At AIIMS, 78-year-old donates both kidneys to 51-year-old: Why this procedure can ease India’s kidney donation waitlist

Who are donors selected for a DKT?

In this procedure, kidneys from donors aged 60 and above can be utilized for transplant, termed expanded criteria donor (ECD) kidneys. Essentially, an ECD refers to donors aged 60 or older, or those over 50 with a history of high blood pressure, a creatinine level equal to or greater than 1.5 (a marker of kidney function), or those who have passed away due to a stroke.

Can kidney donation from an older donor, such as a 78-year-old, effectively benefit patients?

Dr Asuri Krishna, an Additional Professor of Surgery at AIIMS, New Delhi, who conducted the surgery, explains that while organs from brain-dead donors over 65 years old are typically not accepted, due to India’s organ scarcity, his team opted to maximize the utilization of this donor.

“When utilizing a kidney from a young donor, we typically only use one, as the recipient typically thrives with just that single kidney. However, in a unique scenario like this, where the donor was 78 years old, we decided to transplant both kidneys into a single patient. This procedure is quite rare and is usually reserved for elderly donors. As organs age, they tend to lose some functionality. While a kidney from a younger donor would be more efficient, organs from older donors may not function as effectively. Thus, we opted for a dual kidney transplant,” explains Dr. Asuri. “Despite the age of the donor, the patient can still expect to live with these kidneys for 8-10 years.”

How can dual kidney transplants from elderly donors help kidney patients?

A majority of patients needing renal replacement therapy are over 50 years old. Unfortunately, due to the scarcity of organs, there’s often a lengthy wait for both dialysis and kidney transplants. However, Dr Asuri, points out that dual kidney transplants not only address the pressing demand for organs in India but also utilize resources that would typically go unused. “By harnessing the potential of organs from elderly donors that might otherwise be rejected, this surgery serves as a great example of maximizing limited resources to bridge the gap between supply and demand in the organ donation system,” says Dr Asuri.

How was the surgery conducted?

The surgery involved placing two new kidneys in a heterotropic manner alongside the patient’s native kidneys, resulting in a total of four kidneys. Dr Asuri explained that the main challenge was positioning both kidneys on the patient’s right side due to the advanced age of the donor, who was the second oldest organ donor at AIIMS, New Delhi. “..Her single kidney would not have been sufficient for a patient on dialysis. We had to clamp the major artery and vein of the patient to join the 1st kidney and then place the second kidney below it. Therefore, a decision was taken to use both kidneys in a single recipient,” he said.