The proposal, welcomed by nephrologists and other specialists, is based on global data showing minimal additional risk when such organs are carefully screened.
Published Aug 13, 2025 | 4:13 PM ⚊ Updated Aug 13, 2025 | 4:13 PM
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Synopsis: Doctors are emphasising the urgent need to expand the organ donor pool to save more lives. Medical experts say that thousands of patients continue to wait for organs, and broadening eligibility criteria could help bridge the gap.
On World Organ Transplantation Day, 13 August, doctors are emphasising the urgent need to expand the donor pool to save more lives. The day serves as a reminder of the life-saving potential of organ donation and the challenges in meeting the growing demand for transplants.
Medical experts say that thousands of patients continue to wait for organs, and broadening eligibility criteria could help bridge the gap.
In a recent statement, the Indian Society for Organ Transplantation (ISOT) recommended allowing the use of organs from deceased donors with a history of diabetes or hypertension, provided the organs are found viable.
The proposal, welcomed by nephrologists and other specialists, is based on global data showing minimal additional risk when such organs are carefully screened. Experts believe the move could significantly increase the number of transplants, offering new hope to patients in need of kidneys, livers and other vital organs.
According to Dr C Arvind, Senior Consultant Nephrologist and Transplant Physician at Trustwell Hospital, Bengaluru, deceased donors with long-standing diabetes or hypertension may have underlying kidney damage even when routine blood tests appear normal, raising the risk of early graft dysfunction and reduced long-term survival in transplant recipients.
Speaking to South First, he said, “Baseline damage to the filtering units and blood vessels can already be present before the organ is retrieved.”
“This makes the kidney more vulnerable to cold ischemia injury and lowers its functional reserve,” he added,
International studies link such donor profiles to higher rates of delayed graft function (DGF), a complication witnessed in 20–30 percent of so-called marginal kidneys, and a modest but measurable increase in long-term graft loss.
However, Dr Arvind noted that, despite these risks, such kidneys can still offer life-saving benefits for many patients, and he supports the Indian Society of Organ Transplantation’s view that using them is often worthwhile when carefully matched and monitored.
Dr Arvind noted that in diabetes, early microscopic changes include thickening of the glomerular basement membrane and mesangial expansion, progressing to nodular scarring and tubulointerstitial fibrosis in advanced stages.
Hypertension, over time, causes vessel wall thickening, narrowing of blood flow, and eventual loss of filtering units through glomerulosclerosis.
“These changes, whether from high blood sugar or high blood pressure, slowly chip away at the kidney’s reserve,” he said. Even when blood creatinine is within normal range at the time of death, years of poor control can leave fewer functioning nephrons and stiffer vessels.
A review of donor records shows that longer duration of disease, especially diabetes exceeding 10–15 years with poor glycaemic control or hypertension lasting over a decade, increases the likelihood of irreversible damage.
Recipients of such kidneys, especially if they are younger or also diabetic, may face higher rates of graft failure and mortality compared to those receiving organs from healthy donors.
Before approving a kidney from a diabetic or hypertensive donor, Dr Arvind’s team examines blood pressure trends, urine output, protein levels, serum creatinine changes over 48–72 hours, and the cause of death.
“Ideally, a pre-implantation biopsy provides the clearest picture, but it’s not routinely done in India,” he added. Donor comorbidities and a calculated Kidney Donor Profile Index (KDPI) also guide the decision, with scores above 85 percent indicating shorter expected graft survival.
To minimise risks, strategies include pairing higher-risk kidneys with older recipients, considering en bloc transplants for small or scarred kidneys, and maintaining strict blood pressure and sugar control in recipients after surgery. While machine perfusion can improve outcomes, it is not widely available in India.
Despite the risks, Dr Arvind stressed that expanded-criteria donors remain a crucial resource.
“We at Trustwell Hospital liberally take all donors with diabetes and hypertension while keeping a watch on creatinine levels,” he said. “We have even accepted aged donors and those with mild acute kidney injury. With proper selection and follow-up, these kidneys can still give patients a good quality of life.”
Marking Organ Donation Day, Dr Jayanivash J, Consultant, Interventional Nephrologist at SIMS Hospital, Chennai, emphasised the urgent need to address India’s chronic shortage of donor organs.
Speaking to South First, he said, “We definitely have an organ shortage and we need to expand the organ pool, there are no second thoughts about that,” adding that both living and deceased donation programs must be strengthened.
For living donation, he said advances such as laparoscopic retrieval have made the process safer and less invasive, enabling donors to resume normal life within a week to 10 days. “There is no life risk to the donor, and we ensure they are completely fit before they are cleared for donation,” he said.
He stressed that donor selection must consider both recipient outcomes and donor safety. For living donors with conditions like hypertension or diabetes, he said, outcomes could be as good as those of healthy donors if the condition is well controlled and there is no evidence of end-organ damage.
“The ultimate outcome depends on the underlying health of the organ being donated,” he noted.
On deceased donation, Dr Jayanivash urged the public to pledge their organs in advance. “If, God forbid, someone faces a premature end to life due to an accident or other reason, prior pledging can speed up the process and ensure their organs are put to use,” he said, adding that early registration with health organisations helps streamline retrieval and transplantation.
Experts also pointed out that more people might be willing to donate if there were structured benefits for donors or their families. Beyond public recognition, these could include future healthcare support, travel concessions, educational scholarships, or other welfare measures.
(Edited by Muhammed Fazil.)
