Balwani Manish R, Kute Vivek B, Shrimali Jigar, Jagiasi Bharat G, Bhattacharya Pradip Kumar, Pasari Amit, Gumber Manoj, Gulati Sanjeev, Yadav Raj Kanwar, Nagaraju Shankar Prasad, Narasimhan Gomathy, Gopalkrishnan Natarajan, Engineer Divyesh, Dighe Tushar, Rizvi Jamal, Kolte Sanjay P, Ramteke Vishal Vasant, Deshpande Nishant Shantanu, Tolani Priyanka, Abraham Georgi, Patil Abhijit, Gupta Anurag, Agarwal Dhananjai, Khullar Dinesh, Prasad Narayan, Das Pratik, Patil Radhika Krishna, Mohanka Ravi, Mahajan Sandeep, Sharma Sourabh, Banerjee Subho, Bhargava Vinant, Patodia Jyoti, Chaudhury Arpita Ray, Srivastava Aneesh
Department of Nephrology, Saraswati Kidney Care Center, Nagpur and Jawaharlal Nehru Medical College (JNMC), Datta Meghe Institute of Higher Education and Research(DMIHER), Wardha, Maharashtra, India.
Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr. HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujrat, India.
Lancet Reg Health Southeast Asia. 2025 Jul 16;39:100628. doi: 10.1016/j.lansea.2025.100628. eCollection 2025 Aug.
Organ shortage remains a critical challenge in India's transplant landscape, despite established deceased donor organ transplantation (DDOT) programmes. Many potentially viable organs from brain-dead deceased donors (DBDs) are discarded due to uncertainties surrounding donor suitability in specific clinical scenarios. To address this gap, the Indian Society of Organ Transplantation (ISOT) convened a panel of national experts to develop a Delphi consensus statement aimed at guiding transplant professionals on the feasibility of organ donation from DBDs, particularly in complex or marginal donor situations. This position statement presents 19 consensus recommendations based on real-world clinical contexts such as extremes of age, acute kidney injury, infections (including HCV, HBV, HIV, tuberculosis, and tropical diseases), malignancy, diabetes, hypertension, and various surgical anomalies. The guidance is grounded in available literature, registry data, and extensive clinical experience, with the aim of expanding the DBD donor pool across Asia and improving access to transplantation for patients with end-stage organ failure. The consensus does not function as a formal clinical guideline but rather as a practical reference tool, acknowledging the limitations in India-specific data and the contextual differences from Western transplant settings. It encourages critical care and transplant teams to perform structured assessments of organ viability, apply ethical principles, and pursue informed consent in line with local regulations.
尽管印度已建立了已故捐赠者器官移植（DDOT）项目，但器官短缺仍是印度移植领域的一项严峻挑战。由于在特定临床情况下围绕捐赠者适用性存在不确定性，许多来自脑死亡已故捐赠者（DBD）的潜在可用器官被丢弃。为填补这一空白，印度器官移植协会（ISOT）召集了一个全国专家小组，制定一份德尔菲共识声明，旨在指导移植专业人员了解DBD器官捐赠的可行性，特别是在复杂或边缘捐赠者情况下。本立场声明基于现实世界的临床背景，如年龄极端情况、急性肾损伤、感染（包括丙型肝炎病毒、乙型肝炎病毒、艾滋病毒、结核病和热带疾病）、恶性肿瘤、糖尿病、高血压以及各种手术异常情况，提出了19项共识建议。该指南以现有文献、登记数据和丰富的临床经验为基础，旨在扩大亚洲的DBD捐赠者库，并改善终末期器官衰竭患者的移植机会。该共识并非正式的临床指南，而是一种实用的参考工具，承认印度特定数据的局限性以及与西方移植环境的背景差异。它鼓励重症监护和移植团队对器官活力进行结构化评估，应用伦理原则，并根据当地法规寻求知情同意。
