In Pakistan, Living related renal transplant (LRRT) is the preferred renal transplant option. Although the number of cadevaric donors are on the rise but it is still in it`s infancy. In this presentation i have described the necessary requirements for LRRT.

1. PREPARATION OF CASE FOR LIVING
RELATED RENAL TRANSPLANT IN
PAKISTAN
By
Dr. Muhammad Saifullah
Post-Graduate Resident
Department of Urology & Renal Transplantation
Allied Hospital, Faisalabad.

3. The journey of a thousand miles begins with one step.
Lao Tzu
Even the longest and most difficult ventures have a
starting point.

4. Mr. Richard Lee Herrick
(Left)
Is Recipient.
Mr. Ronald Lee Herrick
(Right)
Is Donor.

5. EVALUATION COMMITTEE
APPROVAL

6. EVALUATION COMMITTEE
It includes a Urologist, Nephrologist,
General Surgeon, General Physician,
Neurophysician and Anesthetist.

7. NATIONAL ID CARDS
1. Recipient (B-Form if less than 18 years)
2. Donor

8. RELATION BETWEEN DONOR &
RECIPIENT (LEGAL)
3. Family registration certificate from NADRA

10. FAMILY REGISTRATION
CERTIFICATE
• If the Donor/Recipient are Brother/Sister or
Father/Son etc…… FRC of Father is
required.

11. FRC OF FATHER
Mother Father
Son # 1
Daughter
#1
Son # 2
Daughter
# 2

12. FAMILY REGISTRATION
CERTIFICATE
• If the Donor/Recipient are
Husband/Wife…… FRC of husband is
required.

13. FAMILY REGISTRATION
CERTIFICATE
• If the Donor/Recipient are Cousins…… FRC
of Grandfather, Donor’s Father &
Recipient’s Father is required.

14. FRC OF GRANDFATHER
Grand
Mother
Grand
Father
Son # 1
Grand Son
# 1
Grand Son
# 2
Daughter #1 Son # 2
Son –in-Law
& Daughter
# 2
Grand
Daughter #
1
Grand Son
# 1

15. AFFIDAVIT FROM DONOR
4. Affidavit from donor that he is willing to
donate the Kidney
• With his/her own will (Voluntary intent)
• Without any pressure
• Without any involvement of Money

16. AFFIDAVIT FROM DONOR
• Also mentioning his relationship with the
Recipient
• In presence of two witnesses
• Attested by the Magistrate (Not OATH
COMMISSIONER)

17. AFFIDAVITS
5. In case the donor sister is married ……
Affidavit from husband of the Donor Sister .
6. In case of donor sister is unmarried……
Affidavit from the Father / Brother.

18. MARRIAGE REGISTRATION
CERTIFICATE
7. If donor is wife/husband, Nikkah Nama is
required.

20. PUNJAB HUMAN ORGAN
TRANSPLANT AUTHORITY
APPROVAL
(To be sent for Approval from
Punjab Human Organ Transplant Authority, PHOTA)

21. FILES
1. RECIPIENT FILE with a one copy signed by
Transplant Surgeon and Administator.
2. DONOR FILE with a one copy signed by
Transplant Surgeon and Administator.

22. APPROVAL FEE
3. Rs. 10,000/- Bank Draft in the name of
PUNJAB HUMAN ORGAN TRANSPLANT
AUTHORITY

23. HOTA (PUNJAB) FORMS
4. Donor Form
 Form (I)…… Close Blood Relative
 Form (II)…… Spouse
 Form (III)…… Non-Close Blood
Relatives

24. HOTA (PUNJAB) FORMS
5. Recipient Form
 Form (I)…… Close Blood Relative
 Form (II)…… Spouse
 Form (III)…… Non-Close Blood
Relatives

25. Close
Relative
Father
Mother
Son
Daughter
Sister
Brother

26. Non-
Close
Relative
Uncle
Aunt
NieceNephew
Cousin

27. Non-
Close
Relativ
es
Taya
Chach
a
Mamu
Phuph
i
Khala
Taya
Zaad
Bhai
Chach
a Zaad
BhaiMamu
Zaad
Bhai
Phuph
i Zaad
Bhai
Khala
Zaad
Bhai
Taya
Zaad
Behan
Chach
a
Zaad
Behan
Mamu
Zaad
Behan
Phuph
i Zaad
Behan
Khala
Zaad
Behan

