true story, cadaveric renal transplantation, first in central india, long term survival, dr. pradeep salgia,

1. First Cadaveric Renal
Transplantation
Narrated by – Dr. Pradeep Salgia

2. Tribute to Mayank Mehta
The measure of life is not in its duration, but in its donation

3. Proud parents
Dilip Mehta Sangita Mehta

4. Donation is not new to India
Maharishi Dadhichi donated his bones to Lord Indra
for Making “Vajra”, a most powerful weapon used in
war against asuras.

5. Organ transplantation not new to Indians

6. SUSHRUTA SAMHITA
The art of transplantation was known in ancient India
सुश्रुत संहिता
(ca. 500 BC)

7. Then what holds us back from organ donation?
Knowledge
Desire
Courage
Motivation
Religion

8. Challenges in Organ donation
 Organ shortage
 Family consent and negative attitude contribute towards
organ shortage.
This could be due to the following reasons –
 Misinterpretation of Religion
 Fear, ignorance and misunderstanding
 Legal aspects
 Media reports on scandals involving organ rackets

9. “Whosoever saves a life, it would be as if he
saved the life of all mankind.”
Holy Qur’an, chapter 5, vs. 32
One who saves a single life – it is as if he has
saved an entire world”
Pirke D’Rav Eliezer, Chapter 48
“Of all the things that it is possible to donate, to
donate your own body is infinitely more
worthwhile.” The Manusmruti

10. “Where self exists, there is no God. Where God
exists, there is no self.”
Guru Nanak (founder of Sikh faith, and first of ten
Gurus), Guru Granth Sahib (Sikh Holy Scripture)
“In eternity we will neither have nor need our
earthly bodies: former things will pass away, all
things will be made new.”
Revelation 21:4,5
“What loss do I suffer to give an unwanted organ
after my death to give another person life?”
Dr Desmond Biddulph, Chairman of The Buddhist
Society

11. Don't take your organs to heaven with
you. Heaven knows we need them here
1person can save 50 people
JUST
THINK…
We make a living by what we get, but we make a life
by what we give.

12. Legal aspect
Ministry of Law, Justice and Company Affairs
(Legislative Department)
New Delhi, the 11th July, 1994
The following Act of Parliament received the assent of
the President on the 8th July,
1994 and is hereby published for general information:-
THE TRANSPLANTATION OF HUMAN ORGANS ACT, 1994
No.42 OF 1994
[8th July, 1994]
Transaction of money between Donor and Recipient is against Law

13. MYTHS
 Age – Too young or too old
 Single or multiple/Specific organ donation
 Religious misbelieve
 Favouritism to rich and famous
 Organ donation scandals (true only to a
certain extent)
 Pre-existing Medical diseases

14. Facts
 Age, Sex, religion, nationality, general
medical disability/diseases, financial
status, have no bearing for organ
donation.
 HIV and Hepatitis C are
contraindications.
 Hepatitis C organs may be transplanted
to a patient of Hepatitis C.

15. The First Cadaveric
Renal Transplantation
A true story narrated by Dr. Pradeep Salgia

16. 22nd April, 2000
Mayank Mehta, a 16 year old boy met a severe road
accident and was put on ventilator at Suyash
Hospital.
23rd April, 2000
Neurosurgeon Dr. Rakesh Gupta declared him brain
dead. His parents Dileep & Sangeeta were grief
stricken and refused to accept the situation.
2:00 PM
When I got the news, my wife was sitting beside me
and she asked about the possibility of organ
donation. It was a difficult task to talk about this to
the aggrieved parents in the given situation, when
they would not accept their son’s sudden demise.

17. Had it been a Western country this task would
have been done by the social workers.
4:00 PM
I went to the ICU in Suyash Hospital to inquire
about the exact situation. The duty doctor
confirmed the news, he said that Mayank’s
kidneys were still functioning and he was on
respiratory and blood pressure support.
5:00 PM
I was searching for the parents when the
volunteers from Humad Jain Samaaj arrived
and I explained them the situation. We felt that
it was easier to convince Mayank’s mother than
his father, since she was a religious and bold
lady.

18. 10:00 PM
As soon as I came to know that the family had
agreed for organ donation, I rushed to Choithram
Hospital. I informed the Medical Director, Dr. K. L.
Bandi, Dr. R. K. Lahoti, Dr. C. S. Chamania, Dr. S.
Thatte, Dr. A. Goel, Dr. Satish Pathak, Dr. D. S.
Chitnis, Dr. Bhatia and Dr. C. S. Pandit about the
possibility of Cadaver Transplant late in the night.
12:00 AM (24th April, 2000)
The dialysis unit was opened and the nursing staff
was called for immediately. The contact details of
the dialysis patients with matching blood group
were retrieved from the record book.

19. 1:00 AM
I started calling the dialysis patients. The first
one said that they would think about it the
next morning. The second one refused
bluntly. The third and fourth calls went
unanswered.
I had started getting anxious that nobody
would turn up for the organ transplant. I
made the fifth call to Dewas, where the
patient’s father received the call and
immediately agreed to bring his son. I
instructed him to keep the patient fasting
and rush immediately to Choithram Hospital.

20. 3:00 AM
Patient Ashok Malu arrived in the dialysis unit,
his blood sample was drawn for cross match
and other tests. His dialysis started without
heparin.
3:30 AM
The donor’s blood was brought from Suyash
Hospital and Dr. Chitnis and his team started the
cross match.
Then, I started searching for the next recipient,
the next call was made to a patient staying
close to Choithram Hospital and her husband
agreed immediately.

