Cadaveric Organ Transplant ? A New Lease of Life

Human to human transplantation of organs has been accepted by healthcare professionals all over the world as the best, and often the only one for a wide range of fatal diseases such as end stage kidney failure. It has been one of the greatest advances of medical science that has resulted in many people getting a renewed lease of life. Experts say that the organs from one donor can save as many as 8 lives. The need of Organ Donation in India Organ donation is fast developing into a major treatment protocol. However, it is yet to make a significant dent in India. Every year, hundreds of people die while waiting for an organ transplant. Due to lack of awareness and misconceptions, there is a shortage of organ donors, and with each passing year, the gap between the number of organs donated and the people waiting for organ donation is getting larger. Some disturbing stats around the same are as follows:

• Almost 1.75 lakh people in India need a kidney; however, less than 5000 of them receive one.
• Only 1 out of 30 people who need a kidney receive one.
• 90% of people in the waiting list die without getting an organ.
• India’s annual liver transplant requirement is over100000, but we manage only about 1000.
• 70% liver transplants are taken care of by a live donor, but only 30% are dependent on cadaver (deceased) donors.
• Annually more around 50000 hearts are required along with 20000 lungs.

  Organ donation can occur with: -    A deceased donor, who can give kidneys, pancreas, liver, lungs, heart, intestinal organs -    A living donor, who can give a kidney, or a portion of the liver, lung, intestine or pancreas The Law - Transplantation of Human Organs Act In 1994, the Government of India passed the Transplantation of Human Organs Act that legalized the concept of brain death and, for the first time, facilitated organ procurement from heart beating, brain dead donors. Brain Death – Brain death occurs when a person has an irreversible, catastrophic brain injury, which causes total cessation of all brain functions (the upper brain structure and brain stem). Brain death is not a coma or persistent vegetative state. In brain death, injury occurs to the brain so that the brain dies but the heart continues to beat for a few hours or days and the vital blood supply to the organs is maintained. The diagnosis of brain death is based on simple bedside tests performed by a team of four doctors and repeated after 6 hours. There are a number of physical changes in pupil reaction, heart rate, blood pressure and body temperature that are experienced when the brain dies. These changes, together with the loss of other natural responses such as breathing, coughing and blinking, cause doctors to suspect that brain death as occurred. Once death has been confirmed, appropriate members of the medical team will speak with the family to determine if their relative had expressed any special wishes regarding organ donation. In the case of children, the wishes of the child's parents will be explored. It requires considerable effort on behalf of the treating team to convince the family about brain death before the process of counseling the family by trained transplant coordinators commences. Time is at a premium as gradual deterioration of all organs and tissues is inevitable as the capacity of the body to repair damaged cells is lost and the heart eventually stops beating. Once the consent for organ donation is obtained from the family, a single heart beating brain-dead donor can save nine lives by donating the kidneys, lungs, heart, pancreas small bowel and the liver, which can be split into two. However, this concept has not caught on well in India for want of public education and awareness. Here are key reasons for the shortage of organ donors in India -

1. Ignorance and Lack of Knowledge – There is a major lack of awareness about cadaveric organ transplant in India, and people would come forth if they received more information and ways to register for organ donation.
2. Myths and Beliefs – The Indian society, mired in traditional beliefs, is not very amenable to the idea of cadaver organ transplants. What they fail to realize is that in a country with a long waiting list of transplants, they are spoiling the chance of someone leading a normal life, just because they want to consign the whole body to last rites.
3. Expressing one’s wish to donate – Failure to record one’s wish about organ donation after death with a healthcare facility or with family members also is a major reason for the shortage of organs.

Organ Transplant Process: Organ transplantation is the process of surgically transferring a donated organ into a patient with end-stage organ failure.

