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GOVERNMENT OF PUDUCHERRY

CHIEF SECRETARIAT (HEALTH)

(G.O. Ms. No. 16, Puducherry, dated 13th May 2025)

NOTIFICATION

Considering the large number of patients who are suffering on

account of serious organ ailments ranging from heart, liver, kidney etc.,

and could otherwise lead healthy life if, they had the opportunity to

have transplant surgery and its awareness among general public, there

is a need for streamlining the procedures for deceased donor transplants

in Government and Private hospitals,

2. As per sub-rule (4) (c) of rule 31 of Transplantation of Human

Organs and Tissue Rules, 2014, the allocation of the organ to be shared

is to be decided by the State Networking Organization.



La Gazette de L' État de Poudouchéry

The Gazette of Puducherry

PART - II



EXTRAORDINAIRE

EXTRAORDINARY



Publiée par

Published by



Autorité

Authority

Registered with the Registrar

of Newspapers for India under

No. 10410







2025 }

|

19 {

No. 41 Poudouchéry

Lundi

Mai

2025

No.

Puducherry

Monday

19th

May

2025

(29 Vaisakha 1947)

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3. Further, as per sub-rule (4)(f) of rule 31 of Transplantation of

Human Organs and Tissue Rules, 2014, the allocation criteria may be

State specific which shall be finalized and determined by the

State Government in consultation with the State Level networking

organization wherever such organization exists.

4. As per sub-rule 5 of Rule 31 of Transplantation of Human

Organs and Tissue Rules, 2014,” the networking organizations shall

coordinate retrieval, storage, transportation, matching, allocation and

transplantation of organs and tissues and shall develop norms and

standard operating procedures for such activities and for tissues to the

extent possible”.

5. Accordingly, the Government has requested Transplant Expert

Committee reconstituted by Chief Secretariat (Health), Puducherry

vide G.O. Ms. No. 63, dated 31-12-2024 to suggest the way forward to

formulate such guidelines/policy. In response, the said Committee has

submitted the proposal vide E-office No. 1649 of Directorate of

Health and Family Welfare Services, Puducherry. The same has been

analysed and the Hon’ble Lieutenant-Governor, is pleased to frame the

Guidelines for allocation criteria for cadaver organ transplant as in the

Annexure-I, II and III.

(By order of the Lieutenant-Governor)

S. MURUGESAN,

Under Secretary to Government (Health-I).

————

ANNEXURE-I

ALLOCATION CRITERIA FOR DECEASED DONOR KIDNEY

TRANSPLANT (GUIDELINES)

Preamble

Organ transplant has two sources : living donor and deceased

donor. In case of living donor source, donor is already decided for a

specific recipient. For deceased donor source, recipient needs to be

selected out of a large recipients’ pool. The allocation of organ is a

complex process, influenced by a number of factors including medical

urgency and donor, and recipient matching. Following facts need to be

kept in mind for organ allocation for kidney transplantation.

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Certain Facts for End Stage Renal Disease (ESRD)

1. There is disparity between number of recipients requiring

kidney transplant and the deceased organs available for

kidney transplantation.

2. Some patients need kidney transplant on priority basis

because of their medical condition, as delay in transplant may

lead to mortality.

3. For End Stage Renal Disease (ESRD), maintenance dialysis

is an acceptable and reasonably good alternate therapy so

for majority of ESRD patients, renal transplant is not an

emergency procedure.

Recipient Registration, Listing and Scoring System in the

Waiting List

(Before deceased donor availability).

1. Patient is to be registered by the concerned hospital

through online registration form on website www.notto.mohfw.gov.in

2. Kidney Advisory Committee/Nephrologist of the Institution

will approve registration.

The Kidney Advisory Committee/Nephrologist of the Institution

will confirm the need for renal transplant of every newly registered

patient. Once approved, ONLY then the patient will be put on active list

in the system and ALLOCATION SCORING for that patient will be done

based on the guidelines formed.

3. Patient should be a case of End Stage Renal Disease on

Maintenance dialysis for more than three months on regular basis.

