updates on organ donation
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UPDATES IN ORGAN
DONATION
Mrs Anusha Verghese
Medical Surgical NursingPIMS
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OBJECTIVES
Delineate the criteria required toqualif a! a "otential or#andonor
E$"lain factor! in%uencin# or#an
donation "roce!!& E$"lain the i'"ortance of a tea'
a""roach to fa'il con!ent Pro(ide a #eneral under!tandin#
of the donation "roce!!
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Or#ani!ation hel"in# )ith or#an donation* Tran!"lant! "ro#ra''e! in India
+O,AN -oundation .INOS/ 0 Ta'il Nadu1 AndhraPrade!h1 +ahara!tra
234 Or#an! !hared& . 25206idne!1 70,eart!1 5809i(er /
+O,AN -oundation .INOS/ 0 Ta'il Nadu1 AndhraPrade!h1 +ahara!tra
234 Or#an! !hared& . 25206idne!1 70,eart!1 5809i(er /
-ORTE1 BANGA9ORE 32 Or#an! Shared
. 32 0 6idne!1 50 ,eart1 50 9i(er /
-ORTE1 BANGA9ORE 32 Or#an! Shared
. 32 0 6idne!1 50 ,eart1 50 9i(er /
ZTCC, Mumbai 55 Organs Shared - all kidnes
ZTCC, Mumbai 55 Organs Shared - all kidnes
O!"O, N#$elhi %e& 'rgans shared
O!"O, N#$elhi %e& 'rgans shared
SO!T, C'chin ( 'rgans shared
SO!T, C'chin ( 'rgans shared
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Ta'ilNadu Net)or: for Or#an Sharin#Share Organs Sa)e *i)es
$r#Amal'r+a)anahan,C'n)ener, Cada)erTrans+lan Pr'gramme,-Mail .or#an!tran!"lant;#'ail&co'
Donor! -ro' TN ?*i)er 4480idne 5278Pancreas =Small "'&el 2Total +a@or or#an! 225?
/ear Val)e 123C'rnea 46(Skin 31
"l''d Vessels 3Total Or#an! 378=
Transplants So Far
Performance Report : From Oct 2008 to Oct 31, 2015
mailto:[email protected]:[email protected]:[email protected]:[email protected] -
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Organ donation
Organ donation is the process
of remoing tiss!es or organs
from a lie, or recentl" dead,person to #e !sed in another$
The former is the donor and the
latter is the recipient$
People of all ages can #ecome
donors$
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ORGANS T,AT CAN BEDONATED
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uDonation
Identication and Referral
+aintenance DNRDi!connection of Ventilator !u""ort
Pronounce'ent of rain death
-a'il Refu!al to con!ent for donation
Settin# quiet1 "ri(ate area1 near ut out of the ICU &
S"ea:in# to the fa'il o(er the dead "atient! ed i! di!re!"ectful
and unacce"tale& Decou"lin# The act of a""roachin# a fa'il for or#an donation'u!t e done in the a""ro"riate ti'e1 )ith due re!"ect for their lo!!&The 'u!t e #i(en ti'e to ad@u!t to the lo!! of their lo(ed one&
The r!t !hould in(ol(e the "h!cian and hi! e$"lanation thattheir lo(ed one ha! died&
The !econd the tran!"lant coordinator !hould #o later to e$"lainaout or#an donation and otain infor'ed con!ent&
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Identifin# a PotentialDonor
5& Or#an donor! 'u!t e 'aintainedon a (entilator to :ee" life0!a(in#or#an! o$#enated&
2& The Gla!#o) Co'a Scale 'u!t eF 8
3& There 'u!t e a neurolo#icalin!ult
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Cardio0re!"iratordeath&
*'ss '7 cardiac7unci'n#
*'ss '7 res+ira'r7unci'n#
P'enial issue d'n'r
C'rnea, hear )al)es,skin, l'ngb'nes,sa+nen'us)eins#
Non0 reco(eralerain death&
Irre)ersible l'ss '7brain-sem 7unci'n#
P'enial 'rgan andissue d'n'r
/ear,lungs,kidnes,
+ancreas,li)er,inesine,
issues
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Ideni7ing a P'enial $'n'r
,ere! a li!t of !o'e t"e! of "atient! )ho 'aeco'e donor!
