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CASE REPORT
Year : 2019  |  Volume : 35  |  Issue : 4  |  Page : 303-304
 

Complete situs inversus – is it a contraindication for organ donation?


Department of Urology, Lourdes Hospital, Kochi, Kerala, India

Date of Submission15-Jun-2019
Date of Acceptance18-Jun-2019
Date of Web Publication1-Oct-2019

Correspondence Address:
Krishna H Moorthy
Department of Urology, Lourdes Hospital, Kochi, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.IJU_82_19

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   Abstract 

Complete situs inversus, (SI), the total transposition of thoracic and abdominal organs, is rare and is considered a contraindication for organ donation. We report a patient of complete SI, who underwent donor nephrectomy. A 21-year-old male, without significant medical history, presented for voluntary living-unrelated renal donation and was found to have complete SI on evaluation and underwent right donor nephrectomy. The recipient is doing well on the follow-up. Meticulous surgical planning while selecting kidneys would enable renal donation even in cases of complete SI.



How to cite this article:
Sonawane GB, Moorthy KH, Pillai BS. Complete situs inversus – is it a contraindication for organ donation?. Indian J Urol 2019;35:303-4

How to cite this URL:
Sonawane GB, Moorthy KH, Pillai BS. Complete situs inversus – is it a contraindication for organ donation?. Indian J Urol [serial online] 2019 [cited 2019 Oct 21];35:303-4. Available from: http://www.indianjurol.com/text.asp?2019/35/4/303/268308



   Introduction Top


Complete situs inversus (SI), defined as the total transposition of the thoracic and abdominal organs, is rare.[1],[2] It has been widely believed that SI should be considered an absolute contraindication for organ donation, especially in cases of liver and heart transplantation, where lateralization would alter operative planning and technique.[2],[3] Although various anatomic anomalies have a higher incidence in these patients, the kidneys are rarely involved. As there is an unmet need for organ donation worldwide, minor anatomic variations should not be considered a contraindication while selecting patients for donor nephrectomy. We present the case a patient with SI who underwent live-unrelated donor nephrectomy.


   Case Report Top


A 21-year-old male without significant medical history presented for voluntary living-unrelated renal donation. As a part of donor workup, a computed tomography angiogram of the abdomen was performed, which revealed complete SI of the heart and abdominal organs including the great vessels [Figure 1] and [Figure 2]. After thorough preoperative planning, right donor nephrectomy was performed as the right renal vein was longer. A short right renal artery was anticipated. However, during the surgery, no other anomalies which could have made the donor nephrectomy difficult were observed. The recipient is doing well at 4 years of follow-up.
Figure 1: In this computed tomography image, the liver is on the left side and spleen is on the right side suggestive of complete situs inversus

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Figure 2: In this cross- sectional computed tomography image, the right renal vein is longer and complete transposition of abdominal organs including great vessels is appreciated

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   Discussion Top


Only a few reports on renal donation in patients with complete SI are available. Polak et al. described a case in 2006, where both kidneys were procured from a deceased donor and transplanted into two different recipients.[3] Proper preoperative planning would enable the urologist to harvest a kidney from living donors with SI and achieve good results.


   Conclusions Top


Live renal transplantation is feasible between donors with complete SI and recipient with normal lateralization. In pure SI, there is a reversion in anatomical positions of all the viscera (mirror image) without concomitant anomalies. This report highlights the rarity of renal donation in patients with SI in the literature, the importance of identifying such conditions and proper counseling of the patient before surgery and that SI should not be a contraindication for renal transplantation.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

 
   References Top

1.
Treiger BF, Khazan R, Goldman SM, Marshall FF. Renal cell carcinoma with situs inversus totalis. Urology 1993;41:455-7.  Back to cited text no. 1
    
2.
Douard R, Feldman A, Bargy F, Loric S, Delmas V. Anomalies of lateralization in man: A case of total situs inversus. Surg Radiol Anat 2000;22:293-7.  Back to cited text no. 2
    
3.
Polak WG, Chudoba PJ, Patrzalek D, Szyber P. Organ donor with complete situs inversus. Case report and review of the literature. Ann Transplant 2006;11:43-6.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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