One of the first people who wrote to us after the very first issue of the Indian Transplant Newsletter was Padma Shri D. K. Karanjavala, M.S, FRCS (Eng) from Bombay. Many of us tend to think of cadaveric transplants in India as new but cadaveric renal transplantation were carried out in the mid 1960’s by Dr. D. K. Karanjavala and his team at the K.E.M Hospital, Bombay

Dr. Karanjavala was the Urologist & Surgeon-in-charge of Kidney Transplant programme at K.E.M Hospital for several years. Their work was published in the Indian Journal of Surgery – “Cadaveric Renal Transplantation; A report of initial experience” – Vol.29 No.2, pp.76-87, 1967. Here are a few excerpts from the article by P. K. Sen, D. S. Pardanini, G. B. Parulkar, S. R. Panday, D. K. Karanjavala, Department of surgery, K.E.M Hospital:

“The aim of the paper is to report our initial experience with two cases of cadaveric renal transplantation. Case No.1: A male aged 55 years had undergone right nephrectomy for renal cell carcinoma in 1965.  He also had a left Renal Carcinoma. The patient underwent cadaveric renal transplantation. The donor, a case of head injury, was a young male.

Post-operatively, the patient did well. A renal scan using labelled Neohydrin carried out on the 7^th post-operative day showed good graft function. On the 8^th post-operative day the left kidney and spleen were removed. The graft continued to secrete adequate quantity of urine. However, on the 11^th post-operative day the patient died. Autopsy showed recent myocardial infarction. The renal graft was normal.

Case No.2: A male aged 45 years was diagnosed as a case of hypertension in 1963. On investigation, he was found to have a non functioning right kidney and two calculi in the left kidney. Following right nephrectomy in 1965, for 3 months his blood pressure settled to normal levels. On follow up his blood pressure was found to be 210 / 100 mm Hg. On investigation the kidney showed changes of chronic pyelonephrits. Cadaveric renal transplantation and removal of the left kidney were carried out at the same time on 12.4.66. The donor was again a case of head injury. The patient developed severe respiratory infection and died on the 3rd post-operative day."

The problem that Dr. Karanjavala's renal transplant group was faced with were:

1. Technical difficulties involving surgical grafting and the procurement of the cadaveric renal grafts
2. Immunological problems
3. Infection

However the toughest problem to handle was the very hostile reaction amongst some members of the medical profession and genaral public to the pioneering efforts at using cadaver donors. There was even a talk organised at the Rotary Club under the heading "Neo-Cannibalism". Dr. Karanjavala says this reaction led to a great setback to the cadaver programme in not only Bombay but also perhaps the rest of the country.

A quarter century later, in 1999 the scene in Bombay has changed little, this may be the reason why Bombay today lags behind other cities of the country in this activity - Dr. Karanjavala reiterates. A news item that appeared in The Times of India last year, bemoaned the fact that the cadaveric transplant programme has not taken off in Bombay. The programme was initiated in March 1997 and since then only about 9 transplants have been done. All of these have been only kidney transplants.

There is a lack of awareness, motivation and an underlying sense of suspicion amongst not only the public but also doctors. Dr Sanjay Nagral, a Gastrointestinal Surgeon of Jaslok Hospital and Member Forum for Medical Ethics reiterates the fact that the lack of awareness about cadaver transplantation extends even to the medical profession. He also feels, that there is a lack of effort on the part of institutions to convince the patients' relatives for organ donation. Dr. Nagral pointed out that if the cadaveric programme was to succeed, there had to be a sustained campaign involving the Government, the medical profession and the NGOs.

A beginning has been made with the Sion hospital being named the Zonal Coordination Centre. It has recently proposed the setting up of a computerised central registry to link potential donors and recipients in hospitals, according to Dr. Vatsala Trivedi, Head of the Sion Hospital's Urology Department.

Bombay needs to get inspired by the gesture of the recent cadaver donors families who have gifted the organs of their loved ones, so that someone unknown to them may get a second chance in life. What is now required is a coordinated effort.