21. 4:30 AM
The second recipient also arrives in the hospital.
The atmosphere of the hospital was thrilling at that
moment. Then came a sudden blow, as per the organ
transplant act, the organ retrieval had to be carried
out in Choithram only. Thus, Mayank was to be
shifted from Suyash Hospital and his father refused
to the shift the patient in this condition.
5:00 AM
I rushed to Suyash Hospital and explained Mayank’s
parents about the technical difficulties and was
finally able to convince them to shift Mayank to
Choithram Hospital.

22. 5:30 AM
I shifted the patient in an ambulance on Ambu
bag and dopamine drip along with a duty doctor
and rushed to Choithram Hospital.
6:00 AM
The donor was taken straight to the ICU in
Choithram Hospital and put on life support.
6:30 AM
Members of the brain death committee Dr. J. S,
Kathpal, Dr. V. Haridas and the Medical Director
were called to verify brain death.

23. 9:30 AM
The first recipient Ashok Malu is ready for
the transplant.
10:00 AM
Despite using vasopressor, Mayank’s B.P.
was falling and serum creatinine had started
rising. If the patients kidney goes into Renal
failure, then the transplant outcome would
be poor.
10:30 AM
The tissue cross match is reported negative.

24. 11:00 AM
The brain death committee verifies the brain
death for the second time as per law.
11:30 AM
The donor was shifted to the operation
theatre. Kidney transplant team began
kidney retrieval Dr.S.Pathak took the Biopsy
for frozen section, Dr. Mrs. Shobha
Chamania. and the team started retrieving
the skin from the back Dr.S.Parwani, Dr.
Shreya Thatte took out the corneal grafts.

25. In the meantime Dr. S.Pathak announced that the
tissue architecture in the Biopsy was O.K., so the
second team started to transplant the kidney in to
the first recipient Ashok Malu.
12:30 PM
The ventilator was disconnected after the organ
removal and Mayank was finally declared dead. The
body was handed over for the post-mortem. I
requested the administration of M.Y.H. to expedite
the post-mortem formalities. The second recipient
developed high grade fever while preparing for the
transplant and the surgery had to be cancelled.
Dr.Pandit packed up the second kidney in saline and
double packed it and buried in the ice.

26. 3:00 PM
The first cadaver transplant was carried out
successfully. The patient started making some urine
and was shifted to kidney transplant room.
Since the second recipient was cancelled, I started
looking for other dialysis patients. On my second
attempt, the response came again from a patient
from Dewas.
Yajuvendra Rajput's mother, who was a nurse
volunteered immediately for the second surgery,
but expressed her inability for the surgery due to
financial constrains. The only option left was to
discuss the situation with the management.

27. 5:00 PM
I reached the office of Managing Trustee, Shri
Motiani and told him that we have a Donor
Kidney and a recipient, but it could not be
transplanted due to financial constrains and the
donor’s kidney would go waste. He asked for
the budget and after hearing my reply, gave
me immediate sanctioning and told me to go
ahead with the second transplant without any
deposit.
6:00 PM
Dr. Chitnis started second patients tissue cross
match and we started dialysis, to make him fit
for surgery.

28. 11:00 PM
Second Cadaver transplant began.
2:00 AM (25th April, 2000)
Yajuvendra was shifted to the kidney transplant
room. The entire surgical team was satisfied with
whatever had been done. Dr.Pandit and myself were
under great stress because the second recipient did
not make any urine, but we were hopeful that
sooner or later it would function.
8:00 AM (27th April, 2000)
I left for home after two days and two nights,
without sleep and food, but with great satisfaction
that we could make Choithram Hospital, the first one
in Central India to start cadaver transplant.

29. Mayank Mehta's name became immortal in
the history of Indore.
25th April, 2005
Five years later, I am sitting at my home and
writing the account of the event for the
History book of Choithram Hospital. Both
recipients Ashok Malu & Yajuvendra Rajput
were healthy, happy and enjoyed good life
for five years.

30. • Another case of cadaver transplant done
in 2001.
• Mr. Mathew donated the kidneys his
daughter Shijo after her brain death and
the recipient still living after 11 years.
• The link to the vedio of this patient can
be watched at:
• https://www.youtube.com/watch?v=3T3zMwLg
Zns&feature=youtu.be
10 years survival of cadaver transplant

31. History of the First’s
 The first kidney transplantation in the United
States was performed on June 17, 1950.
 The first kidney transplants between living
patients were undertaken in 1954 in Boston and
Paris.
 In 1967 – First successful cadaveric renal
transplant was done in KEM Mumbai.
 In 1982 - First-ever live-related kidney
transplant was performed at Osmania
General Hospital.
 In 1985 – First live related kidney transplant
was performed at CH&RC, Indore.

32.  In 1994 – First successful heart transplantation
was done at AIIMS, New Delhi.
 In 1995 - First successful multi organ
transplantation was done at Apollo,
Chennai.
 In 1998 – First Successful Lung transplant,
Madras Medical Mission Hospital, Chennai.
 In 1999 – First Pancreas Transplant,
Ahmadabad.
 In 2000 – First Cadaveric transplant performed
at Choithram Hospital.
History of the First’s

33. Dr. K. L. Bandi
Dr. A. Goel
Dr. S. Thatte
Dr. C. S. Chamania
Dr. R. K. Lahoti
Dr. S. Bhatia
Surgical Team
R.K.Lahoti

34. Surgical team working on Donor

35. Harvesting the Kidney

37. Surgical team working on Recipient

38. Perfusion of kidney before transplantation

39. A perfect gift to mankind

40. Surgical Team working on Recipient

41. Vascular anastomosis

42. Dr. Pradeep Salgia
http://www.drpradeepsalgia.com/

43. Thank You