Document:

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                                                                   EXHIBIT 10.18

                AMENDMENT NO. 1 TO SECURITIES PURCHASE AGREEMENT

         THIS Amendment No. 1 (this "Amendment"), dated _____________, 2002 to
the SECURITIES PURCHASE AGREEMENT (the "Agreement"), dated December 17, 1999, is
entered into by and among Allied Healthcare Group Limited, formerly known as
Transworld Holdings (UK) Limited, a company incorporated in England and Wales
with registered number 3890177 ("UK Parent"), Transworld Healthcare (UK)
Limited, a company incorporated in England and Wales with registered number
3370146 and a wholly-owned subsidiary of UK Parent ("TW UK"), each of the
Purchasers and Transworld Healthcare, Inc., a New York corporation and sole
shareholder of UK Parent ("Transworld"). Transworld, UK Parent and TW UK are
hereinafter referred to collectively as the "Corporate Group." All capitalized
terms which are used but otherwise defined herein shall have meanings specified
in the Agreement.

                               W I T N E S S E T H
                               - - - - - - - - - -

         WHEREAS, on December 17, 1999, the parties hereto entered into the
Agreement, pursuant to which (i) UK Parent issued and the Purchasers subscribed
for the Subordinated Notes; (ii) TW UK issued and the Purchasers subscribed for
the Warrants; (iii) TW UK issued and UK Parent subscribed for the Mirror Notes;
and (iv) TW UK issued and the Purchasers' Representative subscribed for a
Special Share of TW UK;

         WHEREAS, as of the date hereof, Transworld has approved the
reorganization of the Corporate Group, pursuant to which TW UK shall become a
wholly-owned subsidiary of UK Parent, which is and shall remain a wholly-owned
subsidiary of Transworld (the "Reorganization") in accordance with that certain
Master Reorganization Agreement, dated as of April ___, 2002 by and among the
Corporate Group and the Investors named therein (the "Master Reorganization
Agreement");

         WHEREAS, in connection with the Reorganization, the Warrants issued to
the Purchasers pursuant to the Agreement shall be cancelled and the Mirror Note
between UK Parent and TW UK is to be amended and restated;

         WHEREAS, in connection with the Reorganization, the Purchasers will be
entitled, subject to the terms and conditions of the Master Reorganization
Agreement, to the right to receive shares of TWUS Common Stock and TWUS
Preferred Stock, and UK Parent will issue shares of the Mirror Preferred Stock
to TWUS; and

         WHEREAS, in connection with the Reorganization and cancellation of the
Warrants the parties hereto desire to amend the Agreement to make appropriate
changes thereto to retain certain of the rights, covenants and agreements
originally provided thereon as to be applicable in light of the Reorganization.

         NOW, THEREFORE, each of Transworld, UK Parent and TW UK, in
consideration of the mutual covenants and agreements set forth herein and for
other good and valuable

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consideration, the receipt and sufficiency of which are hereby acknowledged,
agrees with the Purchasers as follows and vice versa:

         1. Amendment to Mirror Notes. Effective hereby, upon the terms and
subject to the conditions herein, the existing Mirror Notes shall be canceled
and the Amended and Restated Mirror Notes, substantially in the form attached
hereto as Exhibit A shall automatically be substituted therewith.

         2. Amendment to Section 1.1. Effective hereby, the following
definitions shall be substituted in their entirety for the same definition in
Section 1.1 of the Agreement:

         "Affiliate" means, with respect to any specified Person, any other
Person directly or indirectly controlling (including, but not limited to, each
director and executive officer of such Person), controlled by or under direct or
indirect common control with such specified Person. A Person shall be deemed to
control a company if such Person possesses, directly or indirectly, the power to
direct or cause the direction of the management and policies of such company
whether through the ownership of voting securities, by contract or otherwise.
Notwithstanding the foregoing, in no event shall the initial Purchasers be
considered Affiliates of the Companies (including of Transworld) for purposes of
this Agreement.

         "Companies" means collectively, UK Parent and TW UK considered as a
single enterprise, until a successor replaces UK Parent or TW UK and thereafter
includes the successor or successors, as the case may be provided that, with
respect to Articles XVI and XVIII and Section 14 of this Amendment, "Companies"
shall also include Transworld along with UK Parent and TW UK.

         "Covenant Breach" has the meaning ascribed thereto in Section 17 of the
Certificate of Designations.

         "Credit Facility" means the credit agreement dated as of the date of
this Agreement among the Group Companies named therein, the Banks and the other
lenders, if any, parties thereto from time to time, as amended, restated,
supplemented, waived, replaced (whether or not upon termination, and whether
with the original lenders or otherwise), refinanced, restructured, or otherwise
modified from time to time (except to the extent that any such amendment,
restatement, supplement, waiver, replacement, refinancing, restructuring, or
other modification thereto would be prohibited by Section ____ of the
Certificate of Designations unless otherwise agreed by a Majority in Interest of
the Purchasers).

         "Designated Indebtedness" means: (a) Bank Indebtedness, (b) Mezzanine
Indebtedness or (c) Refinancing Indebtedness with respect thereto.

         "Group Companies" means UK Parent, TW UK and their respective
Subsidiaries; provided, that with respect to Articles XVI and XVIII, "Group
Companies" shall also include Transworld and its respective Subsidiaries.

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         "Legal Holiday" means a Saturday, Sunday or a day on which banking
institutions in London, England, or New York, New York are not required to be
open.

         "Liquidity Event" means (i) a sale, assignment, transfer, lease,
conveyance or other disposal of 90% or more of the Capital Shares of any of
Transworld, UK Parent or TW UK to a Person who is not an Institutional Investor
or an Affiliate of an Institutional Investor, including by way of scheme of
arrangement or other business combination (whether or not Transworld, UK Parent
or TW UK is the Surviving Person), whether in one transaction or a series of
related transactions, (ii) a sale, assignment, transfer, lease, conveyance or
disposal of Property or assets of the Group Companies representing in the
aggregate 90% or more of the total value of all Group Assets or generating in
the aggregate 90% or more of all Group Revenues, whether voluntary or
involuntary, in one transaction or a series of related transactions, or (iii) an
Insolvency Event with respect to Transworld, UK Parent or TW UK, other than by
reason of action taken by or on behalf of the Series A Director(s) or the
Purchasers as a group.

         "Majority in Interest of the Purchasers" or "Majority in Interest"
means the holders of greater than 50% of the sum of (i) all shares of Common
Stock issuable upon conversion of all shares of Series A Preferred Stock that
remain outstanding as of the time of determination and (ii) shares of Common
Stock issued upon conversion of the shares of Series A Preferred Stock;
provided, however, that with respect to clause (ii) only those shares of Common
Stock beneficially owned by the Person who converted the corresponding Series A
Preferred stock (or their Affiliates) shall be included in the calculation of a
Majority in Interest.

         "Mirror Notes" has the meaning ascribed thereto in the recitals hereof;
and shall also refer to the refinanced Mirror Notes issued pursuant to Section 1
of the Amendment No. 1 to the Agreement.

         "Purchasers" has the meaning ascribed thereto in the introduction
hereof, provided, however, that with respect to any Securities that are Shares
of Series A Preferred Stock, the Purchasers shall include any "holders" thereof,
as such term is defined in the Certificate of Designations.

         "Qualified Average Price" means the Closing Price per Share of Common
Stock as reported by the principal securities exchange on which the Shares of
Common Stock are listed for trading, so long as such exchange is the New York
Stock Exchange, the NASDAQ National Market, the American Stock Exchange or a
Designated Offshore Securities Market, for 30 consecutive Trading Days, provided
that (i) on each one of such Trading Days the Closing Price is equal to or
higher than the minimum price required to achieve a Qualified Public Value if
such price alone was deemed to equal the Qualified Average Price and (ii)
throughout such 30-day period at least 20% of the Ordinary Shares outstanding
are held by Persons who are not Affiliates of Transworld, any Group Company or
any Purchaser and are freely transferable in the public trading market.

         "Qualified Public Value" means a Qualified Average Price such that the
product of such Qualified Average Price times the aggregate number of shares of
Common Stock issued pursuant

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to or issuable upon conversion of the shares of Series A Preferred Stock is
equal to or greater than 2.5 times the Total Investment.

         "Redemption Security" has the meaning ascribed thereto in Section 6.3
hereof.

         "Securities" mean, collectively, the Subordinated Notes, the PIK Notes,
the Warrants, the Ordinary Shares issuable upon exercise of the Warrants, the
Mirror Notes, the Mirror PIK Notes, the shares of Series A Preferred Stock and
the shares of the Mirror Preferred Stock.

         "Transaction Documents" means, collectively, this Agreement (including
the Amendment), the Subordinated Notes, the PIK Notes, the Warrant Instrument,
the Warrants, the Mirror Notes, the Mirror PIK Notes, the Registration Rights
Agreement, the Voting Trust Agreement, the Intercreditor Agreement, the
Transworld Rights Letter, the Purchaser's Rights Letter, the Joinder Agreement,
the Expenses Sharing Letter Agreement, the Certificate of Designations, the
Charter Documents of Transworld, UK Parent and TW UK, the Master Reorganization
Agreement and any and all agreements, certificates, instruments and other
documents contemplated hereby or thereby or executed and delivered in connection
herewith or therewith.

         "Voting Trust Agreement" means the Voting Trust Agreement, dated as of
the date hereof, by and among TW UK, UK Parent, Transworld, the Purchasers'
Representative and the Trustee, as such is amended from time to time.

         3. Amendment to Section 1.1. Effective hereby, the following
definitions shall be added to the defined terms included in Section 1.1 of the
Agreement:

         "Certificate of Designations" means Sections ___ of the Certificate of
Amendment dated ____, 2002 to Transworld's Certificate of Incorporation.

         "Closing Date" shall have the meaning ascribed to such term in the
Master Reorganization Agreement.

         "Common Stock" means the common stock, par value $.01 per share, of
Transworld.

         "holders" shall mean the holders of the Series A Preferred Stock,
unless such other meaning is clearly ascribed.

         "Holders Redemption" shall have the meaning set forth in Section 8.1 of
this Agreement.

         "Holders' Redemption Offer" shall have the meaning set forth in Section
8.2 of this Agreement.

         "Holders' Redemption Purchase Date" shall have the meaning set forth in
Section 8.2 of this Agreement.

         "Institutional Investors" means Triumph Partners III, L.P., Triumph III
Investors, L.P., and Paribas.

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         "Insolvency Breach" has the meaning ascribed thereto in Section 17(b)
of the Certificate of Designations.

         "Lead Investor" means Triumph Partners III, L.P.

         "Master Reorganization Agreement" has the meaning set forth in Section
__ of the Certificate of Designations.

         "Mirror Note Redemption Price" has the meaning set forth in Section __
of the Certificate of Designations.

         "Mirror PIK Note Redemption Price" has the meaning set forth in Section
__ of the Certificate of Designations.

         "Mirror Preferred Stock" has the meaning set forth in Section __ of the
Certificate of Designations.

         "Mirror Preferred Stock Preference Amount" has the meaning set forth in
Section __ of the Certificate of Designations.

         "Mirror Preferred Stock Purchase Price" has the meaning set forth in
Section __ of the Certificate of Designations.

         "Series A Preferred Stock" has the meaning set forth in Section __ of
the Certificate of Designations.

         "Series A Director" has the meaning set forth in Section 3(a) of the
Certificate of Designations.

         "Series A Preference amount" has the meaning set forth in Section 4(a)
of the Certificate Designations.

         "Series A Purchase Price" shall have the meaning set forth in Section
8(a) of the Certificate of Designations.

         4. Amendment to Section 4.22(c). Effective hereby, the following
paragraph shall be substituted in its entirety for Sections 4.22(c) of the
Agreement:

              (c) TW UK shall be under no liability with respect to any claim
under this Article IV unless and until the aggregate amount of all claims
against TW UK exceed (pound)250,000, but if liability exceeds that figure then
all claims, including claims previously notified, shall accrue against TW UK.
The aggregate liability of TW UK with respect to all claims under this Article
IV shall not exceed (pound)22.0 million, plus all outstanding and accrued
interest on the Subordinated Notes and the PIK Notes and accrued dividends
(whether or not declared or paid) on the shares of Series A Preferred Stock.

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         5. Amendment to Article VI. Effective hereby, the following shall be
substituted in its entirety for Article VI of the Agreement: Intentionally
Omitted.