4. Patient should not have an absolute contraindication for renal

transplant, as given under:

Advanced untreatable cardiovascular disease

Irreversible cerebrovascular accident

Inoperable malignancy

Untreatable major psychiatric illness (to be certified by a

psychiatrist).

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5. Patient should be registered ONLY in ONE hospital registered

under the Transplantation of Human Organs and Tissues Act (THOTA)

with SOTTO, Puducherry. However, he/she can change the hospital at

any stage and his allocation scoring and seniority in central waiting list

will not change. However, his/her seniority in the waiting list of locally

available kidney, with the new Hospital will be applicable one month

after date of change.

6. Patient can be registered for deceased donor even though

the patient is waiting for living donor transplant.

7. Status of patient must be updated regularly by the hospital

in one of the following status:

Active

Suspended

Lost to follow-up

Transplant done

Death

Organs Allocated to the Hospitals may be Utilized as Per

Seniority/Scoring System for Making Priority:

Sl.

Criteria for scoring

Points allotted

No.

(1)

(2)

(3)

Time on dialysis

(0.1) for each month on

Dialysis.

Previous immunological graft failure

(+3) for each graft failure

within 3 months of transplantation.

Age of recipient

(+3) for less than 6 years

(+2) for 6 to less than

12 years.

(+1) for 12 to less than

18 years.

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Patient on temporary Vascular access

4(a) With Failed all A V Fistula sites

(+2)

4(b) With failed AV Graft after all failed

(+4)

AVF sites.

PRA (Panel Reactive Antibody)

(+0.5) for every 10%

above 20 % Scoring

subject to submission of

Certificate from luminous

based NABL accredited

lab.

Previous Living donor now requiring

(+5)

Kidney Transplant.

Near relative (as per definition of

(+5)

THOTA) of previous deceased donor

requiring kidney transplant.

Note : Patients with the same score, priority will be decided based

on the seniority in the waiting list.

Allocation Principles:

1. Allocation will be done first based on Union territory of

Puducherry waiting list. If, no eligible recipient in the waiting list then

organ will be shared by SOTTO, Puducherry to South ROTTO.

2. In order to minimize cold ischemia time, most donated organs

should be allocated within the Union territory of Puducherry where

retrieval has been done.

3. Kidney from Paediatric donor (less than 18 years) first will

go to paediatric patient. If, no paediatric patient eligible, then to adult

patient.

4. Kidney from elderly (age more than 65 years) donor may

preferably allotted to an Elderly Recipient (older above 50 years).

Only

after

certification

the Nephrologist

of the Institution,

the

s c o r i n g

will be done.

(1)

(2)

(3)

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5. Blood group “O” kidney will be allocated to recipient with

group “O”, then to next available on waiting list of other compatible

blood groups i.e., first group “A”, then group “B” and lastly group

“AB” in that sequence.

6. In case of blood group “A” or “B”, the organ will be allocated

to same blood group failing which to blood group “AB”. “AB” will be

allocated to “AB” only.

Allocation Algorithm

Once there is a call for possible deceased donor

Step-1 : Check Blood Group of available deceased donor to

follow principle of allocation based on blood group as above.

Step-2: Recipient requiring multi-organ transplant will get

priority. If, there are more than two recipients in the multi-organ recipient

list, then allocation will be done to patient having more points in the

scoring system.

Step-3: If, NO multi-organ recipient, then allocation will be done

to patient registered for ‘Kidney alone’ transplantation based on the

status of hospital doing retrieval of kidneys means whether it is

transplant hospital or retrieval only hospital.

If, Transplant Hospital

o One kidney be used by that Hospital and other will be

allocated.

If, Retrieval Hospital

o Both will be allocated

Step-4: Kidneys retrieval hospital, whether it is Government

Hospital or Private Hospital:

1. Other Kidney retrieved from a Government Hospital will

be allocated as follows:

(a) First to patients listed in the Combined Government

Hospitals list of the State, then,

(b) Patients listed in the combined private hospital list in the

State, then,

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2. Other Kidney retrieved from a private hospital will be

allocated as follows:

(a) First to patients listed in the Government hospitals list of

UT by Rota, then,

(b) Patients listed in the private hospital list by Rota, then

patient listed in South ROTTO.

