Organ & Tissue Transplantation Awareness and Recent Updates
Dr Amol KingeRes. Medical Officer
Seth GSMC & KEM Hospital, Mumbai
Outline•What is Organ Donation•Need of organ donation•Types of Organ Donation•Which Organs can be Donated•Concept of brain death•Common conditions leading to brain death•Diagnosis of brain death•Myths related to organ donation•Religious views towards organ donation
Facts…1. Today's date there are 55000
waiting for OD.2. At every 16 minutes, new one is
added to the list.3. 10 die daily from the list without the
organ4. Annually only about 7000 solid
organ transplantations done.5. Kidney-6000,
Liver-1200, Heart-17, Cornea- 25000 (Annually)
Rates of OD-
India- 0.16/million population
USA – 22/million population
Spain- 36/million population
Corneal Blindness very common PROBLEM in India. More than 3 million cases in India. 60% are <12 years age group.
Cornea REQUIRED : 1 lakh / year, Cornea DONATED : 25000 / year
Anatomy of Normal EYE
After CORNEAL TRANSPLANT
What is need?•2.5 Lakh new Kidney disease patient every
year and only 750 benefitted with renal transplant.
•More than 80000 patients suffering from Liver diseases
•50,000 patients dying due to Heart diseases
• India is Diabetes capital (2nd in world)
Situation in INDIA
• Annually 1.6 lakh die due to Road Traffic Accidents.
• 67% deaths: Brain stem death.
• 93000: Potential organ donors / year.
• But in reality, only 0.05 / Lakh people donate their.
• Rate of OD is Highest in Spain (35 per 1 lakh population)
• In India, Tamilnadu ranks first among all states.
Deceased Donors Per Million Population
24.2521.721.6521.5
2018.1
13.1512.96
12.1810.62
6.14.3
2.70.75
0.120.05
33.68
0 5 10 15 20 25 30 35
SpainAustria
PortugalBeligium
USAFrance
ItalyCanada
United KingdomGermanyAustralia
HKSingapore
TaiwanKorea
PhilippinesJapan
de Villa VH, Chen CL, et al. Transplantation 2003; 75:S2 (Modified from)
Great scarcity of the organs
VSWastage
of cadaveric organs
Real Problem
Understanding concept
Identify brain-dead patients
Promote Organ Donation
Solution
Types of Organ Donation•After NATURAL DEATH
• By LIVING RELATED DONOR
•By LIVING UNRELATED DONOR
•After BRAIN STEM DEATH
Which Organs Can be Donated by living donor?
Kidney
Blood
Lungs
Part of liver Liver
Part of Pancreas
Living Donor
Bone marrow
2 eyesLungsHeartLiverPancreasAll Bones & CartilagesBlood vessels2 KidneysIntestineMuscles & ligamentsSkin & FasciaLarynx2 hands20 Fingers
What can donated after BSD?
More than 50 organs can be donated after Brain Stem Death
Organs needed in different conditions
Diseases Organs
Heart Failure Heart
Terminal Lung illnesses Lungs
Kidney failure Kidneys
Liver failure Liver
Diabetes Pancreas
Corneal Blindness Eyes
Heart Valvular disease Heart valve
Severe Burns Skin
Age limit for Organ DonationOrgans Age limit
Kidneys, Liver up-to 70 years
Heart, Lungs up-to 50 years
Pancreas, Intestine up-to 60-65 years
Corneas, skin up-to 100 years
Heart valves up-to 50 years
Bone up-to 70 years
Age limit of Different Organs to Donate
Exclusion Criteria (for Deceased Donor)•Absolute
▫Age>70 Yrs▫Renal disease ▫Malignancy ▫Hypertension & infective heart diseases▫ Intravenous drug abuse ▫Seropositive▫Rabies
•Relative▫Age <6years or >60 years▫Mild Hypertension▫Early Diabetes
Skin Donation
• Life saving for burn patients.
• Makes wound healing FAST.
• Removed using specialized knife and preserved like a roll.
• Taken from un-exposed parts of the body: No Disfigurement.
• SKIN BANK to preserve donated skin.