         6. Amendment to Article VII. Effective hereby, the following shall be
substituted in its entirety for Article VII of the Agreement: Intentionally
Omitted

         7. Amendment to Article VIII. Effective hereby, the following shall be
substituted in its entirety for Article VIII of the Agreement:

                                  ARTICLE VIII
                REDEMPTION OF TRANSWORLD SERIES A PREFERRED STOCK

              8.1 Redemption of Transworld Series A Preferred Stock. The Series
         A Preferred Stock, subject to the terms of the Intercreditor Agreement,
         shall be subject to purchase and Redemption by Transworld, in whole or
         in part, at the Series A Purchase Price, at the option of a Majority in
         Interest of the Purchasers ("Holders' Redemption") upon and after the
         occurrence of a Redemption Event; provided, however, that the Holders'
         Redemption cannot be exercised on more than three (3) separate
         occasions or for an aggregate Series A Purchase Price equal to less
         than (i)(pound)5.0 million on any occasion or (ii) 100% of the
         remaining shares of Series A Preferred Stock outstanding at the time if
         exercise of the Holders' Redemption would result in less than(pound)5.0
         million of Original Issue Price being owed with respect to all
         remaining outstanding shares of Series A Preferred Stock in the
         aggregate. In such event UK Parent shall be required to redeem, subject
         to the limitations of Section 8.5, the shares of the Series A Preferred
         Stock in the manner provided in Section 8.3 hereof and TW UK shall be
         required to redeem, subject to the limitations of Section 8.5, the
         Mirror Notes and Mirror PIK Notes in the manner provided in Section 8.3
         hereof. The date on which such Redemption Event occurs is referred to
         as the "Redemption Event Trigger Date." A "Redemption Event" shall
         mean, with respect to the shares of Series A Preferred Stock elected to
         be purchased by the Purchasers, (i) any Liquidity Event, or (ii) a date
         subsequent to the December 17, 2007 if the Bank Indebtedness and the
         Mezzanine Indebtedness have been paid in full on or before such date.
         The "Series A Purchase Price" shall be equal to the Series A Preference
         Amount.

              8.2 Holders' Redemption Offer Procedures. Within five (5) Business
         Days after Transworld becomes aware of the occurrence of a Redemption
         Event and in any event not later than the Redemption Event Trigger
         Date, Transworld shall mail a notice (the "Holders' Redemption Offer")
         to each of the Purchasers notifying them that the shares of Series A
         Preferred Stock will be purchased and redeemed, respectively, at the
         election of the Purchasers in accordance with this Article VIII. If a
         Majority in Interest of the Purchasers elect to exercise their
         redemption rights pursuant to this Article VIII, they shall give notice
         to Transworld setting forth the number of shares of Series A Preferred
         Stock to be

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         redeemed and the purchase date shall be the earlier of (i) a date
         selected by Transworld, but not later than 30 days from the date such
         notice is given, or (ii) if such notice relates to a Liquidity Event
         and is given prior to the occurrence of the Liquidity Event, the date
         of completion of the Liquidity Event (the "Holders' Redemption Purchase
         Date"). An election to exercise purchase and redemption rights pursuant
         to this Article VIII in connection with a Liquidity Event shall in all
         circumstances be conditional upon the completion of the Liquidity Event
         and no obligation to purchase or redeem, as the case may be, shares of
         Series A Preferred Stock shall arise if the Liquidity Event is not
         completed. In the event a Holders' Redemption is exercised with respect
         to a Liquidity Event, the Purchasers will be entitled to withdraw their
         election to tender the shares of Series A Preferred Stock by delivering
         to Transworld, for receipt not later than the close of business on the
         second Business Day preceding the Holders' Redemption Purchase Date,
         facsimile transmission or letter to that effect. Upon a Purchaser's
         election to tender any shares of Series A Preferred Stock, the
         Purchaser will be required to surrender such shares of Series A
         Preferred Stock to Transworld at the address specified in the signature
         page hereto prior to the close of business on the Business Day
         preceding the Holders' Redemption Purchase Date. On the Holders'
         Redemption Purchase Date, Transworld will purchase the shares of Series
         A Preferred Stock tendered pursuant to Section 8.1 hereof for cash in
         an amount equal to the aggregate Series A Purchase Price for all shares
         of Series A Preferred Stock tendered for purchase. If not all of the
         shares of Series A Preferred Stock tendered pursuant to a Holders'
         Redemption Offer can be purchased or redeemed, respectively, by
         Transworld for any reason, Transworld shall select, on or prior to the
         Holders' Redemption Purchase Date, the shares of Series A Preferred
         Stock (or portions thereof) shares of Series A Preferred Stock to be
         purchased and redeemed, as the case may be, pro rata among the
         Purchasers and dividends shall continue to accrue on all shares of
         Series A Preferred Stock not redeemed, provided, however, that nothing
         in this Article VIII shall be deemed a waiver or contractual impairment
         of the right of the Purchasers to have all shares of Series A Preferred
         Stock purchased and redeemed in full pursuant to Section 8.1 hereof and
         Transworld shall not be relieved of its obligations to redeem
         unredeemed shares of Series A Preferred Stock in full. Promptly after
         the Holders' Redemption Purchase Date, Transworld shall, with respect
         to any shares of Series A Preferred Stock not purchased or redeemed,
         respectively, in whole, return to the appropriate Purchaser, the
         unredeemed shares of Series A Preferred Stock or a new stock
         certificate, as the case may be, equal in number to the unredeemed
         portion of the tendered shares of Series A Preferred Stock.

              8.3 Mandatory Redemption of Mirror Preferred Stock and Mirror
         Notes. Upon written notice to each of UK Parent and TW UK of
         Transworld's intention to purchase and redeem the shares of Series A
         Preferred Stock pursuant to Sections 8.1 and 8.2 above (which notice
         Transworld will be required to serve as reasonably practicable after
         notice of election is given to the Corporation pursuant to Section 8.2,
         and subject to the limitations of Section 8.5, UK Parent

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         shall, immediately prior to such purchase and redemption by Transworld,
         redeem and purchase the Mirror Preferred Stock (in accordance with the
         terms and provisions of the Charter Documents of UK Parent.
         Concurrently, and subject to the limitations of Section 8.5, TW UK
         shall, immediately prior to such purchase and redemption of the Mirror
         Preferred Stock by UK Parent, redeem the Mirror Notes and the Mirror
         PIK Notes. Transworld shall use the funds it receives from such
         redemption of the Mirror Preferred Stock to purchase and redeem the
         shares of Series A Preferred Stock tendered by the Purchasers and
         accepted for redemption by Transworld pursuant to Section 8.2 hereof.
         UK Parent shall use the funds it receives from such redemption of the
         Mirror Notes to purchase and redeem the Mirror Preferred Stock tendered
         by Transworld pursuant to this Section 8.3 and the Charter Documents of
         UK Parent.

              8.4 Obligations of UK and TW UK Upon Holders' Redemption. Prior to
         the Holder's Redemption Purchase Date, in connection with a Liquidity
         Event, UK Parent will, and UK Parent shall cause TW UK, in good faith
         to seek, to obtain any required consent of the holders of the Bank
         Indebtedness and/or the Mezzanine Indebtedness the terms of which
         prohibit Transworld from purchasing the Series A Preferred Stock or UK
         Parent from purchasing the Mirror Preferred Stock and/or TW UK from
         redeeming the Mirror Notes and the Mirror PIK Notes, as the case may
         be, so as to permit the making of the Holders' Redemption Offer and the
         purchasing of the shares of Series A Preferred Stock pursuant to
         Section 8.1, respectively, including repayment out of the proceeds of
         such Liquidity Event of all Obligations under such Bank Indebtedness
         and/or Mezzanine Indebtedness to the extent necessary to permit the
         making of the Holders' Redemption Offer and the purchase of shares of
         Series A Preferred Stock and accompanying purchase of the Mirror
         Preferred Stock, Mirror Notes and Mirror PIK Notes pursuant to Section
         8.3 hereof.

              8.5 Holders' Redemption Prohibited. Subject to compliance with
         Section 8.4 hereof, if, at a Holders' Redemption Purchase Date,
         Transworld is prohibited or prevented under Applicable Laws (including
         lack of surplus under the laws of the State of New York) or under any
         other contractual or other arrangement, including, or other legal
         restriction whatsoever, directly or indirectly (which shall be deemed
         to encompass a similar prohibition or prevention with respect to UK
         Parent's or TW UK's or other Subsidiary's of Transworld compliance with
         the provisions of Section 8.3) from purchasing all shares of Series A
         Preferred Stock for which purchase is elected hereunder pursuant to the
         Holders' Redemption, then Transworld shall purchase such shares of
         Series A Preferred Stock, to the extent permissible and shall purchase
         the remaining shares of Series A Preferred Stock, as soon as Transworld
         is not so prohibited. Transworld shall use all reasonable endeavors to
         take such action as shall be necessary or appropriate to review and
         promptly remove any impediment to its ability to purchase the shares of
         Series A Preferred Stock under the circumstances contemplated by
         Section 8.1 hereof (including to cause UK Parent and/or TW UK

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         to take substantially similar actions), other than the Credit
         Agreements and the Intercreditor Agreement; provided, however, that
         this provision shall not require the repayment of Designated
         Indebtedness other then upon the occurrence of a Liquidity Event. In
         the event that Transworld fails for any reason to purchase any shares
         of Series A Preferred Stock for which purchase is required pursuant to
         Section 8.1 hereof , then (i) the Purchasers shall have the right to
         revoke their exercises of the Holders' Redemption at any time and (ii)
         if the Purchasers do not elect to so revoke such exercise, during the
         period from the applicable Holders' Redemption Purchase Date through to
         the date on which such shares of Series A Preferred Stock are purchased
         and redeemed, Transworld shall pay, in addition to such amounts due
         pursuant to exercise of the Holders' Redemption, to the Purchasers an
         amount equal to two percent (2%) per annum of the Series A Purchase
         Price for any of the shares of Series A Preferred Stock not purchased
         hereunder and the shares of Series A Preferred Stock which remain
         outstanding shall continue to accrue dividends at the rate stated in
         Section 2 of the Certificate of Designations, plus two percent (2%) per
         annum. Nothing in this Section 8.5 shall impair or be deemed to limit,
         modify or affect the rights of the Purchasers (unless otherwise
         restricted, including, without limitation, under the Intercreditor
         Agreement) to pursue any available remedy, at law or in equity, to
         enforce or seek to enforce, in any manner whatsoever, Transworld's
         obligations under this Article VIII, including without limitation
         filing any suit or complaint or seeking to file a suit or complaint
         with any court of competent jurisdiction to obtain injunctive or other
         equitable relief and/or damages arising from a breach of Transworld's
         obligation to purchase the shares of Series A Preferred Stock and
         enforcing any judgment obtained in any such suit in any manner
         available under Applicable Law to judgment creditors in general.

              8.6 Failure of Transworld, UK Parent and TW UK to Honor Holders'
         Redemption. In the event that either Transworld or UK Parent fails to
         perform in full its obligations following the Purchasers' election to
         exercise the Holders' Redemption pursuant to Section 8.1 hereof, and TW
         UK fails to perform its obligations as a guarantor of the obligations
         of Transworld and UK Parent pursuant to Section 8.7 hereof, then a
         Majority in Interest of the Purchasers shall have the right to exercise
         the Holders' Redemption against TW UK to the same extent and with the
         same effect as such exercise against Transworld, and TW UK hereby
         agrees that it shall be fully bound by this Article VIII as if it were
         Transworld, except that (A) to the extent that any deductions and
         withholdings on account of Taxes are required under Applicable Law, or
         of any Taxes imposed on any Purchaser as a result of failure of
         Transworld to fulfill its obligations under Section 8.1 hereof, and TW
         UK to fulfill its obligations under Section 8.7 below which would not
         have been required had no such failure occurred (unless such failure
         was directly attributable to a prohibition against such fulfillment by
         Transworld, UK Parent or TW UK, as the case may be, under Applicable
         Law), the Series A Purchase Price shall be increased, as may be
         necessary, so that after making all such deductions and withholdings
         and taking into account all such

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         Taxes (whether applicable to the original redemption price payable
         or to additional sums payable under this Section 8.6, and taking into
         account all Taxes on and arising by reason of the payment of additional
         sums payable under this Section 8.6), the Purchasers receive an amount
         equal to the sum that they would have received had no such deductions
         or withholdings been made or Taxes imposed, (B) the Companies shall
         make required deductions or withholdings, and (C) the Companies shall
         pay the full amount deducted or withheld to the relevant taxing or
         other Governmental Entity.

              8.7 TW UK Guaranty.

                   (a) TW UK hereby unconditionally, irrevocably and absolutely
         guarantees payment in full of the obligations of Transworld and UK
         Parent to the Purchasers upon the election of the Purchasers to
         exercise the Holders' Redemption with respect to the shares of Series A
         Preferred Stock. To the extent that Transworld and/or UK Parent
         defaults on such obligations, TW UK shall be absolutely and
         unconditionally obligated to pay the Series A Purchase Price, in
         immediately available funds in full on the Holders' Redemption Purchase
         Date, and shall not be entitled to set off any claim of any kind which
         Transworld, UK Parent or TW UK may have against anyone whether arising
         under or by reason of this Agreement, the other Transaction Documents
         or for any other reason of any kind. In the event that the Purchasers
         shall not for any reason receive on the Holders' Redemption Purchase
         Date the full payment of the Series A Purchase Price for the shares of
         Series A Preferred Stock being purchased and redeemed, then in any
         proceeding instituted by the Purchasers, no defense by TW UK to its
         obligation to pay the Series A Purchase Price, whether by counterclaim,
         affirmative defense or new matter, that is not also available to
         Transworld with respect to the primary obligation to purchase or redeem
         the shares of Series A Preferred Stock pursuant to the Holders'
         Redemption, shall be interposed or shall be of any force or effect,
         said defenses being waived for purposes of such proceeding.