Inter-State Issues

The Transplant Expert Committee of State Government in

consultation with SOTTO, Puducherry, will approve the inter-state

transport of organs for transplantation.

————

ANNEXURE-II

ALLOCATION CRITERIA FOR DECEASED DONOR LIVER

TRANSPLANTATION RECIPIENT REGISTRATION AND LISTING

1. Patient is to be registered by the concerned hospital through

online registration form on www.notto.mohfw.gov.in.

2. Liver Transplant advisory Committee/Surgical Gastroenterology

of the institution will approve the registration. The Committee Members

will periodically review/update the guidelines.

3. Patient should be less than 65 years of age at the time of

listing.

4. Patients with decompensated cirrhosis of liver should meet

standard criteria for need for liver transplant with Model for End-stage

Liver Disease (MELD) score greater than 15 in patients aged 12 years

or more. Those with cirrhosis of liver with hepato-cellular carcinoma

should be with-in UCSF criteria;

5. Super-Urgent listing can be done in the following situations:-

(a) Primary Non-Function (PNF) of liver allograft.

(b) Living liver donor who develops life threatening liver failure.

(d) Fulminant Hepatic Failure (FHF).

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6. Patients with metabolic disorders and for those with quality

of life issues who do not have the minimum required MELD score e.g.,

chronic hepatic encephalopathy, intractable pruritus and polycystic liver

disease will not be considered for listing for Deceased Donor Liver

Transplant (DDLT) for now.

7. Contraindications to listing for liver transplantation:-

(a) MELD Score <15

(b) Severe cardiac or pulmonary disease, who is unfit for

general Anaesthesia.

(d) Hepatocellular carcinoma beyond UCSF criteria

(e) Uncontrolled sepsis

(f) Intrahepatic Cholangiocarcinoma

(g) Extra-hepatic malignancy

8. Patient should be registered only in one hospital registered

under Transplantation of Human Organs and Tissues Act (THOTA).

9. Patient can be registered for deceased donor even while the

patient is waiting for living donor transplant.

10. Status of the listed patient must be updated by the hospital

monthly.

Allocation Principles

1. Allocation will be done first based on State waiting list. If,

no recipient is eligible in the State waiting list then allocation will be

done to Regional Organ and Tissue Transplant Organization (ROTTO

SOUTH) and then to other ROTTO nationally.

2. Liver from Pediatric donor (less than 16 years) first will go

to Pediatric patient. If, no Pediatric patient eligible, then to adult patient.

3. Blood group “O” Liver will be allocated to recipient with

group “O”, then to any other group.

4. Other than “O” blood group; that is “A”, “B” and “AB” will

be preferably allocated to same blood group, failing which to “AB”

group.

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Allocation Algorithm

Once there is consent for deceased donation

Step-1: Check Blood Group and age of the available deceased

donor and then follow principle of allocation based on blood group as

above.

Step-2: First, the liver will go to the recipient requiring

simultaneous multi-organ transplant i.e., simultaneous liver-kidney

transplant. If, there are more than two recipients in the simultaneous

multi-organ list, then allocation will be done to the patient who has been

waiting longer while on the list.

Step-3: If, there is no multi-organ recipient, then allocation will

be done based on the status of hospital doing the liver retrieval. Status

means whether it is transplant hospital or Non-Transplant Organ

Retrieval Centre (NTORC).

If, Transplant Hospital:

The Liver will be allocated to the local transplant hospital

and the hospital will not lose its turn.

If Non-Transplant Organ Retrieval Centre:

The liver will go to the common pool from where it will be

allocated to the Transplant hospital as per the Rota.

Note:

Each hospital to maintain their own waiting list that should be

uploaded on website of SOTTO.

Once allocated to a hospital, the organ will be used only in a

recipient previously registered with SOTTO at least 48 hours before

organ allocation and as per the seniority on the waiting list.

Step-4: Liver retrieval hospital could be a Government or a

Private hospital:

1. Liver retrieved from a Government hospital will be

allocated as follows:

Government hospitals by rotation.

If, there are no takers in the Government Hospitals, to be

offered to private hospitals as per rota.