1. Hospital Organ Donation registry coordinates the process of cadaver organ donation, i.e., organ donation after death and transplantation.
2. A transplant coordinator travels to the hospital to evaluate each potential donor and to determine the medical suitability of each organ. The transplant coordinator obtains detailed medical information about the patient's current medical condition as well as any past medical history.
3. The transplant coordinator or family services coordinator meets with the potential donor's next of kin, or other authorized party, to offer the opportunity for donation. This conversation is carefully timed and takes place only after the next of kin is given time to understand their loved one is brain dead.
4. After making the decision to donate, the next of kin will be asked to sign a consent form documenting which organs and/or tissues they wish to donate.
5. The recovery of the organs is performed in the operating room where the donor is being cared for. The transplant coordinator oversees the arrival and departure of the surgical recovery team. The recovery team consists of surgeons, nurses, the transplant coordinator and an organ preservation technician.
6. Just prior to being removed from the donor, each organ is flushed free of blood with a specially prepared ice-cold preservation solution that contains electrolytes and nutrients. The organs are then placed in sterile containers, packaged in wet ice, and transported to the recipient's transplant center. It is important to transport the organs from the donor to each intended recipient as quickly as possible. Hearts and lungs must be transplanted within approximately four hours after being removed from the donor. Livers can be preserved between 12 - 18 hours; a pancreas can be preserved 8 - 12 hours; intestines can be preserved approximately 8 hours; kidneys can be preserved 24 - 48 hours.
7. In such a scenario, it is important to be able to transport the organs from one facility to another in a short span of time. Hence the need for a ‘Green Corridor’ such as the one created in Chennai traffic for transporting a donor's heart to the hospital via a specially created route in less than 14 minutes during rush hour. A ‘Green Corridor’ enables healthcare facilities to transport vital organs for transplant from one place to another even in peak traffic hours. This requires an efficient coordination on the part of healthcare facility, the Doctors and awareness among masses to cooperate when such a situation arises.

Role of Fortis Organ Retrieval & Transplant (FORT) FORT has been established with an aim to promote and streamline the process of organ donation following brain death. FORT provides 24-hour referral service for organ and tissue donation and assistance with documentation and procedures related to the same ([email protected]; helpline +91-8447743868). Other functions include carrying out awareness drives with schools, police, corporates and media and also training for transplant coordinators. One can pledge to donate one’s organs by making an organ donor card. The organ donor card has no legal standing. It helps in spreading the message of organ donation and is an expression of one’s desire, which the family members should be made aware of. Myth about Organ Donation Lack of awareness and education is one of the causes for shortage of organ donors in India, but much of it can be attributed to the religious myths and misconceptions of people in our country. Many people believe that organ donation is against one’s religious belief, which is not the case. In fact, organ donation is consistent with the beliefs of most major religions. However, if one has doubts, they can get in contact with their religious advisor before considering being an organ donor. What needs to be done? The successful implementation of cadaveric organ donation hinges on the education of masses and a more proactive attitude towards cadaveric organ donation. Proper counseling of relatives for organ donation in the event of brain death, proper hospital infrastructure, matching and distribution of the organs and coordination among hospitals play a major role. The Government needs to step in with resources to increase awareness from school days onwards. There is a need to educate the public on brain death and organ donation. Chapters in schoolbooks and education while applying for voter card / driving license could be introduced The Government could intervene with various measures such as making it compulsory to donate organs of brain dead and patients, along with various awareness campaigns through media, and indirect incentives to donor families. There is a need to educate the public on brain death and organ donation from school day onwards. Chapters in schoolbooks and education while applying for voter card / driving license could be introduced. However, it is the need of hour that, regardless of a law on organ donation, people must come forth on their own to save a life and record their wish to be an organ donor after death. And this can only happen if the government and healthcare facilities work together to streamline the process in an effective way. We should aim to follow the example of Croatia or Brazil. Croatia was able to increase their organ donation rate from 2.7 per million to 35 per million population over 10 years and today they are second in the world only to Spain. Recognizing organ donation as a priority area, earmarking requisite funds, sustained awareness campaign, training of transplant coordinators and appointing a Key Donation Person in each hospital achieved this feat. Donation/ pledging an organ is a noble cause and nothing could be a better goodbye to the world than knowing that one will be making a difference to numerous lives after they are gone.