                   (b) Subject to compliance in full with this Article VIII by
         the Purchasers, TW UK waives any and all notice of the creation,
         renewal, extension or accrual of any component of the Series A Purchase
         Price and notice of or proof of reliance by the Purchasers upon this
         Section 8.7 or acceptance of this Section 8.7; the obligation to pay
         the Series A Purchase Price shall conclusively be deemed to have been
         created, contracted or incurred in reliance upon this Section 8.7; and
         all dealings between Transworld, UK Parent or TW UK, on the one hand,
         and the Purchasers, on the other, shall likewise be conclusively
         presumed to have been had or consummated in reliance upon this Section
         8.7. TW UK waives diligence, presentment, protest, demand for payment
         and notice of default or nonpayment to or upon TW UK with respect to
         the Series A Purchase Price. TW UK's obligations under this Section 8.7
         shall be construed as a continuing, absolute and unconditional
         guarantee of payment to pay the Series A Purchase

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         Price and shall not be diminished or impaired by (i) any defense,
         set-off or counterclaim (other than a defense of payment) which may at
         any time be available to or be asserted by Transworld, UK Parent or TW
         UK against the Purchasers, or (ii) any other circumstance whatsoever
         (with or without notice to or knowledge of Transworld, UK Parent or TW
         UK) which constitutes, or might be construed to constitute, an
         equitable or legal discharge of Transworld from the obligation to pay
         the entire Series A Purchase Price, or of TW UK under this Section 8.7,
         upon the occurrence of any Insolvency Proceedings or in any other
         instance.

                   (c) This Section 8.7 shall continue to be effective, or be
         reinstated, as the case may be, if at any time payment, or any part
         thereof, of any of the Series A Purchase Price is rescinded or must
         otherwise be restored or returned by the Purchasers upon the occurrence
         of any Insolvency Proceedings relating to Transworld or UK Parent or
         upon or as a result of the appointment of a receiver, intervener or
         conservator of, or trustee or similar officer for, Transworld or UK
         Parent or any substantial part of its property, or otherwise, all as
         though such payments had not been made.

                   (d) Any provision of this Section 8.7 which is prohibited or
         unenforceable in any jurisdiction shall, as to such jurisdiction, be
         ineffective to the extent of such prohibition or unenforceability
         without invalidating the remaining provisions hereof, and any such
         prohibition or unenforceability in any jurisdiction shall not
         invalidate or render unenforceable such provision in any other
         jurisdiction.

                   (e) No failure to exercise, or any delay in exercising, on
         the part of the Purchasers, any right, power or privilege hereunder
         shall operate as a waiver thereof. No single or partial exercise of any
         right, power or privilege hereunder shall preclude any other or further
         exercise thereof or the exercise of any other right, power or
         privilege. A waiver by the Purchasers of any right or remedy hereunder
         on any one occasion shall not be construed as a bar to any right or
         remedy which the Purchaser would otherwise have on any future occasion.
         The rights and remedies provided in this Section 8.7 are cumulative,
         may be exercised singly or concurrently and are not exclusive of any
         rights or remedies provided by law.

              8.8 Further Action. Subject to the requirements of law, each of
         Transworld and UK Parent (or their successors or assigns or any Person
         to whom they transfer any of their shares in UK Parent or TW UK,
         respectively) shall exercise or direct the exercise of their voting
         rights (whether at a general or extraordinary meeting of shareholders
         or by consent in lieu of a meeting of shareholders) and where
         appropriate to give effect to such matters, shall convene any necessary
         shareholders meeting, for the purpose of passing (and, not

                                       11
<PAGE>

         revoking) such resolutions as may be required by law to approve or
         authorize any purchase of Securities pursuant to Article VIII hereof).

         8. Amendments to Articles IX, X, XI, XII, XIII, XIV and XV. Effective
hereby, the following shall be substituted in its entirety for Articles IX, X,
XI, XII, XIII, XIV and XV of the Agreement: Intentionally Omitted

         9. Amendment to Article XVI. Effective hereby, the following shall be
substituted in its entirety for Article XVI of this Agreement:

                                   ARTICLE XVI
                                   SUCCESSORS

              16.1 Merger or Consolidation.

                   (a) The Companies shall not directly or indirectly, by
         operation of law or otherwise (i) be acquired by any other Person; (ii)
         permit substantially all of their assets to be acquired by any other
         Person (including an acquisition of stock of Subsidiaries which in the
         aggregate account for substantially all of the Corporation's assets);
         (iii) consolidate, merge, or otherwise combine with or into any other
         Person; (iv) permit any other Person to acquire, consolidate, merge, or
         otherwise combine with or into the Companies; (v) permit any other
         Person to acquire, consolidate, merge, or otherwise combine with or
         into or be consolidated, merged, or otherwise combined with or into by,
         any Subsidiary (in a transaction in which such Subsidiary (or successor
         Person) remains (or becomes) a Subsidiary); or (vi) directly or
         indirectly, transfer, convey, sell, lease or otherwise dispose of all
         or substantially all of the properties and assets of any of the
         Subsidiaries as an entirety or permit any of the Subsidiaries to do any
         of the foregoing (except for the merger, consolidation or other
         combination of any Subsidiary of the Companies with or into, or the
         disposition of all or substantially all of the assets of any Subsidiary
         of the Companies to, the Companies or any Wholly-Owned Subsidiary of
         the Companies), unless:

                   (i) in any such transaction in which the Person acquires by
              transfer, conveyance, consolidations, merger, combination, sale,
              lease or other disposition, as applicable, all or substantially
              all of the properties and assets of the Companies as an entirety
              (for purposes of this Article XVI, "Successor Companies"), such
              Successor Companies (i) shall be a corporation or limited
              liability company, (ii) shall be organized, duly incorporated and
              validly existing under the laws of the United States or England,
              (iii) shall expressly assume pursuant to the terms and conditions
              of this Agreement, in form reasonably satisfactory to a Majority
              in Interest of the Purchasers, the obligations with respect to the
              shares of Series A Preferred Stock then outstanding, and the
              performance of the covenants and obligations set forth in this
              Agreement and the Certificate of

                                       12
<PAGE>

              Designation on the part of the Companies to be performed or
              observed or shall agree to such alternative obligations, such
              that, following such assumption and agreement, the Purchasers will
              continue to have the right to achieve practical realization of the
              principal benefits intended to be provided to them hereby and
              thereby, which the Companies understand to include, without
              limitation, (A) the practical realization of the principal
              benefits intended to be provided under the Holders' Redemption as
              provided in Article 8, (B) the covenants as provided in Section 13
              of the Certificate of Designations and (C) the enforcement against
              the Companies of any Covenant Breach or Insolvency Breach as
              provided in Section 17 of the Certificate of Designations, as
              nearly as may be, in relation to the circumstances of such
              Successor Companies) and (iv) shall take all such action and pass
              all such resolutions as may be necessary to enable it to assume
              and agree on all such obligations, including, without limitation,
              the obligations with respect to the guarantee of the Holders'
              Redemption and the purchase of shares of Series A Preferred Stock
              under Article VIII hereof;

                   (ii) immediately before and after giving effect to such
              transaction, no Covenant Breach or Event of Default shall have
              occurred and be continuing;

                   (iii) the Companies have delivered to the Purchasers an
              Officers' Certificate and a written opinion from legal counsel,
              each stating that such consolidation, merger, amalgamation,
              combination, conveyance, transfer, lease or acquisition and, if
              the assumption of the obligations of the Companies under this
              Agreement or the Certificate of Designations is required in
              connection with such transaction, such documents effecting such
              assumption, complies with this Article XVI and that all conditions
              precedent herein for relating to such transaction have been
              complied with and satisfied.

                   (b) For purposes of the foregoing, the transfer (by lease,
         assignment, sale or otherwise, in a single transaction or series of
         transactions, of all or substantially all of the properties and assets
         of one or more Subsidiaries, the Capital Shares of which constitutes
         all or substantially all of the properties and assets of the Companies,
         shall be deemed to be the transfer of all or substantially all of the
         properties and assets of the Companies.

              16.2 Surviving Person Substituted. Upon any acquisition, disposal,
         consolidation, merger or other combination, or any transfer of assets
         in accordance with Section 16.1, the Surviving Person (if other than
         the Companies) following such transaction or formed by such
         consolidation or into which the Companies are merged or otherwise
         combined or to which such transfer is made shall succeed to, and be
         substituted for, and may exercise every right and power

                                       13
<PAGE>

         of, the Companies under this Agreement and the Certificate of
         Designations with the same effect as if such Surviving Person had been
         named as the Companies herein. When, and only when, a Successor Company
         assumes all of the obligations of the Companies hereunder and under the
         Securities and agrees to be bound hereby and thereby, the predecessor
         shall be released from such obligations.

         10. Amendment to Article XVII. Effective hereby, the following shall be
substituted in its entirety for Article XVII of the Agreement: Intentionally
Omitted.

         11. Amendment to Article XVIII. Effective hereby, the following shall
be substituted in its entirety for Article XVIII of the Agreement:

                                  ARTICLE XVIII
                                   AMENDMENTS

              18.1 Amendments and Supplements Requiring Consent of Purchasers;
         Other Consents.

                   (a) Except as otherwise provided in Section 18.1(b) or
         18.1(c) hereof, as applicable, this Agreement and the Securities may be
         amended or supplemented with the written consent of, and any existing
         Covenant Breach or Event of Default or compliance with any provision of
         this Agreement or the Securities may be waived only with the
         affirmative vote at a meeting written or the consent of a Majority in
         Interest of Purchasers.

                   (b) Without the consent of every affected Purchaser who is a
         registered owner of shares of Series A Preferred Stock with an
         aggregate Original Issue Price of (pound)500,000 or more, no amendment,
         supplement or waiver to this Agreement shall: (i) reduce the Original
         Issue Price, principal amount or value of the Series A Preferred Stock,
         the Mirror Preferred Stock, the Mirror Notes or the Mirror PIK Notes;
         (ii) reduce the number of shares of Common Stock issuable upon
         conversion of any shares of Series A Preferred Stock (except pursuant
         to adjustment provisions as provided therein), change the fixed
         maturity of any Mirror Note or Mirror PIK Note or alter the provisions
         with respect to the redemption of the Series A Preferred Stock, the
         Mirror Preferred Stock, the Mirror Note or Mirror PIK Note in a manner
         adverse to the Purchasers; (iii) reduce the rate of or change the time
         for payment of dividends or interest on any shares of Series A
         Preferred Stock, the Mirror Preferred Stock, Mirror Note or the Mirror
         PIK Notes; (iv) waive a Covenant Breach or Event of Default in the
         payment of principal of, or interest on, any shares of Series A
         Preferred Stock, the Mirror Preferred Stock, or Mirror Note or the
         Mirror PIK Note or on the payment of the Series A Purchase Price or
         Series A Preference Amount, or the Mirror Preferred Stock Purchase
         Price or the Mirror Preferred Stock Preference Amount or the Mirror
         Note Redemption Price or the Mirror PIK Note Redemption Price

                                       14
<PAGE>

         (except that a Majority in Interest of the Purchasers may (A) rescind
         an Acceleration that resulted from a non-payment default, and (B) waive
         the payment default that resulted from such Acceleration); (v) make any
         share of Series A Preferred Stock or Mirror Preferred Stock or Mirror
         Note or Mirror PIK Notes payable in consideration other than that
         stated in the Certificate of Designation or such instruments; (vi)
         waive a payment of the Series A Purchase Price, Series A Preference
         Amount, Mirror Preferred Stock Purchase Price, Mirror Preferred Stock
         Preference Amount, the Mirror Note Redemption Price or the Mirror PIK
         Note Redemption Price, upon redemption or purchase of the relevant
         Security; or (vii) make any change in this Section 18.1(b).

                   (d) After an amendment, supplement or waiver under this
         Section 18.1 becomes effective, the Companies shall mail to the
         Purchasers a notice briefly describing the amendment, supplement or
         waiver. Any failure of the Companies to mail such notice, or any defect
         therein, shall not, however, in any way impair or affect the validity
         of any such amended or supplemental Agreement or waiver.

              18.2 Revocation and Effect of Consents.

                   (a) Until an amendment, supplement or waiver becomes
         effective, a consent to it by the Purchasers is a continuing consent by
         such Purchasers and every subsequent holder of Securities (whether
         subsequently holding in whole or in part), even if notation of the
         consent is not made on any Security.

                   (b) The Companies may, but shall not be obligated to, fix a
         record date for the purpose of determining the subsequent holders of
         Securities entitled to consent to any amendment or waiver. If a record
         date is fixed, then notwithstanding the provisions of the immediately
         preceding paragraph, those Persons who were holders of Securities at
         such record date (or their duly designated proxies), and only those
         Persons, shall be entitled to consent to such amendment or waiver or to
         revoke any consent previously given, whether or not such Persons
         continue to be holders of such Securities after such record date.

                   (c) After an amendment or waiver becomes effective it shall
         bind the Purchasers and any subsequent holder.

              18.3 Notation on or Exchange of Securities. The Companies may
         place an appropriate notation about an amendment, supplement or waiver
         on any Security thereafter issued in exchange for any Security issued
         and outstanding as of the date of such amendment, supplement or waiver.
         The Companies, in exchange for such issued and outstanding Securities,
         may issue all new Securities that reflect the amendment, supplement or
         waiver. Failure to make the appropriate notation or issue a new
         Security shall not affect the validity and effect of such amendment,
         supplement or waiver.

                                       15
<PAGE>

              18.4 Board Approval. The Companies may not sign an amendment,
         supplement or waiver with respect to this Agreement until the Board of
         Directors of Transworld approves it.