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2. Liver retrieved from a private hospital will be allocated as

follows:

Rota of private hospitals

If, no takers in private hospitals, to be offered to

Government Hospitals

Note :

(a) If, there is a marginal donor, that has been refused by other

center(s) then the center which agrees to use the organ will not lose its

priority in the next round of allocation.

(b) If, a center splits an organ then it is allowed to use for the

2nd recipient at their center and will be counted as one. Further, they

can share one of the split parts with another center, provided the organ

is utilized for a patient registered with SOTTO.

is not used for any Indian patient in the country. This clause will override

any center specific waiting list.

Inter-State Issues

ROTTO in consultation with SOTTO will approve the inter-state

transport of organs for transplantation.

————

ANNEXURE-III

ALLOCATION CRITERIA FOR HEART, LUNG AND

HEART-LUNG CONTENTS

The allocation policy of donated heart and lungs under the

following heads -

(A) Registration of potential recipients

(B) Criteria for suitable donors for Heart and Lung

(D) Details to be recorded on the website

(E) Post-operative update

(F) Donor harvesting charges and charges to recipients

(G) Recognition of hospitals for organ transplantation

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Registration of potential recipients for heart, lung and heart-lung

transplantation:

1. All hospitals should do all necessary investigations needed

for their potential patients waiting for heart, lung and heart-lung

transplantations and then register them with NOTTO portal. Patient is

to be registered by the concerned hospital through online registration

form on website www.notto.mohfw.gov.in

2. Only those patients for whom all the necessary data is

provided and registration charges are paid will be considered in the active

waiting list.

3. The registrations for transplantation will have to be updated

and re-registered every month. Status of patient must be updated

regularly by the hospital to one of the following status:

 Active

 Unfit

 Recipient frequently refused

 Lost to follow-up

 Transplant done

 Death

4. At any time one patient can register only with one

transplantation center. In case he/she wants to shift to some other

center, they need to de-register with first center and then only register

with second center. There should be at least 72 hours of gap before the

next deceased donor's organ retrieval.

5. Registration of Heart and Heart-Lung recipients:

Three categories are proposed:

Priority 1 (emergency) : These are patients on ventricular

assist devices, but still critical, Intra-aortic balloon pump (IABP)

waiting for heart/heart-lung transplantation. These recipients

will get priority based on blood group and size matching.

Their status need to be confirmed on weekly basis.

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Priority 2 (semi emergency) : These are patients in intensive

care unit depending on ionotropic supports for at least a week

and not maintaining hemodynamics if, inotropes are being

weaned off. Their category needs to be updated every 48 hours.

Based on their progress they may stay in priority 2 or change

to other priorities. If, a deceased donor organ is available,

their status need to be confirmed by 3 members of the Heart

Sub Committee as appointed by the Chairman of the Sub

Committee.

Priority 3 (elective) : These are patients electively waiting

for transplantation. Their status need to be confirmed or

changed as per their progress on monthly basis. The concerned

hospital needs to be given a user name and password to enable

them to register the recipients and enter data. They can see only

their waiting patients. The Sub Committee Members to be given

a separate user name and password and they should be able to

see all the waiting list members for heart, lung and heart- lung

transplantation and their details.

Criteria for suitable donors for heart and lungs:

Apart from the general criteria for donors, the following criteria

are needed :

1. Heart

(a) Age less than 60 years. If, donor is more than 40 years,

coronary angiogram is desirable to exclude asymptomatic

coronary artery disease.

(b) No history of heart disease and echo-cardiogram showing

good cardiac function and no anatomical abnormalities.

of inotropes (dopamine less than 10 micrograms/kg./min;

epinephrine, nor epinephrine less than 0.1 micrograms/kg./mn,

dobutamine less than 10 micrograms/kg./mn)

(d) Cardiac arrest - Donors revived after a brief cardiac arrest

must be assessed extra carefully but, can be considered if, the

cardiac function is absolutely normal.

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2. Lung

(a) Age less than 55 years

(b) No active sepsis/malignancy in the lungs and outside

disease

(d) Chest X ray shows clear lung fields without any evidence

of trauma to lungs.

