient information to the CCTP and to the recipient hospitals nominated by him and will facilitate all steps till organ retrieval is carried out, post mortem done if needed and the body is handed over to the relatives. It is the responsibility of the TC to ensure that the relatives of the donor are inconvenienced the least and are kept informed all the time.
In the event an organ is allocated by the CCTP to a recipient in the hospital list, the TC, being the first point of contact, will swing into action and assist the transplant team in contacting the recipient patient, organizing the logistics of the surgery and facilitating the transplant team’s travel. It is the responsibility of the recipient hospital to ensure that it obtains all needed medical and social information regarding the donor from the donor hospital and assess organ suitability for transplant. It is the responsibility of the recipient hospitals to send teams to the donor hospital to retrieve the organs and preserve them till transplantation.
A private donor hospital is entitled to be reimbursed of all costs incurred by it on the donor cadaver from the time the donor family consents to donate, including assistance in removing, transporting and preserving the organs, as determined by it, subject to a ceiling amount of Rs.75,000.. The total cost as above, will be distributed equally on all major organs such as kidney, liver and heart removed from that cadaver by private hospitals, including organs removed by the donor hospital and the private recipient hospitals of those organs will reimburse their share of the cost to that donor hospital on request made to them by the latter. Government donor hospitals and government recipient hospitals are excluded from this procedure.
Every transplant centre will send a detailed statement to the CCTP immediately (within two days) after each organ donation / transplantation in formats that will be provided by the CCTP. It will also send a monthly statement in a specified format, before the 7th of the next month. It is essential that these statements are sent regularly and on time. All communications with the CCTP should preferably be through email.
The CCTP will maintain a recipient registry on computer, programmed to do organ matching and prioritizing based on pre-set criteria. The programme and the systems set up would ensure that the following actions get carried out smoothly. Whenever an online / email addition is made to the list by any hospital, it will be vetted to see if all information are appropriately provided and will then be loaded to the registry list. After each addition or change made by a hospital to its list, it will be sent its updated list by email. The hospital list will carry an identity number for each patient on the list. The full registry will consolidate the kidney lists of all hospitals into three lists – public hospitals list, private hospitals list and combined list. It will hold basic information required for matching and prioritizing and will carry only patient identity numbers, not names. Password to view these lists online will be provided to all participating hospitals.
For liver and heart, only individual hospital lists will be maintained which should be communicated to the CCTP whenever it is updated. Each hospital has to provide the CCTP the prioritization criteria it proposes to adopt when it sends its list the first time and if and when it changes them. Organs retained by a hospital due to cadaver donation within that hospital and liver and heart allotted to another hospital as share organs will be allocated by the hospital itself according to the hospital list maintained by it and according to prioritization criteria determined by it. This process must, however, be transparent and the list and prioritization criteria must be made available to the CCTP. Any deviation from this prioritization must be intimated to him with reasons. When an organ is allotted to the hospital list, it is to the Indian nationals on the list. If no match is found for the organ in that hospital, followed by other hospitals in the State and in the Country for Indian nationals, it will then be allotted to foreigners in the hospital list, followed by State and Country lists. This is to ensure that Indian nationals get due priority over foreigners in case of organ allocation to hospital lists.
When the relatives of a Deceased Donor request that an organ of the Donor be allotted to a near relative of the Donor – as defined in the THOA – suffering from failure of that organ, this may be conceded to by the Convenor, subject to verification by the concerned hospital.
When the CCTP receives information on organ donation from any transplant centre, he would seek the minimum data required for matching and prioritizing and run the information on the registry to decide on the individual recipients most qualified to get the organs, based on the guidelines set in G.O. [Ms] No.287 and further criteria set by the Advisory Committee. In order to minimize delay in organ removal and inconvenience to the donor family, the CCTP will divide the participating hospitals as belonging to three geographic zones and will prioritise distribution of organs within the donor zone. For the organ/s to be retained in the donor hospital, the hospital will allocate the organs according to the priority criteria it has communicated to the CCTP for its hospital list and should intimate the CCTP the allocation made. The hospital will offer the organ to the first on the list and if, for any reason, it does not work out, will move to the next in the list. Any deviation from this prioritization for any reason must be intimated to the Convenor with reasons therefor. For organs to be shared outside the donor hospital, the CCTP will use the full registry and list the first three recipients. He will then intimate the hospitals where the first choice recipients are registered and will give the hospitals one hour to accept the organ donation. He will simultaneously alert the hospitals concerned with the second choice, and the offer will go to them with a 45 minute deadline, should the first offer be turned down or does not fructify within the allotted time. The CCTP can use his discretion to flexibly adopt these time frames to suit specific circumstances. Should any organ not find a match or not accepted within the state, the CCTP can use his discretion to contact similar coordination agencies in other states and offer the organ to them so that donated organs are fully utilized.
All communications in this regard will be through phone, email or fax as convenient. The CCTP will maintain a summarized record of the interactions. The CCTP will post to all participating hospitals a monthly statement showing the donations made and how the organs were shared, before the15th of the next month.
Kidney Allocation Criteria
Organ allocation priority will be based on seniority of period on dialysis for patients registered in the Initial List. Initial List will consist of recipients registered by participating hospitals during a time window to be announced by the Convenor, CTP. For each recipient there should be solid authentication of dialysis start time, which will be verifiable. Any registration made beyond this period will be prioritized on the basis of seniority of wait time on the List.
Other aspects that will govern the allocation of organs, in addition to those specified in G.O.[Ms] No.287, and the Guidelines established by the Advisory Committee are as follows:
- A recipient can be considered for registration on the list, only if she or he has been on dialysis for at least two months.
- Recipients above the age of sixty can also be registered and will be considered for allocation or kidneys from donors above the age of sixty or of other kidneys not matched or accepted by recipients below the age of sixty.
- A recipient below 10 years of age will have priority to be matched with donors below 10 years.
- In blood group matching, O group recipients will have priority to be matched with O group donors.
To enable smooth functioning, the Convenor, TCP, will keep hospitals concerned posted of top five in the wait list in each blood group, who will, in turn, keep the concerned recipients alerted and evaluate their fitness for surgery.