This document discusses organ transplantation in Bangladesh, including: - The Human Organ Transplantation Act of 1999 allows organ donations from living and brain-dead donors, and was amended in 2018. - Currently, kidney, cornea, liver, and bone marrow transplants are performed, but the ultimate goal is to start cadaveric organ transplantation. - Living donor transplants can only involve close relatives, while brain-dead donors' organs can be donated to recipients. Strict guidelines oversee the declaration of brain death and organ recovery process. - Expanding cadaveric donation and increasing transplant infrastructure and capacity across Bangladesh are recommended to help the thousands currently dying while waiting for transplants.

1. Human Organ Transplantation
Act In Bangladesh And
Cadaveric Transplantation
Presented by
Dr. Md. Tasnimul Khair Shovon
MS- Student (Part- 3)
Department of Urology
Sir Salimullah Medical College and Mitford hospital

2. Introduction
 The initiative of cornea transplantation began in
1974 and the successful cornea transplantation
was conducted in 1984.
 First successful live-related donor organ
transplantation (Kidney transplantation -
BSMMU) started in Bangladesh in 1982.

3.  The Human Organ Transplantation Act
came into officially force in Bangladesh
on April 13, 1999, allowing organ
donations from both living and brain-dead
donors.
 The Act was amended by the Parliament
on January 28, 2018 with revised to
extend a living donor pool from close
relatives.

4. Organ that are Transplantable
(according to Act)
 Kidney
 Heart
 Lung
 Liver
 Bone
 Bone marrow
 Cornea (eye
mentioned in Act)
 Skin
 Tissue
 Any organ which can
be transplantable

5. At present organ transplantation
done in Bangladesh
 Kidney
 Cornea
 Liver
 Bone marrow

6. Organ donation from Living Donors
 The Act prescribes that a living person who is
healthy and has the mental capacity can donate
his/her organs or body part to a close relative if
it is not likely to disrupt their ability to live a
normal life (Section 3:1)
 It also prescribes that the condition does not
apply to transplantation of the eye, skin, tissue,
and bone marrow (Section 6:1b).

7. Close relative (according to Act) (Section 2:4)
1. first-degree blood relatives - parents, adult sons and
daughters, adult brothers and sisters
2. second-degree blood relatives- uncles and aunts from
both the paternal and maternal sides
3. non-blood relatives- spouses
4. include certain other relatives such as grandparents,
grandchildren, and first cousins (include in list on
revision of act in 2018)
If the donor and recipient are not close relatives as set out
in the Act, donation is not legally allowed.

8. Brain death
 Brain death is defined in terms of permanent
functional death of the brain stem as neither
consciousness nor spontaneous respiration is
possible in the absence of a functional brain
stem.

9. Declaration of brain Death
 The Act authorizes a brain death committee to
declare brain death included three expert
physicians with the rank of Professor or Associate
Professor in
1. Medicine or Critical Care Medicine
2. Neurology
3. Anesthesiology
None of the member of committee or their close
relative is connected with any transplantation team.

10. Clinical testing for brain-stem death

11. After declaration of brain death by
committee
 Brain death declaration committee will inform the
transplantation co-ordinator (above Associate
Professor – recruit by government)
 Transplantation co-ordinator will inform medical
board to take necessary action for transplatation.

12. Medical board formation
 Related subject professor ( expert in
surgery) – 1
 Above Associate Professor in
Anesthesiology – 1
 Director of the hospital or nominated
person (director rank) – 1

13. Medical board will do
1. Clarify the relationship between donor and
recipient.
2. Take decision for transplantation.
3. Take action for brain death donor organ
collection.
4. Give decision for priority of recipient.

14. Eligible as donor
 Brain death declare as for cadaveric donor -
Age - 2 year to 70 year
 As living donor : age – 18 year to 65 year
(This section will not applicable for eye, skin,
tissue and bone marrow transplantation)

15. Not eligible as donor
 Patient has written objection about organ
donation before death.
 Patient was HBsAg or Anti HCV or HIV
positive.
 Medical board declare as not eligible.
 Presence of cancer except primary CNS or skin
cancer.