(e) Arterial Blood gases: On 100% oxygen and PEEP of 5 mm

of Hg. After 5 mn, PaO2 should be more than 300 mm of HG

(f) If smoker, a smoking history of < 20 pack -years

Criteria for allocation of heart, lung and heart-lung:

Matching of Heart and Lungs are done based on

o Blood group matching and

o Size matching

o Geographical distance

Blood Group Matching.— O group donor organ is matched

with O first. If, no O group recipient is available, then it can be given to

other group recipients as per the following criteria. Once a deceased

donor heart and lungs are available, the hospital/s with first two

recipients in the order of allocation will be informed. If, the first recipient

is not confirmed in 2 hours after that, the organ will go to the next

recipient in the list and so on.

Size and weight mismatch.— There should not be more than

20 percent size mismatch between the donor and the recipient heart/lung.

Larger hearts can go to smaller patients and more mismatch is acceptable

but, problems can occur with small hearts in large recipients. In children

more mismatch is acceptable.

Distance.—The donated Heart should be allocated to a hospital

which is well within the geographical limit of cold-ischemia time for heart/

lung.

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For a heart/lung donated at a Government hospital, the first

priority for allocation should be for a recipient registered with a

Government hospital.

If, any controversies arise in allocation, the decision of the

Advisory sub-committee is final.

1. Heart and Heart-Lung

(a) If deceased donor organs are harvested in an Organ

Transplantation center, heart will go to that center.

One lung will go to that center (both lungs may be used

in one patient at the discretion of Transplant team) and

the other lung will go to the general pool. If, the hospital

does not have recipients, then the heart and both lungs

will go to the general pool.

(b) If deceased donor organs are harvested in a center

recognized only for organ harvesting, heart and both lungs

will go to the general pool. General pool organs will be

distributed first to patients in the priority 1, then to

priority 2 and then to priority 3. If, multiple patients are

there in each category, then heart will be distributed in the

chronological order of patient’s registration with NOTTO

portal. If, donor is CMV positive, and there is a recipient

who is CMV positive, they will be matched provided there

is no waiting patient in priority 1 and 2.

2. Lung

1. If deceased donor organs are harvested in an Organ

Transplantation center, one lung will go to that center

(both lungs may be used in one patient at the discretion

of Transplant team) and the other lung will go to the

general pool. If, the hospital does not have recipients, then

the heart and both lungs will go to the general pool.

2. If deceased donor organs are harvested in a center

recognized only for organ harvesting, both lungs will go

to the general pool.

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Details to be recorded on the website:

The following details should be available on the website regarding

the patients waiting for heart, lung and heart-lung transplantation:

First name :

Last name :

Age:

Sex:

Height:

Weight:

Diagnosis:

Hospital where registered

Date of Registration:

Diabetic: Y/N

Blood Group:

Rh Typing:

CMV IgG

Positive/Negative

PRA I: Percentage:

Positive/Negative:

PRA II: Percentage:

Positive/Negative:

Hbs Ag:

Positive/Negative:

Hep C: Positive/Negative:

HIV: Positive/Negative:

For Heart patients:

Transpulmonary grtadient:

PVR

For Lung recipients:

Room Air ABG report

6 min walk test results:

Plan : Heart/single lung/bilateral lung/heart-lung transplantation.

Priority: 1/2/3.

Post-operative update

It is the responsibility of the hospital to update about the

recipient condition on a monthly basis in the first 6 months, then once

in 2 months for the next 2 months and then every 6 months and whenever

patient is readmitted.

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Recognition of Hospitals for Organ Transplantation:

It is noted that some hospitals have applied for transplantation

permission at multiple branches. It is recommended that only those

hospitals/branches which have in-house full time transplantation team

are to be permitted to enable round the clock care.

Appropriate recognition of a centre should be in-place as either

a “harvest” centre or as a “harvest plus transplant” centre.

The above Guidelines are subject to change in the future

consequent to changing patterns of patient management and are to be

changed after adequate consultation with the stakeholder.

————

online publication at “https://styandptg.py.gov.in”

Published by the Director, Government Press, Puducherry.