Introduction: Thomas E. Starzl, conducted the first paediatric liver transplant in 1963, a routine successful clinical procedure today due to his pioneering efforts. India the second most populous country, 41% under 18 yrs of age, has followed on the heels of developed nations with 1522 pediatric transplants from 2013-2020 for all organs but majority done in private sector. To enable equality and equity, Govt of India has proposed establishing department of transplant medicine in major government hospitals, at least one in each state in the latest National Organ Transplant Program Guidelines. Our aim is to develop an SOP for the establishment of paediatric transplant units in line with the Transplantation of Human Organs and Tissues Rules 2014, starting with VMMC & SJH.

Materials & Methods: In 2019, India reported 4,49,002 Road traffic accidents(RTA) with resultant 1,51,113 deaths.  Delhi accounted for 5610 RTA with 1463 deaths.DD transplants prove to be exceptionally useful in diseases with high risk of recurrence particularly in children. VMMC & SJH is one of the largest govt tertiary care centres in Delhi catering to a large paediatric population and a large proportion of the RTA victims, the greatest source of deceased donor (DD) organs, if tapped. Living Donor Renal transplant is conducted in adult patients on a regular basis by urologists.  A paediatric nephrologist being available, the paediatric renal transplant program can be started by a combined team of paediatric surgeons & urologists. Training in paediatric liver transplants can be done either locally in ILBS, Delhi or internationally through TTS-ILTS paired centers program similar to JIPMER, Pondicherry with St.James University hospital Leeds, UK. TTS in collaboration with NOTTO conducted an online survey of intensivists with regard to brain death declaration. The intensivists need to be trained for brain death declaration and donor maintenance to enable DD transplants. Augmentation of pediatric transplant intensive care beds and personnel is required along with round the clock lab facilities.

Results: The Govts of Delhi, Tamilnadu, Kerala, Maharashtra, etc have issued have issued GOs for mandatory declaration of brain death in all patients who fulfill the criteria. DGHS has sought monthly submission of brain death data. Intensivist training for brain death declaration and donor maintenance was first started by NOTTO during the CAST 2019 congress and two more have followed. However, progress can only be achieved with implementation of training and establishment of dedicated centers.