A proposed domino kidney transplant in the city is facing legal hurdles. The process is stuck because the law says one of the pairs is that of a maternal uncle and his niece and they cannot be treated as close relatives. As such, the State Authorisation Committee, Maharashtra has refused to give its nod for the procedure. According to the treating doctors, the law is supposed to facilitate the procedure but it's stalling the entire plan to save three lives.

This one would have been the country's third domino transplant involving three donors and three recipients.

The pair in question are residents of Karnataka. The uncle was to donate his kidney to the recipient of another pair and the entire chain of donations would have ensured that his niece received the organ from the donor of another pair. Treating doctors had been trying to get the legal nod for almost a year.

In India, kidney transplant is performed as per the Human Organ Transplant Act (Hota), 1994, which was amended in 2014. The law says the donors and recipients should be close relatives in domino kidney transplant.

“The committee has found that as per the Act maternal uncle and niece are not closely related. Hence, permission was denied,” said Dr Pravin Shingare, chairperson, State Authorisation Committee, Maharashtra.

Two of the three domino transplant procedures were to be conducted in Hinduja Hospital and one was to be done in Bombay Hospital.

Nephrologist from Hinduja Hospital Dr Jatin Kothari said: “Through this domino kidney transplant procedure, we would have given life to three patients. But it is very strange that permission has been denied even in such a situation. We don't know why it was denied in this case. There is no exploitation, eventually it's to help the patients. We will now try to seek legal opinion and approach the higher authority. This is the only way we can curtail the waiting list of kidney transplant patients.”

It takes one year to make a domino kidney transplant successful. “We really don't understand why the government has denied permission. Without the domino method, patients have to wait for seven to nine years for a transplant,” said Dr Ganesh Sanap, who maintains the swap registry at Shushrut Hospital in Chembur.

However, Dr Shingare said: “We understand the pain of the patients, but our committee has worked as per the law. We first go through all legal documents because if patients are related, permission is granted at the hospital level. When the donor and recipient are unrelated, only then does the matter come to us,” said Dr Shingare.

For a regular organ transplant, it is necessary that the blood and tissue of the donor and recipient match. When that doesn't happen, a domino transplant is resorted to. In this procedure, the donor of one pair gives the organ to the recipient of another pair, the donor of which then gives the organ to the next pair and so on.

The previous domino transplant, consisting of six donors and six recipients, was held on January 25, 2014, in Mumbai.

What is domino kidney transplant?The donor of one pair donates a kidney to the recipient of another pair. The transplant is then carried out in a series till the last donor in the chain donates to the first recipient in the line-up.

(Names of patients have been changed to protect identities)