28. EVALUATION COMMITTEE
APPROVAL
4. Certifcate of Approval from Evaluation
Committee

29. NATIONAL ID CARDS
5. Recipient CNIC (B-Form if less than 18
years)
6. Donor CNIC

30. RELATION BETWEEN DONOR &
RECIPIENT (LEGAL)
7. Family registration certificate from NADRA

31. AFFIDAVIT FROM DONOR
8. Affidavit from donor that he is willing to
donate the Kidney

32. FILE PREPARATION
RECIPIENT

33. 1. LEGAL WORKUP
2. GENERAL INVESTIGATIONS
3. FINAL INVESTIGATIONS
4. VACCINATION STATUS
5. IMPORTANT TASKS DURING
ADMISSION (IF REQUIRED)

34. 1. LEGAL WORKUP
 CNIC
 Family Registration Certificate
 Affidavit from Donor
 Computerized Marriage Certificate
 Affidavit from married sister’s husband

35. 2. GENERAL INVESTIGATIONS
 Hematological
 Blood Grouping (ABO)
 CBC
 PT, APTT
 B. Urea / s. Creatinine
 s. Electrolytes (Na, K, Ca,
Phosp, Cl & HCO3
 S. Uric Acid
 Fasting Lipid Profile
 Liver Function Tests
 Fasting Blood Sugar
 Parathyroid hormone

36. 2. GENERAL INVESTIGATIONS
 Urine
 Complete Exam
 Culture / Sensitivity
 24 hour Urinary
Proteins
 Immunology
 HBsAg
 Anti-HBsAg Titre
 Anti-HCV
 CMV IgG
 CMV IgM
Approximately 20% to 60% of all transplant recipients develop symptomatic CMV infection

37. 2. GENERAL INVESTIGATIONS
 Radiological
 ECG
 Chest X-Ray
 Ultrasound Abdomen &
KUB
 Echocardiography
 Doppler for Pelvic
Vessels (Especially for
Diabetics)
 Stress Thalium Scan
(Especially for Diabetics)

38. 3. FINAL INVESTIGATIONS
 HLA Tissue Typing
 HLA Cross MAtch

39. 3. FINAL INVESTIGATIONS
The effects of HLA-DR mismatches are the most
important in the first 6 months after transplantation,
the HLA-B effect emerges in the first 2 years
and HLA-A mismatches have a deleterious effect on
long-term graft survival .
Reference: Mahdi BM. A glow of HLA typing in organ transplantation. Clin Transl Med. 2013;2:6.

40. 4. VACCINATION STATUS
 Hepatitis B
 Pneumococcus
 H. Influenzae

41. 5. IMPORTANT TASKS DURING
ADMISSION (IF REQUIRED)
Involvement of
 Nephrologist
 Cardiologist
 Pulmonologist
 Anesthetist
 Dentist
 Gastroenlerologist
 Ophthalmologist (For
Fundoscopy)
(For treatment of Co-morbid
conditions)

42. FILE PREPARATION
DONOR

43. 1. LEGAL WORKUP
2. GENERAL INVESTIGATIONS
3. FINAL INVESTIGATIONS

44. 1. LEGAL WORKUP
 CNIC
 Family Registration Certificate
 Affidavit from Donor
 Computerized Marriage Certificate
 Affidavit from married sister’s husband

45. 2. GENERAL INVESTIGATIONS
 Hematological
 Blood Grouping
 CBC
 PT, APTT
 B. Urea / s. Creatinine
 s. Electrolytes (Na, K, Ca,
Phosp, Cl & HCO3
 S. Uric Acid
 Fasting Blood Sugar
 Oral Glucose Tolerance
Test
 HbA1c
 Fasting Lipid Profile
 Liver Function Tests
 Parathyroid hormone

46. 2. GENERAL INVESTIGATIONS
 Urine
 Complete Exam
 Culture / Sensitivity
 24 hour Urinary Proteins
 24 hour Urine for
Creatinine clearance
 Urine Pregnancy Test (If
required)
 Immunology
 HBsAg
 Anti-HBsAg Titre
 Anti-HCV
 CMV IgG
 CMV IgM

47. 2. GENERAL INVESTIGATIONS
 Radiological
 ECG
 Chest X-Ray
 Ultrasound Abdomen &
KUB
 Echocardiography
 CT-Angiopyelogram
 Intravenous Urogram
 Retrograde Urethrogram
 DTPA Scan

48. 3. FINAL INVESTIGATIONS
 HLA Tissue Typing
 HLA Cross MAtch