Sridhara-samhita

This is a modern update to the work of:

Sushruta (flourished c. 6th century BCE) was an ancient Indian surgeon known for his pioneering operations and techniques and for his influential treatise Sushruta-samhita, the main source of knowledge about surgery in ancient India.

For Sushruta, the concept of shalya tantra (surgical science) was all-encompassing. Examples of some of his groundbreaking operations include rhinoplasty (the repairing or remaking of a nose), removal of a dead fetus, and lithotomy (surgical incision into hollow organs such as the urinary bladder to remove stones, or calculi). He also developed many unique and practical techniques to dissect the human body and study its structure.

On the occasion of the online publication in Operations Research of (see To Split, or not to Split)

Split Liver Transplantation: An Analytical Decision Support Model,

and the acceptance of our abstract at the World Transplant Congress (San Francisco, August 2-6, 2025) of

Mission Impossible: Maximizing Deceased Liver Allograft Utilization Does Not Solve the Organ Shortage,

I asked Perplexity AI to create an update to Sushruta-samhita by Sanskritizing (and then re-translating to English) my papers on Organ Transplantation.

Here we go (with some light editing from my part).

These shlokas reflect ancient wisdom while addressing modern innovations in organ transplantation.

OrganJet

शरीरं दुर्गमं याति, जीवनं रक्षणाय च।
संगमं साधयेत् यंत्रं, दानं जीविताय च॥
The body travels across distances, to preserve life in need.
Let the aircraft unite regions, enabling donation to save lives.

Nudge Videos

ज्ञानं प्रदीपवत् दद्यात्, दानं प्रेरणाय च।
स्नेहेन बंधुजनान्, जीवनं रक्षणाय च॥
Knowledge spreads like a lamp, inspiring the act of giving.
With love, guide families toward saving lives through donation.

Split Liver Transplantation

यथा एकं फलम् वृक्षात्, द्वयोः जीवनाय च।
तथा यकृत् विभज्यते, द्वयोः आयुः प्रदाय च॥
As one fruit from a tree nourishes two lives,
So too the liver is divided to grant life to two.

Dynamic Exception Points for Fair Liver Allocation

न्यायेन सर्वजीवेषु, मरणं निवारणाय।
उन्नतं यंत्रमस्तु तत्, लघुजनहिताय च॥
Equity among all beings prevents untimely death.
Let advanced systems serve justice for those of smaller stature.

Introduction

This modern shastra integrates the surgical wisdom of Sushruta with Sridhar Tayur’s innovative approaches to organ transplantation. It aims to address the challenges of organ scarcity, equitable access, and ethical considerations while maintaining the spirit of ancient Ayurvedic principles.

Structure

The shastra is divided into five sections, modeled after the Sushruta Samhita:

1. Sutrasthana (Foundational Principles): Ethical and philosophical foundations for organ donation and transplantation.
2. Nidanasthana (Diagnosis): Identifying disparities in organ allocation and donor consent rates.
3. Chikitsasthana (Treatment): Practical solutions like OrganJet and Nudge Videos for equitable access and increased donations.
4. Kalpasthana (Preparation): Guidelines for preserving organs using techniques like machine perfusion.
5. Uttara Tantra (Advanced Practices): Innovations such as split liver transplantation.

Key Contributions

Ethical Framework

• Inspired by Sushruta’s emphasis on paropakara (benevolence), this shastra views organ donation as a supreme act of selflessness akin to the sacrifices of sages like Dadhichi.

Innovative Solutions

• OrganJet: Ensures equitable access by facilitating transport for underprivileged patients to regions with available organs.
• Nudge Videos: Behavioral interventions to increase consent rates among next of kin, emphasizing cultural sensitivity.

Technological Advancements

• Machine perfusion techniques to preserve organ quality before transplantation.
• Data-driven methods like machine learning for predicting outcomes and optimizing donor-recipient matches.

Conclusion

This shastra bridges ancient surgical wisdom with modern innovations, promoting fairness, accessibility, and ethical practices in organ transplantation. It embodies the essence of both Sushruta’s pioneering spirit and Tayur’s transformative contributions.

Key Principles of the Sushruta Samhita Applicable to Organ Transplantation

The Sushruta Samhita, an ancient text on surgery, offers foundational principles that can be adapted to modern organ transplantation practices. These principles include:

1. Ethical Responsibility and Compassion

Sushruta emphasized treating patients with utmost respect, likening them to one’s own family. This aligns with the ethical principle of “respect for persons” in organ transplantation, ensuring dignity and compassion for both donors and recipients.

2. Precision and Skill in Surgery

Sushruta highlighted the importance of surgical precision, steady hands, and mastery over instruments. In organ transplantation, this principle underscores the need for meticulous surgical techniques to ensure successful grafting and minimal harm.

3. Pre- and Post-Operative Care

The text detailed protocols for preparation, anesthesia, and post-operative care, which are critical in organ transplantation for reducing complications and enhancing graft survival.

4. Balancing Utility and Justice

Sushruta advocated removing factors causing pain or misery while maintaining balance in bodily humors. Similarly, organ allocation must balance utility (maximizing benefits) with justice (ensuring fairness), as highlighted in modern ethical frameworks

5. Use of Resources to Prevent Infection

Sushruta recommended fumigation with herbs to disinfect surgical environments. This principle is akin to modern sterilization techniques used to prevent infections during transplantation.

6. Altruism and Selfless Giving

The concept of daan (donation) in Hindu philosophy resonates with organ donation as a selfless act to alleviate suffering, reflecting Sushruta’s ethos of service to humanity.

These principles provide a timeless ethical and procedural framework that complements contemporary practices in organ transplantation.

Speaking about altruism and philanthropy (recall La Femme Nikki?):

Hello Sridhar,

Greetings from Williams, Arizona, about an hour south of the Grand Canyon. Emily and I are here with our kids for a family spring break trip.

I’m writing to share the poster for this year’s Kedia-Tayur lecture, and to thank you again for your generosity in making this lecture possible. Like last time, the talk will be co-sponsored by SAADA, and an accompanying essay will be published in TIDES, SAADA’s online forum. I’m really delighted to be able to see this collaboration continue.

The poster is attached and in case it is helpful, here is the registration link for convenience.

Hope you are having a lovely week and a wonderful spring.

Thank you again!

Nico

Let me also provide the poster of the upcoming Kedia-Tayur Distinguished Lecture in South Asian American History:

Hope to see many of you there!

PS. We – with students and faculty from CMU English Department – had a spirited dinner with our speaker Srikanth Reddy after his poetry reading at the International Poetry Forum event last week. Stay tuned for some follow-ups!