         12. Amendment to Section 21.10. Effective hereby, the following shall
be substituted in its entirety for Section 21.10. of the Agreement:

              21.10 Merger. This Agreement, the Subordinated Notes, the PIK
         Notes, the Warrant Instrument, the Mirror Notes, the Mirror PIK Notes,
         the shares of Series A Preferred Stock, the Certificate of
         Designations, the shares of Mirror Preferred Stock, and the other
         Transaction Documents collectively constitute the entire agreement of
         the Companies and the Purchasers and express the entire understanding
         of the Companies and the Purchasers with respect to the Securities.

         13. Amendment to Section 21.12. Effective hereby, the following shall
be substituted in its entirety for Section 21.12 of the Agreement:

              21.12 Conflict. If there is a conflict between the provisions of
         (i) this Agreement or the Voting Trust Agreement and (ii) the Charter
         Documents of Transworld, TW UK or UK Parent or any of the other Group
         Companies during the continuance of this Agreement or the Voting Trust
         Agreement (as the case may be), it is the intention of the parties
         hereto that the provisions of this Agreement or the Voting Trust
         Agreement (as the case may be) shall prevail over such Charter
         Documents during such period and accordingly Transworld, the Companies
         and the Purchasers shall exercise all voting and other rights and
         powers available to them so as to give effect to the provisions of this
         Agreement or the Voting Trust Agreement (as the case may be) and shall
         further if necessary procure any required amendment to the Charter
         Documents of the Group Companies.

         14. Tax Covenants of the Companies Applicable to the Purchasers'
Securities. As a material inducement for the Purchasers to enter into this
Amendment and the Master Reorganization Agreement, each of the Companies hereby
makes the following covenants and agreements; provided, however, that all such
covenants and agreements shall, notwithstanding the terms thereof, lapse upon
the Lead Investor (or any of its Affiliates, which, for purposes of this
paragraph 14, shall included any limited partner or other constituent owner of
the Lead Investor) holding none of the shares of Series A Preferred Stock issued
to the Lead Investor on the Closing Date (including shares of Common Stock
issued upon conversion thereof):

              (a) None of the Companies and any of their respective Subsidiaries
and other affiliates shall take any action, or fail to take any action, that
would cause the exchanges set forth in Section 1.1(a), (b), (c)(ii), (d)(ii),
and (e)(ii) of the Master Reorganization Agreement (collectively, the "Tax-Free
Exchanges") not to qualify as a "B" reorganization within the meaning of Section
368(a)(1)(B) of the Code.

              (b) Without limiting the foregoing Section 16(a):

                                       16
<PAGE>

                   (i) none of the Companies and any of their respective
         Subsidiaries and other affiliates will file any Tax Return or take any
         position inconsistent with the treatment of the Tax-Free Exchanges as a
         "B" reorganization within the meaning of Section 368(a)(1)(B) of the
         Code;

                   (ii) each of the Companies and their respective Subsidiaries
         and other affiliates will comply with the record keeping and
         information reporting requirements set forth in Treasury Regulations
         Section 1.368-3;

                   (iii) each of the Companies, the Subsidiaries and other
         Affiliates covenant that UK Parent will at all times during the
         two-year period commencing with the Closing Date continue to be an
         entity that is disregarded as separate from its owner for U.S. federal
         income tax purposes as contemplated by Treasury Regulations Section
         301.7701-3;

                   (iv) each of the Companies, the Subsidiaries and other
         Affiliates covenant that TW UK will at all times during the two-year
         period commencing with the Closing Date continue to be a corporation,
         as defined under Treasury Regulations Section 301.7701-2(b), for U.S.
         federal income tax purposes;

                   (v) each of the Companies, the Subsidiaries and other
         Affiliates covenant that the voting trust established pursuant to the
         Voting Trust Agreement will at all times during the two-year period
         commencing with the Closing Date continue to be either an entity that
         is disregarded as separate from its owner as contemplated by Treasury
         Regulations Section 301.7701-3 or a grantor trust for U.S. federal
         income tax purposes;

                   (vi) each of the Companies, the Subsidiaries and other
         Affiliates covenant that TWUS will legally and beneficially own 100% of
         the stock TW UK immediately after the consummation of the
         Reorganization (as defined in the Master Reorganization Agreement)
         either directly or indirectly through UK Parent and the voting trust
         established by the Voting Trust Agreement, and TWUS shall at all times
         during the two-year period commencing with the Closing Date retain
         control of TW UK within the meaning of Code Section 368(c)(1);

                   (vii) on or prior to the Closing Date, none of TWUS, any of
         its Subsidiaries or other affiliates (including, without limitation, UK
         Parent) will acquire any shares of stock of TW UK other than pursuant
         to the terms of this Agreement;

                   (viii) on or prior to the Closing Date, TWUS will treat
         itself, for U.S. federal income tax purposes, as the direct owner of
         the shares of TW UK beneficially owned by UK Parent and legally owned
         by the voting trust established by the Voting Trust Agreement for the
         two-year period commencing with the Closing Date, and shall not file
         Tax Returns relating to such two-year period, including amended Tax
         Returns, inconsistent with such treatment; and

                                       17
<PAGE>

                   (ix) TW UK solely shall pay the expenses and taxes required
         to be paid by Section 1.3 of the Master Reorganization Agreement and
         Section 10.7 of the Master Reorganization Agreement, such expenses and
         taxes shall be paid out of the operating cash flow and cash balances of
         TW UK, TW UK shall not borrow any amounts or otherwise incur any
         indebtedness for the purpose of or in connection with the paying of any
         such expenses and taxes, and TW UK shall not be reimbursed, directly or
         indirectly, by TWUS or any of the Subsidiaries or other affiliates of
         TWUS (including, without limitation, UK Parent) for any such
         expenditures.

              (c) TWUS and UK Parent represent and warrant that, at all times
since December 17, 1999, (i) none of TWUS, any of its Subsidiaries and other
affiliates (including, without limitation, UK Parent but excluding TW UK) has
acquired stock of TW UK other than directly from TW UK in connection with the
formation of TW UK; (ii) TW UK acquired shares of its own stock, if any such
acquisitions have occurred, solely with consideration attributable to its own
operating cash flow and cash balances and not with consideration attributable to
a loan or other indebtedness or capital contribution to TW UK; and (iii) TWUS
has treated itself for U.S. federal income tax purposes as the direct owner of
the shares of TW UK beneficially owned by UK Parent and legally owned by the
voting trust established pursuant to the Voting Trust Agreement, and the voting
trust established pursuant to the Voting Trust Agreement has at all times been
either an entity that is disregarded as separate from its owner as contemplated
by Treasury Regulations Section 301.7701-3 or a grantor trust for U.S. federal
income tax purposes.

              (d) None of the Companies and any of their respective Subsidiaries
and other affiliates is aware of any fact that would cause the Tax-Free
Exchanges not to qualify as a "B" reorganization within the meaning of Section
368(a)(1)(B) of the Code.

              (e) Each of the Companies, their Subsidiaries and other Affiliates
represents and warrants that it has no present plan or intention to take any
actions or fail to take any actions that would cause the covenants set forth in
Section 14(b)(iii)-(vi) and (viii) to be violated as if such covenants were not
limited to the two-year period therein.

              (f) None of the Companies, any of their Subsidiaries or other
Affiliates has acquired stock of TWUK in anticipation or contemplation of the
Tax-Free Exchange.

         15. Directors. Each of TWUS and UK Parent hereby agrees to use its best
efforts to nominate for director(s) of TWUS and UK Parent, respectively, at any
instance whereupon a vote or selection for such director(s) shall occur,
including without limitation, at each meeting of the stockholders of TW UK and
UK Parent, respectively (or in each action by written consent in lieu of a
meeting), for the election of director or upon the creation of or existence of
any vacancy in the Board of Directors, those individuals as appropriate such
that the Board of Directors of TWUS and UK Parent, respectively, will be
comprised identically to the Board of Directors of TW UK.

         16. Other Provisions Unchanged. Except as specifically amended hereby,
all other terms and conditions of the Agreement shall remain in full force and
effect. To the extent that

                                       18
<PAGE>

the Agreement includes such terms as "herein," "hereto," "in this Agreement" and
the like, such terms shall be interpreted to refer to the Agreement, as modified
by this Amendment.

         17. Counterparts. This Amendment may be executed in separate
counterparts, each of which shall be an original and all of which taken together
shall constitute one and the same instruments.

                [REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK]

                                       19
<PAGE>

         IN WITNESS WHEREOF, the parties hereto have executed and delivered this
Amendment to the Agreement on the date first written above.

                                       COMPANIES:

                                       SIGNED AS A DEED FOR AND ON BEHALF OF
                                       TRANSWORLD HEALTHCARE (UK) LIMITED

                                       By:
                                           -------------------------------------
                                           Name:
                                           Title:

                                       By:
                                           -------------------------------------
                                           Name:
                                           Title:

                                       SIGNED AS A DEED FOR AND ON BEHALF OF
                                       ALLIED HEALTHCARE GROUP LIMITED,
                                       FORMERLY KNOWN AS
                                       TRANSWORLD HOLDINGS (UK) LIMITED

                                       By:
                                           -------------------------------------
                                           Name:
                                           Title:

                                       By:
                                           -------------------------------------
                                           Name:
                                           Title:

                                       20
<PAGE>

                                       PURCHASERS:

                                       Signed as a deed for and on behalf of
                                       TRIUMPH PARTNERS III, L.P.

                                       By: Triumph III Advisors, L.P., its
                                           general partner

                                       By: Triumph III Advisors, Inc., its
                                           general partner

                                       By:
                                           -------------------------------------
                                           Name:
                                           Title:

                                       By:
                                           -------------------------------------
                                           Name:
                                           Title:

                                       Signed as a deed for and on behalf of
                                       TRIUMPH III INVESTORS, L.P.

                                       By: Triumph III Investors, Inc., its
                                           general partner

                                       By:
                                           -------------------------------------
                                           Name:
                                           Title:

                                       By:
                                           -------------------------------------
                                           Name:
                                           Title:

                                       21
<PAGE>

                                       Signed as a Deed by
                                       PARIBAS
                                       acting by its duly authorized attorney

                                       -----------------------------------------
                                       Name:

                                       22
<PAGE>

                                       SIGNED AS A DEED BY
                                       TRANSWORLD HEALTHCARE, INC.
                                       ACTING BY ITS DULY AUTHORIZED ATTORNEY

                                       By:
                                           -------------------------------------
                                           Name:
                                           Title:

                                       [OTHER PURCHASERS TO BE ADDED]

                                       23<PAGE>

                                                                   EXHIBIT 10.19

                          REGISTRATION RIGHTS AGREEMENT

                                  BY AND AMONG

                          TRANSWORLD HEALTHCARE, INC.,

                                       AND

                            THE HOLDERS NAMED HEREIN

                         DATED AS OF ____________, 2002

<PAGE>
                          REGISTRATION RIGHTS AGREEMENT

         THIS REGISTRATION RIGHTS AGREEMENT (this "Agreement") is entered into
as of __________, 2002 by and among Transworld Healthcare, Inc., a New York
corporation ("TWUS"), the holders of ordinary shares of Transworld Healthcare
(UK) Limited, a company incorporated in England and Wales with registered number
3370146 ("TWUK"), named in Exhibit A attached hereto (the "Ordinary
Shareholders," and each individually, an "Ordinary Shareholder"), Triumph
Partners III, L.P. and Triumph III Investors, L.P. (together "Triumph"), the
holders of redeemable shares of TWUK named in Exhibit B attached hereto (the
"Redeemable Shareholders," and, each individually, a "Redeemable Shareholder"),
the holders of equity warrants of TWUK named in Exhibit C attached hereto (the
"Equity Warrant Holders," and each individually, an "Equity Warrant Holder"),
the holders of mezzanine warrants of TWUK named in Exhibit D attached hereto
(the "Mezzanine Warrant Holders," and each individually, a "Mezzanine Warrant
Holder"), Hyperion Partners II L.P., Hyperion TW Fund L.P., Hyperion TWH Fund
LLC, and Hyperion TWH Fund II LLC (collectively, "Hyperion") and Timothy M.
Aitken and Sarah L. Eames (together, the "Employees"). The Ordinary
Shareholders, Triumph, the Redeemable Shareholders, the Equity Warrant Holders
and the Mezzanine Warrant Holders shall be referred to collectively herein as
the "Investors." The Investors, Hyperion, Triumph and the Employees
collectively, the "Holders" and individually a "Holder."