#un!hot )ound
'otor (ehicle accident )ith clo!edo"enhead in@urie!
cerero0(a!cular accident
dru# o(erdo!e
ano$ic in@ur han#in#
dro)nin#
cardiac arre!t
"ri'ar rain tu'or )ithout 'et!
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Denition!
Tran!"lant Coordinator
A "er!on a""ointed a ho!"italto coordinate all 'atter! relatin#to re'o(al or tran!"lantation ofhu'an or#an!ti!!ue!
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3.
COLLABORATION
WITH HEALTH
CARE TEAM
3.
COLLABORATION
WITH HEALTH
CARE TEAM
2$%&'('%)&
)SS*SS+*(T,
')-(OST'%T*ST'(-./&) Tiss!e
t"ping and %ross
match,
O()R
+)()-*+*(T
2$%&'('%)&
)SS*SS+*(T,
')-(OST'%T*ST'(-./&) Tiss!e
t"ping and %ross
match,
O()R
+)()-*+*(T
4 .EDUCATION4 .EDUCATION
5.CHECK PATIENTHAEMODYNAMIC
SUPPORT,VENTILATOR
SUPPORT
5.CHECK PATIENTHAEMODYNAMIC
SUPPORT,VENTILATOR
SUPPORT
ROLE OF TRANSPLANT COORDINATOR
6.FAMILY SUPPOR
, COMMUNICATION
CONSENT
6.FAMILY SUPPOR
, COMMUNICATION
CONSENT
7.OPERATIONROOM
SCHEDULING
,COMMUNICATION,
PREPARATION
7.OPERATIONROOM
SCHEDULING
,COMMUNICATION,
PREPARATION
1.DONAR
IDENTIFICATION,
REFERRAL,ONSITE
RESPONSE
1.DONAR
IDENTIFICATION,
REFERRAL,ONSITE
RESPONSE
.ORGAN
ALLOCATION
AND
SURGICAL
RECOVERY
.ORGANALLOCATION
AND
SURGICAL
RECOVERY
! .PATIENT
FOLLOW"UP
! .PATIENT
FOLLOW"UP
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ORGANPROCURE+ENT
ORGANTRANSP9ANT
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NUC9EAR SCAN
GA++A CA+ERA AND ISOTOPE& TC 77 ,+POA COST RS 38??
TI+E 2?+INS
-A+I9H CAN STAH IT, PATIENTDURING PROCEDURE ANDEP9ANATION O- PATIENT
PROGRESS DONE IT,DISP9AHING PICTURES
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MANAGEMENT OF BRAIN DEAD DONOR
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INTENSIVE CARE +ANAGE+ENT -OR T,EPOTENTIA9 ORGAN DONOR
Rule! of 5??!& +aintain ,eart rateK 5?? eat!'in
+aintain BP at 5?? !!tolic1
+aintain urine out"ut at 5??cc "erhour1
:ee" PO2 at 5?? '',#&
Place Cenral line and Arerial line /8POT/!MIA -Mainain n'rm'hermia
&ih &arming9c''ling blanke :;#
check CVP :6-43 mm '7 hg>
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INTENSIVE CARE+ANAGE+ENT
,HPOTENSION6ee" +AP L
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ENDOCRINE SUPPORT
+ET,HPREDNISO9ONE 58+G6GBO9US15G+DAH
TRIODOT,HRONINE.T3/ = +CGBO9US13+CGS,R
T,HROIN T= 12?+CGS BO9US15?+CGS,R
VASOPRESSIN ?&802&= UNITS,R
INSU9IN IN-USION 15UNIT,R.TITRATE B9OOD G9UCOSEAT 58? +GD9 5>? +GD9/
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,OR+ONA9 SUPPORT
I+PROVES ORGAN DONATIONAND GRA-T SURVIVA9&
INCREASES TISSUEOHGENATION AND DONAR 9UNGRECOVERH&
I+PROVES CARDIAC
-UNCTION.INCREASESABP1CARDIAC OUTPUT19V-UNCTION/&
DECREASES INOTROPE
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AI+
T' mainain
hae'odna'ic!tailit7'r o"ti'alor#an "erfu!ionunil
'rgans are retrie(edfro' rain dead+aien
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ORGAN DONATION PROCESS
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*i)er rans+lan
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,EART TRANSP9ANT
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,EART TRANSP9ANT
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,EART TRANSP9ANT