Concept of Death•Ultimate reality of life•Something fearful and unwanted •No discussion•End point •Clinically cessation of cardio-respiratory
function
Cardio-respiratory Arrest
Complete Cessation Of Breathing And
Circulation
Death
Concept of Brain Stem Death
Common Causes of Brain Death
•Head injury• Intra cerebral
hemorrhage• Ischemic brain
damage•Tumor•Hanging•Drowning
Diagnosis of Brain stem death
(According to Harward criteria)
• Unreceptivity & Unresponsivity
• No Movements / Breathing• No Reflexes• Only in ICU settings• Two independent teams to
declare• Two brain death declarations
with 6 hr interval
Body Donation• Whole body donation is covered by the
Anatomy Act 1984.
• Defined as the “Act of giving only Body after death for Medical Research and Education.” Those donated cadavers remain a principal teaching tool for anatomists and medical educators teaching gross anatomy.
• Bodies are not accepted for teaching purposes if organs have been donated or if there has been a post-mortem examination.
You can Help by:•A. Becoming a Donor, and talking to
your family about your decision of saving lives of others.
•B. Promoting donation by motivating people at work place, in your community, at your place of worship, and in your civic organizations.
Who will tell me..???Transplant Coordinator and Treating Registered Medical Practitioner will explain you about the process of Transplant.
Transplant CoordinatorCounsel the grieved family
Make them comfortable
Approach the subject of eye donation
solid organ donation
If the family gives consent
Inform the Nodal Officer
HOTA act-1994
•Brain death a Legally Accepted form
•Established criteria for Brain Stem Death Declaration
•Donation only with Consent of next of kin
•Commercial Dealings of such organs are prohibited
Some recent Amendments in LAW
•TOHO (Transplantation of human organs) & Tissue act
•SWAP donation permitted.•Grand parents and grand children included in
Near Relatives.•Waiting Registries: Regional level and State
level•Provision of Appropriate Authority in case of
Donor if Living.
SWAP Donation
•Located at 4th and 5th Floor of Institute of Pathology (ICMR) Building in Safdarjung Hospital New Delhi
Divisions:•"National Human Organ and Tissue
Removal and Storage Network”•"National Biomaterial Centre”.
Zonal Transplant Coordination Committee
• Maintains list of hospitals registered for organs retrieval and transplantation.• Maintains waiting list of patients who are desirous for organs.• carries fair distribution of organs based on waiting list.• waiting list is prepared on the basis of - Age
- Severity of disease- Prognosis/expected survival
after transplant
Organ Retrieving Hospitals
Government control(As per HOTA act-1994)
ZTCC
No hospital can transplant organ without prior information or permission of ZTCC.
Organs Transplanting hospitals
Multi-organs transplant centres
Problems in Promoting Organ Donation
•Religious myths•Professional Ignorance •Apathy to the cause •Shy/afraid of discussing donation •Don’t know –what to do???? •Scared of bad reputation •Fear of litigation •Poor communication
Religious Views: Hinduism•Believe in rebirth of the soul•Body is cremated after death•Human form is the highest in the order of
re-births before the soul reaches the creator
•Sacrifice to the fellow humans considered equivalent to service to god
•Religious laws and scriptures do not prohibit organ donation
LIFE IS AMAZING… PASS IT ON…!!!
Religious Views: Islam•Until early 90s the religious leaders failed
to approve of organ donation•Mid 90s the religious leader in saudi
(Mecca) passed a fatwa, making organ donation after death permissible under islamic law
LIFE IS AMAZING… PASS IT ON…!!!
Religious Views: Christian•Catholics view organ donation as an act of
charity•Ethically and morally acceptable to the
vatican•Pope John Paul ii has given his support to
organ donation•Protestant groups generally endorse organ
donationLIFE IS AMAZING… PASS IT ON…!!!
Overall Religious ViewsAll other major religions such as Sikhism, Buddhism and Jainism do not oppose organ donation and share similar views as that of Hinduism.
Positive Changes
Aishwarya Rai, Amitabh Bachhan, Jaya Bhachhan, Rajnikanth, Amir Khan and many other film
personalities have pledged their Eyes at different times on media
Anil Kumble, Sunil Shetty, Yukta Mukhi, Revathi Menon and Madhavan have endorsed their views on multi-organ donation
Green Corridor
LIFE IS AMAZING… PASS IT ON…!!!
LIFE IS AMAZING… PASS IT ON…!!!
You choose…
LIFE IS AMAZING… PASS IT ON…!!!
You don’t need to be DOCTOR to save LIVES !!!
I am an ORGAN DONOR…Are YOU….???
THANK YOU…