16. Eligible as recipient
 Age – 2 year to 70 year (15 year to 50 year of
age patient will get Priority as recipient)
 Medical board declare as eligible.

17. Cadaveric national committee
1. Vice-chancellor of BSMMU – President
2. Joint secretary of health service division of MOHFW- 01-
member secretary
3. Head of department of related subject of transplantation
hospital.- 01
4. Professor of related subject from BSMMU – 01
5. Joint secretary from legislative and parliament division -01
6. One director from DGHS -01
7. one representative from related specialized govt. hospital -
01

18. 8. one representative from BMDC-01
9. Government recruit famous
I. Neurologist – 01
II. Cardiologist- 01
III. Anesthesiologists -01

19. Cadaveric national committee
function
 Give valuable openion and direction about
cadaveric organ collection.
 Inspection of cadaveric organ collection.
 Give immediate advise about Cadaveric organ
collection.
 Give opinion to government about the program.

20. Organ recovery from brain death
donors
 After brain-stem death has been confirmed (in ICU)
 Donors are a usually given vasopressin,
methylprednisolone to aid fluid and metabolic
management, together with triiodothyronine (T3) to help
cardiovascular stability
 Donor shift to OT , incision was made, perfused with
chilled organ preservation solution via an aortic and
portal cannula.

21.  Blood and perfusate are vented from the left atrial
appendage and the inferior venacava, Additional surface
cooling of the abdominal organs may be achieved by
application of saline ice slush
 heart and lungs are excised simultaneously with the liver
and pancreas, followed by the kidneys, either en bloc or
separately.

22.  When removing the donor kidneys care is taken to
ensure that any polar renal arteries are included on an
aortic patch with the renal artery

23.  After removal from the donor, the organs may undergo a
further flush with chilled preservation solution before
they are placed in double or triple sterile bags and stored
at 4°C by immersion in ice, while they are transported to
the recipient centre and await implantation.

24. Technique of renal Implantation
 curved incision is made in the lower abdomen and, after
dividing the muscles of the abdominal wall, the
peritoneum is swept upwards and medially to expose the
iliac vessels, controlled with vascular clamps.
 kidney is then removed from ice and the donor renal
vein is anastomosed end to side to the external iliac vein.

25.  donor renal artery (patch of donor aorta) is
anastomosed end to side to the external
iliac artery.
 While the vascular anastomoses are being
undertaken, the kidney is kept cold by
application of topical ice.

26.  After completion of the venous and
arterial anastomoses, the vascular clamps
are removed and the kidney is allowed to
reperfuse with blood.
 Then direct implantation of the ureter into
the dome of the bladder with a mucosa-to-
mucosal anastomosis with double j stent
in situ.

27. Transplant kidney is placed in the iliac fossa, in
the retroperitoneal position, leaving the native
kidneys in situ.

28. Living donor kidney implantation

29. Punishment according to act
 If any one give wrong information about closed relative
will be punished – not more than 2 year Rigorous
imprisonment or not more than 5 lac penalty or both
 Other than this if the law is broken - not more than 3
year Rigorous imprisonment or not more than 10 lac
penalty or both
 If any doctor punish by this law, his or her registration
will be canceled from BMDC.

30. Limitation of the Act
 only allows Bangladeshis to legally donate their
organs to save the lives of relatives.
 There is no scope of financial compensation for
a distant relative donor’s post-operative care in
the absence of healthcare coverage.

31. Conclusion
 Chronic kidney disease and subsequent End
Stage Renal Failure is a major health concern in
Bangladesh afflicting huge number of patients.
 They need renal replacement therapy like
dialysis or kidney transplantation.
 Living donor kidney transplantation is currently
the main type of transplantation in Bangladesh.

32.  Because of the shortage of organ donation and
capacity for organ transplantation, each year
thousands of Bangladeshis die while waiting for
an organ donor and possible transplantation.

33. Recommendation
 We need to start cadaveric organ transplantation
for save our people.
 We need to develop efficient dedicated
transplant surgeon and transplant unit to expand
the transplantation program in every division of
our country.

34. THANK YOU