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9un# Tran!"lantation
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6idne tran!"lant
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A+END+ENTS
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The Tran!"lantation of ,u'anOr#an! .A'end'ent/ Bill1 2?55
Se+ember, 3( - !e)ie&C'mmiee se u+ ' e?amine+r')isi'ns '7 T/O Ac and he !ules#
The Tran!"lantation of ,u'anOr#an! .A'end'ent/ Bill1 2?55$ra7ed b Minisr '7 /ealh#
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T,O ACT TO COVER BOT,ORGANS * TISSUES
Re#ulation of re'o(al1 !tora#eand tran!"lantation of hu'anor#an! and ti!!ue! forthera"eutic "ur"o!e!
Pre(ention of co''ercial
dealin#! of hu'an or#an! andti!!ue!
CO S
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REUIRED CONSENTREUEST Manda'r 7'r IC@ d'c'r, in c'nsulai'n
&ih rans+lan c''rdina'r ' reuesrelai)es '7 brain dead +aiens 7'r 'rgan
d'nai'n#
!ec'rd '7 all brain dead +aiens and ha'7 he ne? '7 kin &h' are a++r'ached '
be ke+#
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S"ecial Pro(i!ion for Re'o(al ofCornea!
Technician "o!!e!!in# !uchqualication! and e$"erience1 a! 'a
e "re!cried1 'a enucleate an ee&
C i i f B i
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Certication of BrainDeath ?+ansi'n '7 ceri7ing +anel '7 e?+ers#
In addii'n ' neur'surge'n 9 neur'l'gis,!ur#eon "h!ician and an
ane!theti!t inten!i(i!tn'minaed 7r'ma +anel alread a++r')ed b heA++r'+riae Auh'ri#
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-orei#n National!
Authori!ation Co''ittee to "rohiit
or#an tran!"lantation )here reci"ient
i! a forei#n national and donor i! an
Indian national&
A""ro(al of Authori!ation Co''ittee
required 0 Donor and or reci"ientein# near relati(e! are forei#n
national!&
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+inor!
No hu'an or#an! or ti!!ue! to e re'o(ed
fro' li(in# 'inor for tran!"lantation&
E$ce"tion!
-a'ilial donation of re#enerati(e cell!
.)hen a thera"euticall co'"arale adult
donor i! not a(ailale/
6idne tran!"lant! et)een identical t)in!
.En!ure no #enetic di!order "re!ent& No
i''uno!u""re!!ion required for reci"ient
t)in/&
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+entall challen#ed
No hu'an or#an or ti!!ue to e
re'o(ed fro' the od of a 'entall
challen#ed "er!on efore hi! death
for the "ur"o!e of tran!"lantation&
+ental illne!! li:e de'entia1
!chio"hrenia
+ental retardation
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Tran!"lant Coordinator!
+andator for ho!"ital!1 "rior tore#i!tration a! a tran!"lant centre1 to
a""oint a Tran!"lant Coordinator&
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A""ro"riate Authorit
Sin#le 'e'er od
Central Go(ern'ent for Union
Territorie! 0 Director General of
,ealth Ser(ice!1 Go(ern'ent of India
State Go(ern'ent for State! 0
Secretar .,ealth/ or the Director of
,ealth Ser(ice! of the StateGo(ern'ent concerned&
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Po)er! of the A""ro"riateAuthorit
To #rant re#i!tration to a ho!"ital for
the re'o(al1 !tora#e and
tran!"lantation of an hu'an or#an&
To !u!"end or cancel !uch
re#i!tration&
To enforce !tandard! for ho!"ital!