                                    RECITALS

         WHEREAS, the Investors are to receive an aggregate of up to
[__________] shares (the "Investor Shares") of TWUS common stock, par value $.01
per share ("TWUS Common Stock"), and the Equity Warrant Holders are to receive
an aggregate of up to [_________] shares of TWUS preferred stock, par value $.01
per share ("TWUS Preferred Stock"), which is convertible into up to [__________]
shares of common stock of TWUS (the "Conversion Shares"), pursuant to the terms
of that certain Master Reorganization Agreement, dated as of April 24, 2002 by
and among TWUS, TWUK, Allied Healthcare Group (UK) Ltd., a company incorporated
in England and Wales with registered number 3890177 ("AHG," and, together with
TWUS and TWUK, the "Corporate Group") and the Investors (the "Reorganization
Agreement");

         WHEREAS, dividends on the TWUS Preferred Stock may under certain
circumstances be paid through the delivery of additional shares of TWUS Common
Stock (the "Dividend Shares");

         WHEREAS, it is a condition to the obligations of the Investors that
TWUS grant certain registration rights to the Investors with respect to the
Investor Shares, the Conversion Shares and the Dividend Shares to be received by
the Investors;

                                       1
<PAGE>

         WHEREAS, TWUS has agreed to grant certain registration rights to
Hyperion in connection with the shares of TWUS Common Stock held by Hyperion as
of the date hereof (the "Hyperion Shares");

         WHEREAS, TWUS has agreed to grant certain registration rights to
Triumph in connection with the 370,500 shares of TWUS Common Stock purchased by
Triumph Partners III, L.P. on April 22, 2002 and the 4,500 shares of TWUS Common
Stock purchased by Triumph III Investors, L.P. on April 22, 2002 (together, the
"Triumph Shares");

         WHEREAS, TWUS has agreed to grant certain registration rights to the
Employees in connection with the 684,258 shares of TWUS Common Stock issued to
Timothy Aitken on April 22, 2002 and the 487,099 shares of TWUS Common Stock
issued to Sarah Eames on April 22, 2002 (the "Compensatory Shares");

         NOW, THEREFORE, in consideration of the foregoing, the mutual promises
and agreements set forth herein, and other valuable consideration, the receipt
and sufficiency of which are hereby acknowledged, the parties hereto hereby
agree as follows:

         1. Certain Definitions.

         As used in this Agreement, the following terms shall have the following
respective meanings:

         "Affiliate" of a Person shall mean any person or entity which directly
or indirectly controls, is controlled by, or is under common control with such
person or entity.

         "Affiliate Registration Statement" shall have the meaning set forth in
Section 2(b) hereof.

         "Agreement" shall have the meaning set forth in the preamble hereof.

         "AHG" shall have the meaning set forth in the recitals hereof.

         "AMEX" shall have the meaning set forth in Section 4 hereof.

         "Arbitrator" shall have the meaning set forth in Section 17(a) hereof.

         "Closing" shall have the meaning ascribed thereto in the Reorganization
Agreement.

         "Commission" shall mean the United States Securities and Exchange
Commission, or any other federal agency administering the Securities Act and the
Exchange Act at the time.

         "Compensatory Shares" shall have the meaning set forth in the recitals
hereof.

         "Conversion Shares" shall have the meaning set forth in the recitals
hereof.

                                       2
<PAGE>

         "Corporate Group" shall have the meaning set forth in the recitals
hereof.

         "Demand Notice" shall have the meaning set forth in Section 2(d)
hereof.

         "Demand Registration" shall have the meaning set forth in Section 2(d)
hereof.

         "Dividend Shares" shall have the meaning set forth in the recitals
hereof.

         "Employees" shall have the meaning set forth in the recitals hereof.

         "Equity Warrant Holder(s)" shall have the meaning set forth in the
preamble hereof.

         "Exchange Act" shall mean the Securities Exchange Act of 1934, as
amended from time to time, or any similar successor federal statute, and the
rules and regulations promulgated thereunder.

         "Fair Market Value" shall mean the closing sales price, or the closing
sales bid if no sales were reported, of the TWUS Common Stock as quoted on AMEX
on the date immediately preceding the date of calculation or if there are no
sales or bids for such date, then for the last preceding business day for such
sales or bids, as reported in The Wall Street Journal or similar publication.

         "Holder(s)" shall have the meaning set forth in the preamble hereof.

         "Hyperion" shall have the meaning set forth in the preamble hereof.

         "Hyperion Shares" shall have the meaning set forth in the recitals
hereof.

         "Indemnified Person" shall have the meaning set forth in Sections 6(a)
and 6(b) hereof.

         "Indemnifying Person" shall have the meaning set forth in Section 6(d)
hereof.

         "Indemnitee" shall have the meaning set forth in Section 6 hereof.

         "Inspectors" shall have the meaning set forth in Section 3(k) hereof.

         "Investors" shall have the meaning set forth in the preamble hereof.

         "Investors' Shares" shall have the meaning set forth in the recitals
hereof.

         "Liability" shall have the meaning set forth in Section 6(a) hereof.

         "Majority in Interest" shall mean, with respect to the registrations
subject to Section 2(a) (or a demand registration in lieu thereof), the meaning
ascribed thereto in the Reorganization

                                       3
<PAGE>

Agreement and, with respect to any other registrations a majority of the
Registrable Shares proposed to be registered under such Registration Satement.

         "Mezzanine Warrant Holder(s)" shall have the meaning set forth in the
preamble hereof.

         "NASD" shall have the meaning set forth in the Section 3(q) hereof.

         "Offering Blackout Period" shall have the meaning set forth in the
Section 10(c) hereof.

         "Ordinary Shareholder(s)" shall have the meaning set forth in the
preamble hereof.

         "Person" shall mean an individual, a corporation, a partnership, a
joint venture, a trust, an unincorporated organization, a limited liability
company or partnership, a government and any agency or political subdivision
thereof.

         "Prospectus" shall mean the prospectus included in a Registration
Statement, including any preliminary prospectus, as amended or supplemented by
any prospectus supplement with respect to the terms of the offering of any
portion of the Registrable Shares covered by such Registration Statement, and by
all other amendments and supplements to such prospectus, including
post-effective amendments, and in each case including all material incorporated
by reference therein.

         "Qualified Offering" shall have the meaning set forth in Section
2(e)(ii) hereof.

         "Records" shall have the meaning set forth in Section 3(k) hereof

         "Redeemable Shareholder(s)" shall have the meaning set forth in the
preamble hereof.

         "Registrable Shares" shall mean the Shares, excluding (i) Shares for
which a Registration Statement relating to the resale thereof by the holder
thereof shall have become effective under the Securities Act and which have been
disposed of under such Registration Statement, (ii) Shares actually sold
pursuant to Rule 144, or (iii) Shares eligible for sale pursuant to Rule 144(k)
(or any successor provision).

         "Registration Expenses" shall mean the expenses so described in Section
5 hereof.

         "Registration Statement" shall mean any registration statement of TWUS
which covers the offer and sale of any of the Registrable Shares under the
Securities Act on an appropriate form, and all amendments and supplements to
such registration statement, including post-effective amendments, in each case
including the Prospectus contained therein, all exhibits thereto and all
materials incorporated by reference therein.

         "Reorganization" shall have the meaning set forth in Section 2(a)
hereof.

         "Reorganization Agreement" shall have the meaning set forth in the
recitals hereof.

                                       4
<PAGE>

         "Resale Registration Statement" shall have the meaning set forth in
Section 2(a) hereof.

         "Rule 144" means Rule 144 under the Securities Act (or any successor
provision).

         "Securities Act" shall mean the Securities Act of 1933, as amended from
time to time, or any similar successor federal statute, and the rules and
regulations of the Commission thereunder.

         "Shares" shall mean collectively the Investors' Shares, the Conversion
Shares, the Dividend Shares, the Hyperion Shares, the Compensatory Shares and
the Triumph Shares.

         "Suspension Event" shall have the meaning set forth in Section 10(b)
hereof.

         "Triumph" shall have the meaning set forth in the preamble hereof.

         "Triumph Shares" shall have the meaning set forth in the recitals
hereof.

         "TWUK" shall have the meaning set forth in the preamble hereof.

         "TWUS" shall have the meaning set forth in the preamble hereof.

         "TWUS Common Stock" shall have the meaning set forth in the recitals
hereof.

         "TWUS Offering" shall have the meaning set forth in the Section 10(c)
hereof.

         "TWUS Preferred Stock" shall have the meaning set forth in the recitals
hereof.

         All other capitalized terms not defined herein shall have the meaning
set forth in the Reorganization Agreement unless otherwise indicated.

         2. Registration.

              (a) Amendment of Registration Statement. Subject to the provisions
of Section 2(c) below, TWUS shall (i) originally file with the Commission its
Registration Statement on Form S-4 covering the issuance of Shares in the
reorganization of the Corporate Group pursuant to which TWUK will become a
wholly-owned subsidiary of AHG, which is a wholly-owned subsidiary of TWUS (the
"Reorganization"), to also serve after the consummation of the Reorganization as
a resale registration statement under Rule 415 covering the sale by the
Investors of all or any portion of their Registrable Shares (other than the
Compensatory Shares and the Triumph Shares), or (ii) if TWUS is unable to comply
with clause (i) above for any reason, prepare and file a resale registration
statement on Form S-3, or such other applicable forms, with the Commission,
under Rule 415 under the Securities Act, covering the sale by the Investors of
all or any portion of their Registrable Shares in accordance with the terms
hereof

                                       5
<PAGE>

(each of the registration statement(s) described in clauses (i) and (ii) above
hereafter a "Resale Registration Statement"). A filing described in clause (ii)
above shall be made on a date reasonably designed to allow TWUS to have such
Registration Statement declared effective by the date of the Closing of the
Reorganization, but in any event such Resale Registration Statement shall be
declared effective not later than thirty (30) calendar days after the Closing of
the Reorganization. TWUS shall use its reasonable best efforts to cause the
Resale Registration Statement to be declared effective by the Commission for all
of the Registrable Shares covered thereby by the earliest practicable date after
filing with the Commission. In the event that TWUS is unable to cause such
Resale Registration Statement to be declared effective by the Commission within
thirty (30) calendar days following the Closing of the Reorganization, then the
provisions of Section 2(c) shall apply. TWUS agrees to use its reasonable
efforts to keep the Resale Registration Statement continuously effective until
no shares of TWUS Preferred Stock remain outstanding and no Investors' Shares,
Conversion Shares or Dividend Shares that constitute Registrable Shares remain
outstanding. In the event that a Person not named in a Resale Registration
Statement as a potential selling stockholder becomes a Holder of Registrable
Shares, TWUS will make such changes to the then effective Resale Registration
Statement as are necessary to include such Person as a potential selling
stockholder with respect to its Registrable Shares under the Resale Registration
Statement, unless the inclusion of such Person is prohibited by the Commission
or applicable law.

              (b) Registration Statement Covering Resale of Hyperion Shares,
Compensatory Shares and Triumph Shares. TWUS shall prepare and file a
registration statement on Form S-3 (the "Affiliate Registration Statement"), or
such other applicable forms, with the Commission, under Rule 415 under the
Securities Act, in connection with the sale by Hyperion, the Employees and
Triumph at the time of such filing of all of the Hyperion Shares, the
Compensatory Shares and the Triumph Shares in accordance with the terms hereof
(and, in the event that a Person not named in an Affiliate Registration
Statement as a potential selling stockholder becomes a Holder of Hyperion
Shares, Compensatory Shares or Triumph Shares, TWUS will make such changes to
the then effective Affiliate Registration Statement as are necessary to include
such Person as a potential selling stockholder with respect to its Hyperion
Shares, Compensatory Shares or Triumph Shares under the Affiliate Registration
Statement, unless the inclusion of such Person is prohibited by the Commission
or applicable law), such filing to be made on a date reasonably designed to
allow TWUS to have such Affiliate Registration Statement declared effective by
the date of the Closing of the Reorganization, but in any event such Affiliate
Registration Statement shall be declared effective not later than thirty (30)
calendar days after the Closing of the Reorganization. TWUS shall use its
reasonable best efforts to cause the Affiliate Registration Statement to be
declared effective by the Commission for all of the Registrable Shares covered
thereby by the earliest practicable date after filing with the Commission. In
the event that TWUS is unable to cause such Affiliate Registration Statement to
be declared effective by the Commission within thirty (30) calendar days
following the Closing of the Reorganization, then the provisions of Section 2(c)
shall apply. TWUS agrees to use its reasonable efforts to keep the Affiliate
Registration Statement continuously effective until no Hyperion Shares,
Compensatory Shares or Triumph Shares that constitute Registrable Shares remain
outstanding.

                                       6
<PAGE>

              (c) Demand Registration. In the event that, for any reason, TWUS
is unable to cause a Resale Registration Statement or an Affiliate Registration
Statement to be declared effective by the Commission within thirty (30) days
following the Closing of the Reorganization or is unable or it is impracticable
to keep such Resale Registration Statement or Affiliate Registration Statement
continuously effective for the period set forth in Section 2(a) or 2(b), as
applicable, TWUS shall, within ten (10) days after TWUS makes such determination
or such shorter period as the Commission may provide to TWUS in the event such
event involves an action or determination by the Commission (in which case TWUS
shall immediately forward to the Investors, Hyperion, Triumph and the Employees
copies of all relevant correspondence to and from the Commission), give notice
to the Investors, Hyperion, Triumph and the Employees, as the case may be, of
such fact and of the circumstances giving rise to such inability or
impracticability, so as to enable the Investors, Hyperion, Triumph and the
Employees to exercise their rights as set for in this Section 2(c). At any time
any shares of TWUS Preferred Stock or Registrable Shares are outstanding and a
Resale Registration Statement or an Affiliate Registration Statement, as
applicable, covering the resale of their respective Registrable Shares is not
effective, TWUS shall, at the written request of any Investor, Hyperion, Triumph
or the Employees, as the case may be (a "Demand Notice"), cause to be filed as
soon as practicable after the date of such request a Registration Statement in
accordance with Rule 415 under the Securities Act (or such other rule as is
applicable to the proposed sale) relating to the resale by such Investor,
Hyperion, Triumph or the Employees of all or any portion of the Registrable
Shares held by such Investor (including Conversion Shares and/or Dividend Shares
issuable to such Investor), Hyperion, Triumph or the Employees in accordance
with the terms hereof, and shall use its reasonable best efforts to cause such
Registration Statement to be declared effective by the Commission as soon as
practicable thereafter (a "Demand Registration"); provided, however, that TWUS
shall not be required to file such Registration Statement unless the number of
Registrable Shares included in such Demand Notice have a Fair Market Value in
excess of $1,000,000. TWUS agrees to use its reasonable best efforts to keep the
Demand Registration continuously effective, after its date of effectiveness,
with respect to the Registrable Shares of the requesting Investor, Hyperion,
Triumph or the Employees until the date on which such Investor, Hyperion,
Triumph or the Employees no longer holds any Registrable Shares.

