Development of cadaver renal transplantation in India

We have established a successful cadaver transplant programme in Chennai that could serve as a model for any developing country. A survey of public opinion showed that the higher the educational level, the more willing was the subject to donate. This was because of greater awareness of the possibility of successful transplantation, and indicated the need for education of the public on this aspect. The first step is to enact suitable legislation. Families of potential donors might hesitate to consent to donation if they doubt the legality of the procedure. In India, the doctor commands respect and is more likely to be able to obtain consent than a coordinator. The patient is permitted to stay on dialysis at any convenient city, so long as he or she can reach Chennai within 24 h of being called. To improve the yield, we accept kidneys from donors in acute renal failure, if we know renal function was normal at the time of entry to the hospital. We also accept non-heart beating donors. Marginal kidneys are accepted and both kidneys are transplanted to one recipient. The success with all these procedures is as good as with the others. We were able to perform 88 renal transplants in 4.5 years with a 1 year graft survival of 72%, and a 4 year survival of 63%. Ten donors were in acute renal failure and the 1 year graft survival was 70%. Nine dual transplants were performed with 75% 1 year graft survival.