en#a#ed in the re'o(al !tora#e ortran!"lantation of hu'an or#an!&
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Po)er! of the A""ro"riateAuthorit
To in(e!ti#ate an co'"laint orreach of an "ro(i!ion of the Act orthe Rule!&
To in!"ect ho!"ital! "eriodicall fore$a'ination of the qualit oftran!"lantation and follo)0u" 'edicalcare to the reci"ient! a! )ell a!
donor!& Po)er to !u''on "er!on!1 !ee:
"roduction of docu'ent!1 i!!ue!earch )arrant!&
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Ad(i!or Co''ittee
To a!!i!t A""ro"riate Authorit in thedi!char#e of it! function!
Con!tituted for a "eriod of t)o ear!
Re"re!entation fro' an NGO )or:in#
in the eld of or#an or ti!!uedonation
A th i ti
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Authori!ationCo''ittee! ,o!"ital le(el Authori!ation
Co''ittee!
State or Di!trict le(el Authori!ation
Co''ittee! Central Go(ern'ent to "re!crie
co'"o!ition of Authori!ationCo''ittee! to en!ure unifor'it
Actual a""oint'ent! 'ade re!"ecti(e State Go(ern'ent! UnionTerritorie!&
,o!"ital A thori!ation
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,o!"ital Authori!ationCo''ittee /'s+ial d'es m're han 35
rans+lans annuall
Medical direc'r9su+erinenden
T&' d'c'rs n' +ar '7 rans+laneam
T&' members 7r'm s'cie
$irec'r9secrear '7 healh ser)ices
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National Re#i!tr
Cenral B')# ' de)el'+men andmainain nai'nal regisr '7 reci+iens#
)aluai'n '7 scienic and clinical saus
'7 'rgan rans+lanai'n#
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National Or#an Retrie(al1 Ban:in#and Tran!"lantation Net)or:
Organ !erie)al D "anking Organisai'n
:O!"O> se u+ a AIIMS in Ne& $elhi#
sablishmen '7 a nai'n-&ide ne&'rk, '
include. All rans+lan cenres
All rerie)al 'rganisai'ns
All ceried /*A esing labs
In 7uure all rauma cenres, all dialsis
cenres, all h's+ials &ih IC@s
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National Or#an Retrie(al1 Ban:in#and Tran!"lantation Net)or:
Mainain &aiing lis '7 +aiens a&aiingrans+lanai'n#
$iEeren liss 7'r diEeren 'rgans#
%aciliae maching '7 'rgans hr'ugh ac'm+ueriFed daabase#
OM * P lti
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OMence! * Penaltie!
Enhance'ent of Penaltie!
Re'o(al of hu'an or#an )ithout authorit I'"ri!on'ent 0 U" to 5? ear!
-ine 0 U" to R!&2? la:h
Re'o(al of hu'an ti!!ue )ithout authorit
I'"ri!on'ent 0 U" to 3 ear! -ine 0 U" to R!&8 la:h! 2? la:h!
9i(e unrelated or#an donation fal!e
docu'ent! I'"ri!on'ent 8 to 5? ear!
-ine R!&2? la:h to R!&5 crore
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OMence! * Penaltie!
Penaltie! for doctor! -ir!t oMence na'e !truc: oM fro'
State +edical Council for three
ear! Second oMence na'e !truc: oM
"er'anentl
: l
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Po)er to +a:e Rule!
E$"and rule0'a:in# "o)er! of CentralGo(ern'ent to "ro(ide for
ualication and e$"erience to e"o!!e!!ed a technician to e eli#ile for
enucleatin# a cornea&
Condition! for an ane!theti!t inten!i(i!tand !ur#eon "h!ician for ein# includedon the 'edical oard for certication of
rain death& ualication! and e$"erience required for
the "o!ition of tran!"lant coordinator&
The co'"o!ition of Authori!ation
Co''ittee!&
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D
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Donar a""
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T,AN6 HOU
In 'end
i! 'e#innin#
-T#S#li', %'urGuares