              (d) Underwritten Offering.

                   (i) If one or more Holders shall propose to sell Registrable
              Shares in an underwritten offering pursuant to a Registration
              Statement filed under Section 2 hereof, such Holders shall be
              entitled to select one (1) lead underwriter for such offering
              (selected by a Majority in Interest of the Holders of the
              Registrable Shares proposed to be included in such underwritten
              offering), which selection shall be subject to the reasonable
              approval of TWUS. At TWUS' option, following such selection and
              approval of a lead underwriter by the Holders, TWUS shall be
              entitled to select a co-lead underwriter with respect to such
              underwritten offering (and both such underwriters shall
              accordingly be co-leads; provided that the underwriter designated
              by the Holders shall be responsible for maintaining the order book
              with respect to such offering).

                                       7
<PAGE>

                   (ii) If one or more Holders propose to sell in an
              underwritten offering Registrable Shares which have an aggregate
              Fair Market Value of $5,000,000 or more (a "Qualified Offering"),
              then TWUS shall make available members of the management of TWUS
              and its Affiliates for reasonable assistance in selling efforts
              related to such offering (including, without limitation, senior
              management attendance at due diligence meetings with underwriters
              and their counsel and road shows) and shall enter into
              underwriting agreements containing usual and customary terms and
              conditions for such types of offerings (including, but not limited
              to, indemnification terms customary therein) and take all such
              other reasonable actions in connection therewith in order to
              expedite or facilitate the disposition of such Registrable Shares,
              including without limitation: (A) make such representations and
              warranties to the underwriters with respect to the business of
              TWUS, the Registration Statement, the Prospectus and any
              documents, if any, incorporated or deemed to be incorporated by
              reference therein, as may reasonably be required by the
              underwriters; (B) obtain opinions of counsel to TWUS and updates
              thereof, addressed to the Holders and each of the underwriters;
              (C) obtain "cold comfort" letters and updates thereof from the
              independent certified public accountants of TWUS addressed to the
              Holders and each of the underwriters; (D) ensure that, if an
              underwriting agreement is entered into, such agreement shall
              contain indemnification provisions and procedures that are usual
              and customary for an offering of such size; and (E) deliver such
              documents and certificates as may be reasonably requested by the
              underwriters and their respective counsel to evidence the
              continued validity of the representations and warranties made
              pursuant to clause (A) of this Section 2(d)(ii).

         3. Registration Procedures. When TWUS is required pursuant to the
provisions of this Agreement to effect the registration of any of the Shares
under the Securities Act, TWUS will:

              (a) prepare and file with the Commission a Registration Statement
on the appropriate form under the Securities Act with respect to such
securities, which form shall comply in all material respects with the
requirements of the applicable form and include all financial statements
required by the Commission to be filed therewith, and use its reasonable best
efforts to cause such Registration Statement to become and remain effective
until completion of the proposed offering;

              (b) prepare and file with the Commission such amendments and
supplements to such Registration Statement and the Prospectus used in connection
therewith as may be necessary to keep such Registration Statement effective
until the Holders shall have completed the sales described in such Registration
Statement and to comply with the provisions of the Securities Act with respect
to the sale or other disposition of all securities covered by such

                                       8
<PAGE>

Registration Statement whenever the seller or sellers of such securities shall
desire to sell or otherwise dispose of the same, but only to the extent provided
in this Agreement

              (c) furnish to the Holders and the underwriters, if any, such
number of copies of any Registration Statement, any amendments thereto, any
documents incorporated by reference therein, the Prospectus, including a
preliminary prospectus in conformity with the requirements of the Securities
Act, and such other documents as the Holders or underwriters may reasonably
request in order to facilitate the public sale or other disposition of the
Shares owned by the Holders or underwriters;

              (d) file and use its reasonable best efforts to register or
qualify the Shares covered by such Registration Statement under such other
securities or state securities or "blue sky" laws of such jurisdictions as the
Holders shall request, and do any and all other acts and things that may be
necessary under such state securities or "blue sky" laws to enable the Holders
to consummate the public sale or other disposition in such jurisdictions of the
Shares owned by such Holder, except that TWUS shall not for any such purpose be
required to qualify to do business as a foreign corporation in any jurisdiction
wherein it is not so qualified;

              (e) within a reasonable time before each filing of a Registration
Statement or Prospectus or amendments or supplements thereto with the
Commission, furnish to counsel selected by the Holders of a Majority in Interest
of the Registrable Shares participating in such registration, copies of such
documents proposed to be filed, which documents shall be subject to the approval
of such counsel;

              (f) immediately notify the Holders, their respective counsel and
any underwriter and (if requested by any such Person) confirm such notice in
writing, of the happening of any event which makes any statement made in a
Registration Statement or related Prospectus untrue or that requires the making
of any changes in such Registration Statement or Prospectus so that they will
not contain any untrue statement of a material fact or omit to state any
material fact required to be stated therein or necessary to make the statements
therein in the light of the circumstances under which they were made not
misleading; and, as promptly as practicable thereafter, prepare and file with
the Commission and furnish a supplement or amendment to such Registration
Statement or Prospectus so that, as thereafter deliverable to the purchasers of
such Registrable Shares, such Registration Statement or Prospectus will not
contain any untrue statement of a material fact or omit to state a material fact
necessary to make the statements therein, in the light of the circumstances
under which they were made, not misleading;

              (g) make generally available to the Holders an earnings statement
satisfying the provisions of Section 11(a) of the Securities Act no later than
sixty (60) days after the end of the 12-month period beginning with the first
day of TWUS' first fiscal quarter commencing after

                                       9
<PAGE>

the effective date of a Registration Statement, which earnings statement shall
cover said 12-month period, and which requirement will be deemed to be satisfied
if TWUS satisfies the requirements of Rule 158 under the Securities Act and
otherwise complies with all applicable rules and regulations of the Commission;

              (h) use its reasonable best efforts to prevent the issuance of any
order suspending the effectiveness of a Registration Statement, and if one is
issued, use its reasonable best efforts to obtain the withdrawal of any order
suspending the effectiveness of a Registration Statement at the earliest
possible moment; provided, however, that TWUS may postpone the filing or
effectiveness of any Registration Statement required to be filed hereunder for a
reasonable period of time, not to exceed ninety (90) days in the aggregate
during any 12-month period, if the TWUS has been advised by legal counsel that
such filing or effectiveness would require a special audit or the disclosure of
a material impending transaction or other matter and TWUS' Board of Directors
determines reasonably and in good faith that such disclosure would have a
material adverse effect on TWUS;

              (i) use its reasonable best efforts to cause, to the extent
applicable, the Registrable Shares covered by a Registration Statement to be
registered with or approved by such other governmental agencies or authorities
and to obtain such approvals, consents and make such filings as may be necessary
by virtue of the business and operations of TWUS to enable the Holders to
consummate the disposition of such Registrable Shares in accordance with their
intended method of distribution thereof;

              (j) if requested by the managing underwriter or underwriters (if
any), a Holder or their respective counsel, promptly incorporate into a
Prospectus supplement or post-effective amendment such information as such
Person requests to be included therein, including, without limitation, with
respect to the Shares being sold by such Holder to such underwriter or
underwriters, the purchase price being paid therefor by such underwriter or
underwriters and any other terms of an underwritten offering of the Shares to be
sold in such offering, and promptly make all required filings of such prospectus
supplement or post-effective amendment;

              (k) subject to appropriate confidentiality agreements, make
available to each Holder, any underwriter participating in any disposition
pursuant to a Registration Statement, and any attorney, accountant or other
agent or representative retained by any such Holder or underwriter
(collectively, the "Inspectors"), all financial and other records, pertinent
corporate documents and properties of TWUS (collectively, the "Records")
reasonably necessary to enable them to exercise their due diligence
responsibility, and cause TWUS' officers, directors and employees to supply all
information requested by any such Inspector in connection with such Registration
Statement;

                                       10
<PAGE>

              (l) enter into such customary agreements (including, if
applicable, an underwriting agreement in customary form) and take such other
actions as the Holders or the underwriters retained by the Holders participating
in an underwritten public offering, if any, may reasonably request in order to
expedite or facilitate the disposition of Registrable Shares (and the Holders
may, at their option, require that any or all of the representations, warranties
and covenants of TWUS to or for the benefit of any underwriters also be made to
and for the benefit of the Holders);

              (m) furnish to each prospective selling Holder a signed
counterpart, addressed to the prospective selling Holder, of (i) an opinion of
counsel for TWUS, dated the effective date of the Registration Statement, and
(ii) a "comfort" letter signed by the independent public accountants who have
certified TWUS' financial statements included in the Registration Statement,
covering substantially the same matters with respect to the Registration
Statement (and the Prospectus included therein) and (in the case of the
accountants' letter) with respect to events subsequent to the date of the
financial statements, as are customarily covered (at the time of such
registration) in opinions of TWUS' counsel and in accountants' letters delivered
to the underwriters in underwritten public offerings of securities;

              (n) cause the Shares covered by such Registration Statement to be
listed on the national securities exchange or quoted on the quotation system on
which the TWUS Common Stock is then listed or quoted;

              (o) in connection with an underwritten offering, participate, to
the extent reasonably requested by the managing underwriter for the offering or
the Holders, in customary efforts to sell the Shares being offered, and cause
such steps to be taken as to ensure such good faith participation of senior
management officers of TWUS in "road shows" as is customary;

              (p) if the Registrable Shares are of a class of securities that is
listed on a national securities exchange, file copies of any Prospectus with
such exchange in compliance with Rule 153 under the Securities Act so that the
holders of Registrable Shares benefit from the Prospectus delivery procedures
described therein;

              (q) cooperate with each Holder and each underwriter participating
in the disposition of Registrable Shares and their respective counsel in
connection with any filings required to be made with the National Association of
Securities Dealers, Inc. ("NASD"), including, if appropriate, the pre-filing of
a Prospectus as part of a shelf registration statement in advance of an
underwritten offering;

              (r) otherwise cooperate with the underwriter(s), the Commission
and other regulatory agencies and take all actions and execute and deliver or
cause to be executed and

                                       11
<PAGE>

delivered all documents necessary to effect the registration and sale of any
Registrable Shares under this Agreement;

              (s) correct any deficiency (in the judgment of either TWUS or the
Holders of Registrable Shares acting reasonably) between the preliminary
Prospectus and the final Prospectus, and pay any expenses associated with the
recirculation of the final Prospectus following the correction of such
deficiency, if required;

              (t) during the period when the Prospectus is required to be
delivered under the Securities Act, promptly file all documents required to be
filed with the Commission, including pursuant to Sections 13(a), 13(c), 14, or
15(d) of the Exchange Act; and

              (u) provide a transfer agent and registrar for all Registrable
Shares registered pursuant hereunder and a CUSIP number for all such Registrable
Shares, in each case no later than the effective date of such registration.

         If any Registration Statement refers to any Holder by name or otherwise
as the holder of any securities of TWUS, then such Holder shall have the right
to require (i) the insertion therein of language, in form and substance
reasonably satisfactory to such Holder, to the effect that the holding by such
Holder of such securities is not to be construed as a recommendation by such
Holder of the investment quality of TWUS' securities covered thereby and that
such holding does not imply that such Holder will assist in meeting any future
financial requirements of TWUS, or (ii) in the event that such reference to such
Holder by name or otherwise is not required by the Securities Act or any similar
Federal or state securities or "blue sky" statute and the rules and regulations
thereunder then in force, deletion of the reference to such Holder.

         4. Listing. TWUS will use reasonable efforts to cause all Registrable
Shares to be listed or otherwise eligible for full trading privileges on the
principal national securities exchange (currently the American Stock Exchange
("AMEX")) on which the TWUS Common Stock are then listed, in each case not later
than the date on which a Registration Statement covering the Registrable Shares
becomes effective or the Registrable Shares are issued by TWUS to a Holder,
whichever is later. TWUS will use reasonable efforts to continue the listing or
trading privilege for all Registrable Shares on such exchange. TWUS will
promptly notify the Holders of, and confirm in writing, the delisting of TWUS
Common Stock by such exchange.

         5. Expenses. All expenses incurred by TWUS or the Holders in effecting
the registrations provided for in Section 2, including, without limitation, all
registration and filing fees, printing expenses, fees and disbursements of
counsel for TWUS and of a single counsel for the Holders participating in such
registration as a group (selected by, in the case of a registration under
Section 2(c), the Holders of a Majority in Interest of the Registrable Shares
who initiate the registration under such Section 2(c), and, in the case of all
other registrations hereunder, the

                                       12
<PAGE>

Holders of a Majority in Interest of the Registrable Shares participating in the
registration), expenses of any audits incident to or required by any such
registration and expenses of complying with the state securities or "blue sky"
laws of any jurisdictions (all of such expenses referred to as "Registration
Expenses"), shall be paid by TWUS whether or not the registration statement to
which such Registration Expenses relate becomes effective.

