Donor’s syndrome kills renal transplant patient

Flavian Kandhari was relieved two months ago when he learnt his five-year wait for a kidney had ended. He was to receive the organ from a brain-dead 17-year-old. But on Sunday, two months after the transplant, Kandhari, 33, passed away, leaving behind a grieving mother and several questions for the medical fraternity to answer.

Kandhari died of Guillain-Barre syndrome (GBS), the same condition afflicting the donor. The cause of death has baffled Kandhari’s family, which says the Zonal Transplant Coordination Committee (ZTCC) may not have properly checked if the kidney was safe for transplant.

But ZTCC chairman Dr Vatsala Trivedi said it was medically impossible to relate Kandhari’s death to the donor because GBS is non-transmittable. It is not a disease but a syndrome, meaning it is a collection of symptoms and not a disorder caused by any particular agent. But the fact remains, says his family, that both donor and recipient died of the same condition.

Doctors say a person dying of GBS is rare. “In GBS, the person’s immune system produces antibodies that attack healthy cells and tissues. Fatality varies from person to person. Some may recover completely,” said Dr Joy Desai, consultant neurologist, Jaslok Hospital. “Medical journals suggest that GBS is not contagious and poses zero-risk to others.”

Dr Trivedi said: “Kandhari died of a non-infective, non-transmissible and inflammatory condition (the death certificate states he died of acute respiratory distress syndrome with encephalomyelitis — inflammation of the brain — with GBS in a renal transplant). Besides, he was immuno-suppressed and was suffering from the near-fatal Stevens-Johnson syndrome.”  

She said in transplant patients, even mild sore throat could trigger major problems.
Nanavati hospital nephrologist Dr Martin D’Souza, who carried out the transplant, said the hospital panel had approved of the transplant only after checking that GBS was non-communicable. “(GBS causing the death of both the 17-year-old and Kandhari) is a mere coincidence and nothing more,” he said, adding that post-surgery, Kandhari had contacted a viral infection “which could have triggered the syndrome in him”.

But Kandhari’s family thinks he died of the transplant. “How do we know if he was transplanted a healthy kidney and not one carrying an infection from the donor’s body?” asked his aunt Alina. She lamented having gone ahead with the transplant as a family member was ready to donate a kidney. “We have learnt that at times an infection can trigger GBS. So it is possible that Flavian was killed by the same infection that caused the donor’s death,” she said.

Kandhari’s mother Jane said her son developed GBS a month after the transplant but started experiencing the symptoms almost immediately after his surgery. “His right leg started hurting and he subsequently lost sensation. Soon, the pain spread to his left leg and then moved up, eventually affecting his brain,” she said.

Kandhari — whose kidneys were damaged by a drug overdose in 2003 — underwent transplant of the right kidney on May 14 at Nanavati hospital.

The donor died of GBS at Sion hospital on May 13. Doctors at Sion said his other kidney had shrunk and was not fit for transplantation.