Dr. Rajesh Bharani

Organ donation is the process of removing tissues or organs from a live, or recently dead, person to be used in another.

The former is the donor and the latter is the recipient.

People of all ages can become donors.

What is Organ donation?

NEED OF THE HOUR

In India

10 Lakhs need Organ Donation

Organ DonationType of donorsSome organs can be donated by a living person

Almost all organs can be donated by someone dead but this has to reach the recipient within a few hours after the donor's death.

In case of live donation the donor should give his consent.

In case of cadaver donation, relatives need to provide consent.

Organ Donation

Voluntary Donation

Everywhere organ donation is voluntary

Two voluntary systems include –

1.Opt In - Where the donor gives consent

2.Opt Out - Where anyone who has not refused is considered as a donor

In India we have the Opt in system, while many western countries practice the opt out system

Organs for Donation

Some of the organs that are commonly donated …,

Skin and Bones

Annual Number of kidney transplantations per

million population (pmp) per year -

USA - 52 Predominantly Cadaver

Donors

Europe - 27 Predominantly Cadaver

Donors

Asia - 3 Predominantly Living DonorsIn last 10 to 15 years the rate of both kidney and liver transplants have increased but heart has remained static. In 2000 approx. 15,000 kidneys

were transplanted in each region.

Live◦ Majority ◦ No waiting◦ Less time on dialysis◦ Needs from Family

members only◦ Blood group

constraints◦ In diabetics and

Family diseases difficult.

Cadaver◦ Occasional◦ In families with familial

disease and blood group incompatibility this is the solution

◦ Small families◦ Will help many patients

who will otherwise live on dialysis

Living or Deceased Donor Kidney

Transplantation: A Comparison of Results

and Survival Rates Among Iranian Patients

◦ Living donor kidney transplantations showed

comparable graft survival and acute rejection

rates compared with those from deceased donors

Transplantation proceedings 2009: 41:2772-4

10% of willing and affording renal failure

patients gets Transplant

Non availability of donor.

1967 - First successful cadaver Kidney Transplant in India at KEM Hospital, Bombay

1994 - First successful heart transplant done at AIIMS, N.Delhi

1995 - First successful multi-organ transplant done at Apollo Hospital, Chennai

1998 – First Successful Lung transplant, Madras Medical Mission Hospital, Chennai

1999 – First Pancreas Transplant, Ahemdabad

Types-

Somatic death

◦ Home – Eyes, Skin

◦ Hospital- Eyes, Skin, Bone

Brain death – Kidney, Liver, Heart, Lung,

Intestine, Pancreas

• BLOOD

• KIDNEY

• LIVER (1/4)

Each Body Donation –

10-15 medical students benefited

Each cadaver organ Donor –

50 persons benefited

Body Donation V/S Organ Donation

Community Problem No Awareness of “Brain-

Death” Concept, Misconcepts

Hospital problem No efforts to identify &

maintain “Brain

Dead” donors

Govt. Problem No Funding for programme

No Interest

Spain has the highest number of brain death patients going on to organ donation – 32 per million population

Dealing with community problems

Mass education by all possible medium.

Media & Organ Donation

◦ The power of the press can also be demonstrated in the so-called

"Nicholas Green effect.“

◦ Nicholas was a 7-year-old American child, shot dead by bandits in

Italy in 1994

◦ His parents agreed to donate his organs

◦ Italian press reported it extensively

◦ The positives impact kick started the Italian cadaver programme

Many donor relatives have stated that donating their loved one's organs does not make the pain of their death disappear

Bereaved families can experience comfort that their loved one's gift gave another person a second chance at life

When the wishes of the deceased are not known, only 50% of people will agree to organ retrieval from their relatives

No disfigurement of body Rituals possible Encouraging people to speak about organ

donation and transplantation and to make their wishes known to their relatives could change the picture resulting in 93-94% of people allowing donation

Initiation by Eye and Skin Donation

Hospital and Doctors related Problem

There is underreporting of brain death cases. There is underreporting of brain death cases.

Neurologists and Neurosurgeons have to take lead

In Tamilnadu- Declaration of braindeath has been made mandatory in medical colleges. G.O. No. 75 dated 03.03.2008.

Transport of organs –between cities

Transport of organs –between cities

Adequate No. of Qualified Intensivists in ICUs

Adequate No. of Qualified Intensivists in ICUs

Well qualified Surgeons to undertake Retrieval & TX

Well qualified Surgeons to undertake Retrieval & TX

HLA Tissue typing and Cross-matchHLA Tissue typing and Cross-match

Qualified

Trained transplant

Co-coordinators

Qualified

Trained transplant

Co-coordinators

Support Organisation to Network

Support Organisation to Network

Hospital Infra-Structural & Support LogisticsHospital Infra-Structural & Support Logistics

The Way Ahead

Education of Doctors, Health care workers regarding THOA

Education of Society regarding organ donation and concept of Brain Death.

Media support Government support

◦ Strengthen the Transplant Network.◦ Transport facilities for organ donor◦ Establish a common programme.◦ Initiatives to promote concept and making some

changes as done by Tamilnadu government◦ Start sharing organs that are not used locally

Employing and training more transplant councilors-coordinators.