         6. Indemnification.

              (a) TWUS shall indemnify and hold harmless each selling Holder of
Registrable Shares, and directors, officers, partners, shareholders, members,
employees and agents of any of them, and each Person who participates in the
offering of such securities and each Affiliate of such seller or participating
Person (individually and collectively, the "Indemnified Person") against any
losses, claims, damages or liabilities, including reasonable legal fees,
disbursements and expenses of counsel (including any such fees, disbursements
and expenses incurred as a result of a third party action or as a result of the
Indemnified Person enforcing its rights under this Section 6(a) against TWUS)
(collectively, "Liability"), joint or several, to which such Indemnified Person
may become subject under the Securities Act or any other statute or at common
law, insofar as the Liability (or action in respect thereof) arises out of, is
based upon or relates to (i) any untrue statement or alleged untrue statement of
any material fact contained, on the effective date thereof, in any Registration
Statement under which such securities were registered under the Securities Act,
any preliminary Prospectus or final Prospectus contained therein, or any
amendment or supplement thereto, (ii) any omission or alleged omission to state
therein a material fact required to be stated therein or necessary to make the
statements therein not misleading, or (iii) any violation or alleged violation
by TWUS of the Securities Act, any state securities or "blue sky" laws or any
sale or regulation thereunder in connection with such registration. Except as
otherwise provided in Section 6(c), TWUS shall reimburse each such Indemnified
Person for all reasonable legal and other expenses incurred in connection with
investigating or defending any Liability; provided, however, that TWUS shall not
be liable to any Indemnified Person in any such case to the extent that the
Liability arises out of, is based upon or relates to any untrue statement or
alleged untrue statement or omission or alleged omission made in such
Registration Statement, preliminary or final Prospectus, or amendment or
supplement thereto in reliance upon and in conformity with information furnished
in writing to TWUS by such Person specifically for use therein; and provided
further, that TWUS shall not be required to indemnify any Person against
Liability that arises out of the failure of any Person to deliver a Prospectus
as required by the Securities Act regardless of any investigation made by or on
behalf of such Indemnified Person and TWUS' indemnification obligations shall
survive transfer of such securities by such seller.

              (b) Each Holder of Registrable Shares holding any securities
included in such registration being effected shall indemnify and hold harmless
each other selling Holder of Registrable Shares (including to the extent
applicable its partners, members and shareholders (including partners of
partners and shareholders of such partners)), TWUS, and directors, officers,
employees and agents of each of them, and each Affiliate of such seller and
directors,

                                       13
<PAGE>

officers, employees and agents of any of them (individually and collectively
also the "Indemnified Person"), against any liability, joint or several, to
which the Indemnified Person may become subject under the Securities Act or any
other statute or at common law, insofar as such liability (or actions in respect
thereof) arises out of or is based upon (i) any untrue statement or alleged
untrue statement of any material fact contained, on the effective date thereof,
in any Registration Statement under which securities were registered under the
Securities Act at the request of such selling Holder, any preliminary Prospectus
or final Prospectus contained therein, or any amendment or supplement thereto,
(ii) any omission or alleged omission by such selling Holder to state therein a
material fact required to be stated therein or necessary to make the statements
therein not misleading, or (iii) any violation or alleged violation by such
selling Holder of the Securities Act, any state securities or "blue sky" laws or
any sale or regulation thereunder in connection with such registration; in the
case of subclause (i) and (ii) to the extent, but only to the extent, that such
untrue statement or alleged untrue statement or omission or alleged omission was
made in such Registration Statement, preliminary or final Prospectus, amendment
or supplement thereto in reliance upon and in conformity with information
furnished in writing to TWUS by such selling Holder specifically for use
therein. The liability of any Holder for indemnification under this Section 6 in
its capacity as a seller of Registrable Shares shall not exceed the lesser of
(i) that proportion of the total of such losses, claims, damages, expenses or
liabilities indemnified against equal to the proportion of the total securities
sold under such Registration Statement held by such Holder, and (ii) the amount
equal to the net proceeds to such Holder of the securities sold in any such
registration; provided that no selling Holder shall be required to indemnify any
Person against any liability arising from any untrue or misleading statement or
omission contained in any preliminary Prospectus if such deficiency is corrected
in the final Prospectus or for any liability which arises out of the failure of
any Person to deliver a Prospectus as required by the Securities Act.

              (c) In the event TWUS, any selling Holder or other Person receives
a complaint, claim or other notice of any liability or action, giving rise to a
claim for indemnification under Sections 6(a) or (b) above, the Person claiming
indemnification under such paragraphs shall promptly notify the Person against
whom indemnification is sought (the "Indemnifying Person") of such complaint,
notice, claim or action, and the Indemnifying Person shall have the right to
investigate and defend any such loss, claim, damage, liability or action;
provided that the failure to promptly give notice shall not relieve the
Indemnifying Person from any Liability except to the extent that it is
materially prejudiced by the failure or delay of the Indemnified Person in
giving such notice. If any such complaint, claim or other notice of any
Liability or action is brought against any Indemnified Person and it notifies
the Indemnifying Person of its commencement, the Indemnifying Person will be
entitled to participate in and, to the extent that it elects by delivering
written notice to the Indemnified Person promptly after receiving notice of the
commencement of the action from the Indemnified Person, jointly with any other
Indemnifying Person similarly notified, to assume the defense of the action,
with counsel reasonably satisfactory to the Indemnified Person, and after notice
from the Indemnifying Person to the Indemnified Person of its election to assume
the defense, the Indemnifying Person shall not be liable to the Indemnified
Person for any legal or other expenses except as provided below and except for
the reasonable costs of investigation subsequently

                                       14
<PAGE>

incurred by the Indemnified Person in connection with the defense. The
Indemnified Person shall have the right to employ its own counsel in any such
action, but the fees, expenses and other charges of such counsel shall be at the
expense of the Indemnified Person unless (i) the employment of counsel by the
Indemnified Person has been authorized in writing by the Indemnifying Person,
(ii) the Indemnified Person has reasonably concluded (based on advice of
counsel) that there may be legal defenses available to it or other Indemnified
Persons different from or in addition to those available to the Indemnifying
Person or Persons, (iii) a conflict or potential conflict exists (based on
advice of counsel to the Indemnified Person) between the Indemnified Person and
the Indemnifying Person (in which case the Indemnifying Person shall not have
the right to direct the defense of such action on behalf of the Indemnified
Person), or (iv) the Indemnifying Person has not in fact employed counsel to
assume the defense of such action within a reasonable time after receiving
notice of the commencement of the action or has failed to employ counsel
reasonably satisfactory to such Indemnified Person, in each of which cases the
reasonable fees, disbursements and other charges of counsel will be at the
expense of the Indemnifying Person or Persons. The Indemnifying Person or
Persons shall not, unless there exists a conflict of interest among the
Indemnified Persons, in connection with any proceeding or related proceedings in
the same jurisdiction, be liable for the reasonable fees, disbursements and
other charges of more than one separate firm admitted to practice in such
jurisdiction at any time for all such Indemnified Persons. All such fees,
disbursements and other charges shall be reimbursed by the Indemnifying Person
promptly as they are incurred. An Indemnifying Person shall not be liable for
any settlement of any action or claim effected without its written consent
(which consent will not be unreasonably withheld). No Indemnifying Person shall,
without the prior written consent of each Indemnified Person, settle or
compromise or consent to the entry of any judgment in any pending or threatened
claim, action or proceeding relating to the matters contemplated by this Section
6 (whether or not any Indemnified Person is a party thereto), unless such
settlement, compromise or consent (i) includes an unconditional release of each
Indemnified Person from all liability arising or that may arise out of such
claim, action or proceeding, (ii) does not include a statement as to or an
admission of fault, culpability or a failure to act by or on behalf of any
Indemnified Person, and (iii) does not commit the Indemnified Person to take, or
to forbear to take, any action. If a settlement is reached with such consent or
if a final judgment is entered for the plaintiff, the Indemnifying Person agrees
to indemnify any Indemnified Person from and against any loss or liability by
reason of such settlement or judgment.

              (d) If the indemnification provided for in this Section 6 for any
reason is held by a court of competent jurisdiction to be unavailable to an
Indemnified Person in respect of any losses, claims, damages expenses or
liabilities referred to therein, then each Indemnifying Person under this
Section 6, in lieu of indemnifying the Indemnified Person thereunder, shall
contribute to the amount paid or payable by the Indemnified Person as a result
of such losses, claims, damages, expenses or liabilities (i) in such proportion
as is appropriate to reflect the relative benefits received by TWUS and the
Holder or Holders of Registrable Shares from the offering of Registrable Shares
or (ii) if the allocation provided by clause (i) above is not permitted by
applicable law, in such proportion as is appropriate to reflect not only the
relative benefits referred to in clause (i) above but also the relative fault of
TWUS, the other Holders of

                                       15
<PAGE>

Registrable Shares in connection with the statements or omissions that resulted
in such losses, claims, damages expenses or liabilities, as well as any other
relevant equitable considerations. The relative benefits received by TWUS and
the Holders of Registrable Shares shall be deemed to be in the same respective
proportions that the net proceeds from the offering (before deducting expenses)
received by TWUS and the Holders of Registrable Shares, in each case as set
forth in the table on the cover page of the applicable prospectus, bear to the
aggregate public offering price of the Registrable Shares. The relative fault of
TWUS and the Holders of Registrable Shares shall be determined by reference to,
among other things, whether the untrue or alleged untrue statement of a material
fact or the omission or alleged omission to state a material fact relates to
information supplied by TWUS or the Holders of Registrable Shares, and the
parties' relative intent, knowledge, access to information and opportunity to
correct or prevent such statement or omission.

         TWUS and the Holders of Registrable Shares agree that it would not be
just and equitable if contribution pursuant to this Section 6(d) were determined
by a method of allocation that does not take account the equitable
considerations referred to in the immediately preceding paragraph, provided that
a Holder of Registrable Shares shall not be required to contribute under this
Section 6(d) in excess of the lesser of (i) that proportion of the total
Liability indemnified against equal to the proportion of the total Registrable
Shares sold under such Registration Statement by such Holder and (ii) the net
proceeds received by such Holder from its sale of Registrable Shares under such
Registration Statement. No Person found guilty of fraudulent representation
(within the meaning of Section 11(f) of the Securities Act) shall be entitled to
contribution from any person not found guilty of such fraudulent
misrepresentation.

              (e) The amount paid by an Indemnifying Person or payable to an
Indemnified Person as a result of the losses, claims, damages, expenses and
liabilities referred to in this Section 6 shall be deemed to include, subject to
limitations set forth above, any legal or other expenses reasonably incurred by
such Indemnified Person in connection with investigating or defending any such
action or claim, payable as the same are incurred. The indemnification and
contribution provided for in this Section 6 shall remain in full force and
effect regardless of any investigation made by or on behalf of the indemnified
parties or any other officer, director, employee, agent or controlling person of
the indemnified parties.

         7. Compliance with Rule 144. TWUS shall use its reasonable best efforts
to file with the Commission such information as is required under the Exchange
Act for so long as there are holders of Registrable Shares; and in such event,
TWUS shall use its reasonable best efforts to take all action as may be required
as a condition to the availability of Rule 144 under the Securities Act (or any
comparable successor rules). TWUS shall furnish to any holder of Registrable
Shares upon request a written statement executed by TWUS as to the steps it has
taken to comply with the current public information requirement of Rule 144 (or
such comparable successor rules). TWUS shall use its reasonable best efforts to
facilitate and expedite transfers of Registrable Shares pursuant to Rule 144
under the Securities Act, which

                                       16
<PAGE>

efforts shall include timely notice to its transfer agent to expedite such
transfers of Registrable Shares.

         8. Intentionally Omitted.

         9. Amendments. This Agreement may be amended, and TWUS may take any
action herein prohibited or omit to perform any act herein required to be
performed by it, only if TWUS has obtained the written consent of (i) a Majority
in Interest with respect to the rights of the Investors, (ii) Hyperion with
respect to the rights of Hyperion, (iii) Triumph with respect to the rights of
Triumph, or (iv) each of the Employees with respect to the rights of such
Employee. For the purposes of this Agreement and all agreements executed
pursuant hereto, no course of dealing between or among any of the parties hereto
and no delay on the part of any party hereto in exercising any rights hereunder
or thereunder shall operate as a waiver of the rights hereof and thereof.

         10. Suspension of Registration Requirement; Restriction on Sales.

              (a) TWUS shall promptly notify each Holder of, and confirm in
writing, (i) the receipt of any oral or written communication that could
reasonably lead TWUS to be unable to keep a Resale Registration Statement or
Affiliate Registration Statement continuously effective for the period set forth
in Section 2 hereof, or (ii) the issuance by the Commission of any stop order
suspending the effectiveness of a Registration Statement with respect to such
holder's Registrable Shares or the initiation of any proceedings for that
purpose. TWUS shall use its reasonable best efforts to obtain the withdrawal of
any order suspending the effectiveness of such a Registration Statement at the
earliest possible moment and in any event within thirty (30) days from the
initial date of such suspension.