Regular Courses to impart expertise to the councilors-coordinators

Training and sensitizing ICU staff on brain-death.

Proactive steps to promote Programme. Help in educating public by all means. Think beyond business

MOHAN Foundation (INOS) - Tamil Nadu, Andhra Pradesh, Maharastra

236 Organs shared236 Organs shared. ( 212-Kidneys, 9-Hearts, 15-Liver )

MOHAN Foundation (INOS) - Tamil Nadu, Andhra Pradesh, Maharastra

236 Organs shared236 Organs shared. ( 212-Kidneys, 9-Hearts, 15-Liver )

FORTE, BANGALORE – 32 Organs Shared

( 32 - Kidneys, 1- Heart, 1- Liver )

FORTE, BANGALORE – 32 Organs Shared

( 32 - Kidneys, 1- Heart, 1- Liver )

ZTCC, Mumbai – 55 Organs Shared - all kidneysZTCC, Mumbai – 55 Organs Shared - all kidneys

ORBO, N.Delhi – Few organs sharedORBO, N.Delhi – Few organs shared

SORT, Cochin – 4 organs sharedSORT, Cochin – 4 organs shared

Pre-mortem – via Donor Cards, Driving License

Consent of his family following death Some form of a combination of the two are

necessary ‘Supererogatory permission’ - Underlying

premise of such a consent would be that “organs of dead people are public goods”, and donation must be considered “similar to other compulsory civil obligations” within society◦ The permission is a moral rather than a legal

requirement

For cadaveric donation - “society remains a crucial aspect in a transplant programme”

Strategies to decrease refusal rates by families include efforts at education - ◦ the general population, ◦ Religious heads & opinion leaders◦ health care workers individually ◦ through the mass media

At the time of issuing driving license, filling form for other government schemes like Adhar Card.

Government help and determination needed

Study shows that blood donors have better knowledge of organ donation and are more willing to donate their organs and sign an Donor card than general public.

It would be useful to design promotion programs to facilitate blood donor and families of Skin and Eye donors participation in organ donation.

Social Appreciation for donors and their families

Most families faced with brain stem death of a relative find the concept difficult to understand and have trouble in accepting that their relative is actually dead

Family members were given choice to be or not to be present during brain stem death testing

It is suggested that presence of family members during brain stem death testing not only helps families to accept this concept of death but also promotes the grieving process

The presence of family during brain stem death testing. Doran M. Intensive Crit Care Nurs. 2004 Feb;20(1):32-7

Requires that formal request for organ donation be

made of the families of all potential donors in the ICU.

◦ The rationale is that a statutory approach would

overcome hesitancy by healthcare professionals at a

time of such emotional distress.

Required Request Law has been introduced into many

states in India by legislation to improve organ

donation.

If in India - 1 per million donation rate we would have 1100 organ donors – 2200 kidneys,1000 hearts, 1100 Livers, 2200 Eyes

At 10 per million donation rate- 11,000 organ donors 22,000 kidneys, 11,000 hearts, 11,000 Livers, 22,000 Eyes

20 per million donation rate - 22,000 organ donors44,000 kidneys, 22,000 hearts, 22,000 Livers, 22,400 Eyes

Current organ donation rate - India is 0.05 per million population per year

At 3 per million Donation rate we would have 3300 organ donors – 6600 kidneys,3300 hearts, 33001 Livers, 6600 Eyes

Source: Indian Transplant Newsletter Issue no.19 Feb 2006

This can be performed only at centers

approved for Transplant surgery.

Retrieval time -2 to4 hours

Problem-

◦ Need to shift brain death person from one hospital

to other.

◦ Loss of organs from small center and peripheral

centers.

Tamilnadu government introduced a law by which they approved all hospitals in state with bed more than 25 an OT and ICU as NON TRANSPLANT ORGAN RETRIVEAL CENTRES ( NTORCs)

NTORC works in collaboration of Transplant center for all procedures from declaration of brain death to removal of organs.

Standardize retrieval techniques

CD be made on kidney Retrieval to be circulated to all the hospital.

Packing of organs being standardised for transportation

Education and training of coordinators and

NGO or Groups involved in Organ donation in any part of the M.P. have to tackle various issues in the field of cadaver organ donation and transplantation simultaneously

More Support groups with common objectives are needed

More resources necessary to Kick start such an Initiative like cross match lab

What is Required

Need of time

Formation of state level coordination committee to streamline project

Common lab for Cross match of tissue

Common waiting list of patients

Proper format for unbiased distribution of organ.Committee should decide for best possible recipient for said organ

All center should work under committee

SOP for declaration to transplantation

Organ Shortage is a Crisis, however the Crisis has a Cure In india we need to Network and start thinking of sharing resources, expertise and organs Set up Collaborative projects Use Media for Promotion Get Religious heads to Participate Have Transparency in programme Set up regional Transplant co-ordinators ForumsSocial appreciation of donor family.

Cadaver Transplant - Conclusion

THANK YOUTHANK YOU

In my end is my beginning                     -

T.S.Eliot, Four Quartets