              (b) Notwithstanding anything to the contrary set forth in this
Agreement, TWUS' obligations under this Agreement to file, amend or supplement a
Registration Statement, or to cause a Registration Statement, or any filings
with any state securities commission, to become effective shall be suspended,
for one or more periods not to exceed the period described in Section 11 below,
in the event of pending negotiations relating to, or consummation of, a
transaction or the occurrence of an event that (i) would require additional
disclosure of material information by the TWUS in the Registration Statement or
such filing, as to which TWUS has a bona fide business purpose for preserving
confidentiality, or (ii) render TWUS unable to comply with the Commission
requirements (any such circumstances being hereinafter referred to as a
"Suspension Event"). TWUS shall notify the Holders of the Shares of the
existence of any Suspension Event by promptly delivering to each Holder a
certificate signed by an executive officer of TWUS stating that a Suspension
Event has occurred and is continuing.

                                       17
<PAGE>

              (c) Subject to the terms of Section 11 below, so long as all
officers and directors of TWUS are bound by similar restrictions, each Holder of
Registrable Shares agrees, if requested by TWUS in the case of a TWUS-initiated
non-underwritten offering of TWUS Common Stock registered under the Securities
Act or if requested by the managing underwriter or underwriters in a
TWUS-initiated underwritten offering of TWUS Common Stock (each, a "TWUS
Offering"), not to directly or indirectly offer, sell, contract to sell, sell
any option or contract to purchase, purchase any option or contract to sell,
grant any option, right or warrant for the sale of or otherwise dispose of or
transfer any Shares held by it during the period (the "Offering Blackout
Period") beginning upon receipt by such Holder of written notice from TWUS, but
in any event no earlier than the tenth (10th) day preceding the anticipated date
of pricing of such TWUS Offering, and ending on the earlier to occur of:

                   (i)    sixty (60) days after the closing date of such TWUS
                          Offering; or

                   (ii)   one (1) day after the date on which the Fair Market
                          Value of the TWUS Common Stock shall have averaged for
                          a period of twenty (20) consecutive trading days at
                          least one-hundred-five percent (105%) of the initial
                          price to the public of such security in such TWUS
                          Offering, but in any event not earlier than forty-five
                          (45) days after the closing date of such TWUS
                          Offering; or

                   (iii)  the date on which TWUS may begin to effect any public
                          sale or distribution of any TWUS Common Stock
                          following such TWUS Offering pursuant to any
                          contractual lock-up or similar restrictions on the
                          sale of such securities; or

                   (iv)   the date on which all directors and executive officers
                          who have been required to enter into contractual
                          lock-up or similar restrictions on the sale of TWUS
                          Common Stock owned by them may begin to effect public
                          sales of such shares following such TWUS Offering,
                          including pursuant to waivers of the restrictions by
                          the managing underwriter or underwriters; or

                   (v)    the date TWUS or managing underwriter or underwriters
                          withdraws such request in writing.

              (d) Subject to the terms of Section 11 below, each Holder of
Registrable Shares agrees that, following the effectiveness of any Registration
Statement relating to Registrable Shares of such Holder, such Holder will not
effect any sales of the Shares pursuant to such Registration Statement or any
filings with any state securities commission at any time after such Holder has
received notice from TWUS to suspend sales as a result of the occurrence or
existence of any Suspension Event or so that TWUS may correct or update the
Registration Statement or such filing. The Holders may recommence effecting
sales of the Shares pursuant to the Registration Statement or such filings, and
all other obligations which are suspended as a result of a Suspension Event
shall no longer be so suspended, following further notice to such

                                       18
<PAGE>

effect from TWUS, which notice shall be given by TWUS not later than one (1)
business day after the conclusion of any such Suspension Event.

         11. Limitations on Suspension/Blackout Periods. Notwithstanding
anything herein to the contrary, TWUS covenants and agrees that (a) TWUS' rights
to suspend its obligation under this Agreement to file, amend or supplement a
Registration Statement and maintain the effectiveness of any Registration
Statement during the pendency of any Suspension Event, (b) the Holders'
obligation to suspend public sales of Shares during one or more Offering
Blackout Periods and (c) the Holders' obligations to suspend sales of Shares
pursuant to a Registration Statement during the pendency of any Suspension
Event, shall not (i) be exercised or triggered by TWUS pursuant to Section 10 or
otherwise more than two (2) times during any 12-month period or (ii) in the
aggregate, cause the Holders to be required to suspend sales of Shares or
relieve TWUS of its obligation to file, amend or supplement and maintain the
effectiveness of a Registration Statement for longer than ninety (90) days
during any 12-month period.

         12. Transferability of Registration Rights. The registration rights set
forth in this Agreement are transferable to each transferee of Registrable
Shares, who shall thereafter be deemed a "Holder" for purposes of this
Agreement. Each subsequent Holder of Registrable Shares must consent in writing
to be bound by the terms and conditions of this Agreement in order to acquire
the rights granted pursuant to this Agreement. This Agreement shall inure to the
benefit of and be binding on the successors and assigns of each of the parties
hereto. If any transferee of any Holder shall acquire Registrable Shares in any
manner, whether by operation of law or otherwise, such Registrable Shares shall
be held subject to all of the terms of this Agreement, and by taking and holding
such Registrable Shares such Person shall be conclusively deemed to have agreed
to be bound by and to perform all of the terms and provisions of this Agreement
and such Person shall be entitled to receive the benefits hereof.

         13. Intentionally Omitted.

         14. Damages. TWUS stipulates that each Holder of Registrable Shares
shall not have an adequate remedy if TWUS fails to comply with this Agreement
and that damages shall not be readily ascertainable, and accordingly, TWUS shall
not oppose an application by any Holder of Registrable Shares or any other
Person entitled to the benefits of this Agreement to require specific
performance of any and all provisions hereof or enjoining TWUS from continuing
to commit any such breach of this Agreement.

         15. Miscellaneous.

                                       19
<PAGE>

              (a) Notices. Any notice or demand which is required or provided to
be given under this Agreement shall be deemed to have been sufficiently given
and received for all purposes when delivered in writing by hand, telecopy, telex
or other method of facsimile, or five (5) days after being sent by certified or
registered mail, postage and charges prepaid, return receipt requested, or two
(2) days after being sent by overnight delivery providing receipt of delivery,
to the following addresses:

         If to TWUS:

              Transworld Healthcare, Inc.
              555 Madison Avenue
              New York, NY  10022
              Attention: Jack Wynne
              Telecopy No.: (212) 750-7221

         With a copy to:

              Brown Raysman Millstein Felder & Steiner LLP
              900 Third Avenue
              New York, NY  10022
              Attention: Leslie J. Levinson, Esq.
              Telecopy No.: (212) 895-2900

         If to the Investors or Triumph:

              Triumph Partners III, L.P.
              Triumph III Investors, L.P.
              28 State Street, 37th Floor
              Boston, MA  02109
              Attention: Frederick S. Moseley IV
              Telecopy No.: (___) ___-____

         With a copy to:

              Goodwin Procter LLP
              Exchange Place
              53 State Street
              Boston, MA  02109
              Attention: Ettore A. Santucci, P.C.
              Telecopy No.:  (617) 523-1231

                                       20
<PAGE>

         If to Hyperion:

              Hyperion Partners II L.P.,
              50 Charles Lindbergh Parkway
              Uniondale, NY  11553
              Attention: Scott Shay
              Telecopy No.: (516) 745-6787

         With a copy to:

              Proskauer Rose LLP
              1585 Broadway
              New York, NY  10036
              Attention: Bruce Lieb, Esq.
              Telecopy No.: (212) 969-3000

         If to the Employees:

              Transworld Healthcare, Inc.
              555 Madison Avenue
              New York, NY  10022
              Attention: Timothy Aitken and Sarah Eames
              Telecopy No.: (212) 750-7221

         With a copy to:

              Brown Raysman Millstein Felder & Steiner LLP
              900 Third Avenue
              New York, NY  10022
              Attention: Leslie J. Levinson, Esq.
              Telecopy No.: (212) 895-2900

         If to any other Holder of Registrable Shares:

              At such Person's address for notice as set forth in the books and
records of TWUS or, as to each of the foregoing, at such other address as shall
be designated by such Person in a written notice to other parties complying as
to delivery with the terms of this subsection (a).

         16. Governing Law. This Agreement shall be deemed to be a contract made
under and shall be construed in accordance with the laws of the state of New
York, without giving effect to conflict of laws principles thereof.

         17. Choice of Law/Consent to Jurisdiction. All disputes, claims or
controversies arising out of this Agreement, or the negotiation, validity or
performance of this Agreement shall be governed by and construed in accordance
with the laws of the State of New York without

                                       21
<PAGE>

regard to its rules of conflict of laws. Each of TWUS and the Holders hereby
irrevocably and unconditionally consents to submit to the sole and exclusive
jurisdiction of the courts of the State of New York and of the United States of
America located in the State of New York (the "New York Courts") for any
litigation arising out of or relating to this Agreement, or the negotiation,
validity or performance of this Agreement (and agrees not to commence any
litigation relating thereto except in such courts), waives any objection to the
laying of venue of any such litigation in the New York Courts and agrees not to
plead or claim in any New York Court that such litigation brought therein has
been brought in any inconvenient forum. Each of the parties hereto agrees, (a)
to the extent such party is not otherwise subject to service of process in the
State of New York, to appoint and maintain an agent in the State of New York as
such party's agent for acceptance of legal process, and (b) that service of
process may also be made on such party by prepaid certified mail with a proof of
mailing receipt validated by the United States Postal Service constituting
evidence of valid service. Service made pursuant to (a) or (b) above shall have
the same legal force and effect as if served upon such party personally within
the State of New York. For purposes of implementing the parties' agreement to
appoint and maintain an agent for service of process in the State of New York,
each party shall appoint an agent that is reasonably acceptable to the Holders
and TWUS.

         18. Counterparts. This Agreement may be executed simultaneously in any
number of counterparts, each of which when so executed and delivered shall be
taken to be an original, but such counterparts shall together constitute but one
and the same document.

         19. Severability. Whenever possible, each provision of this Agreement
shall be interpreted in such a manner as to be effective and valid under
applicable law, but if any provision of this Agreement shall be deemed
prohibited or invalid under such applicable law, such provision shall be
ineffective to the extent of such prohibition or invalidity, and such
prohibition or invalidity shall not invalidate the remainder of such provision
or the other provisions of this Agreement.

         20. Integration. This Agreement, including the exhibits, the
Reorganization Agreement and instruments referred to herein or therein,
constitutes the entire agreement, and supersedes all other prior agreements and
understandings, both written and oral, among the parties with respect to the
subject matter hereof.

                                       22
<PAGE>

         IN WITNESS WHEREOF, the parties hereto have caused this Registration
Rights Agreement to be duly executed as of the date first set forth above.

                                       TWUS:

                                       TRANSWORLD HEALTHCARE, INC.

                                       By:
                                          -------------------------------------
                                       Name:
                                            -----------------------------------
                                       Title:
                                             ----------------------------------

                                       S-1
<PAGE>

                                       HOLDERS:

                                       TRIUMPH PARTNERS III, L.P.

                                       By:  Triumph III Advisors, L.P., its
                                            general partner

                                       By:  Triumph III Advisors, Inc., its
                                            general partner

                                       By:
                                           -------------------------------------
                                           Name:    Frederick S. Moseley, IV
                                           Title:   President

                                       TRIUMPH III INVESTORS, L.P.

                                       By:  Triumph III Investors, Inc., its
                                            general partner

                                       By:
                                           -------------------------------------
                                           Name:    Frederick S. Moseley, IV
                                           Title:   President

                                      S-2
<PAGE>

                                       HYPERION PARTNERS II L.P.

                                       By:  Hyperion Ventures II L.P.
                                            its general partner

                                       By:  Hyperion Funding II Corp.
                                            its general partner

                                       By:
                                           -------------------------------------
                                           Name:    Scott A. Shay
                                           Title:   Executive Vice President

                                       HYPERION TW FUND L.P.

                                       By:  Hyperion TW LLC
                                            its general partner

                                       By:
                                           -------------------------------------
                                           Name:    Scott A. Shay
                                           Title:   Executive Vice President

                                       HYPERION TWH FUND LLC

                                       By:
                                           -------------------------------------
                                           Name:    Scott A. Shay
                                           Title:   Managing Member

                                       HYPERION TWH FUND II LLC

                                       By:
                                           -------------------------------------
                                           Name:    [Scott A. Shay]
                                           Title:   [Managing Member]

                                      S-3

<PAGE>

                                       THE EMPLOYEES

                                       By:
                                           -------------------------------------
                                           Name:    Timothy M. Aitken

                                       By:
                                           -------------------------------------
                                           Name:    Sarah L. Eames

                                      S-4

<PAGE>

                                       EQUITY WARRANT HOLDERS

                                       TRIUMPH PARTNERS III, L.P.

                                       By:  Triumph III Advisors, L.P., its
                                            general partner

                                       By:  Triumph III Advisors, Inc., its
                                            general partner

                                       By:
                                           -------------------------------------
                                           Name:    Frederick S. Moseley, IV
                                           Title:   President

                                       TRIUMPH III INVESTORS, L.P.

                                       By:  Triumph III Investors, Inc., its
                                            general partner

                                       By:
                                           -------------------------------------
                                           Name:  Frederick S. Moseley, IV
                                           Title:   President

                                       AITKEN ENGLISH COMPANY

                                       By:
                                           -------------------------------------
                                       Name:
                                             -----------------------------------
                                       Title:
                                             -----------------------------------

                                       S-5

<PAGE>

                                           -------------------------------------
                                           Timothy M. Aitken

                                           -------------------------------------
                                           Sarah L. Eames

                                      S-6

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