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ORGAN DONATION – A GIFT OF LIFE!!!
Organ Transplantation – Our Understanding
Medical Science is expanding its horizons by leaps and bounds and edging towards
newer successes by unveiling God’s miraculous mystery – Human being &
primarily human body.
In case any of the organs of the human body fails of function, medical science can
extend its functioning for some time, but when an end stage failure is reached,
just like a machine whose parts are changed, the failed organ needs to be
replaced.
A human body has 2 Kidneys and a normal human being can survive even with
one Kidney. This fact allows a normal human being to donate one of his Kidneys to
a needy patient. However, this is not the case in case of Heart, Liver, Lungs,
Pancreas etc. There are millions of needy patients all over the World who suffer
from various end stage organ failures and whose lives can be saved only by the
timely replacement of the failed organ.
Human to human (allogeneic) transplantation of cell tissue and organs has become
the best treatment and often the only for a wide range of fatal diseases.
Transplantation has been increasing over the previous decades. However, the
human origin of the therapeutic material entails the potential for safety and ethical
violations.
One of the miraculous discoveries of medical science has brought a ray of hope in
the lives of these needy patients by transplanting these functioning organs from
the bodies of brain dead patients to these patients. This is cadaver organ
transplantation.
Whenever there is an injury to the brain stem or an intracranial haemorrhage the
patient goes into coma. The brain is the utmost important organ of the body and
an irreversible damage to the same leads to the death of the living being but other
internal organs remain functional for some time aided by artificial respiration and
various drugs. During this time even though the patient is dead, these organs
which are kept viable artificially, can be transplanted to various needy patients
and a gift of life can be given to them.
One brain dead patient can donate
• both Kidneys,
• Heart,
• Liver,
• Pancreas,
• Lungs,
• Skin
• & both corneas
• to various needy patients
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Transplantation of Human Organs Act, 1994
The Transplantation of Human Organs Bill, 1994 aims to provide for the
regulation of removal, storage and transplantation of human organs for
therapeutic purposes and for the prevention of commercial dealings in
human organs and for matters connected therewith or incidental thereto.
Thus the Act envisaged the achievement of 2 goals:
 The propagation of cadaveric transplantation and
 The curtailing of commercial trading of human organs.
After the Transplantation of Human Organ Act passed in 1994, brain stem
death has been legally accepted as definition of death for transplantation
purposes.
Till the enactment of the Transplantation of Human Organs Act, 1994
(THOA), there was no comprehensive legislation allowing the removal of
human organs from brain-dead cadavers. The Act legalized “brain death”
making removal of organs permissible after proper consent. Number of
cadaveric transplants undertaken however, is still below expected.
Current Scenario in India
The annual number of organ transplants (including renal, cardiac and liver)
carried out in India is a mere 3,500 cases. The main reason for the low
figure rate is non-availability of donor organs. Moreover, the number of
cadaveric transplants is low mainly due to lack of infrastructure and
ignorance about donation.
A majority of the transplants conducted are kidney transplants. Kidney
transplant has become the treatment of choice for End Stage Renal Disease
(ESRD). Every year, over 100,000 people in India (10,000 in Maharashtra
alone) are diagnosed with ESRD and require a transplant. However, only
3,500 transplants are actually undertaken. About 99 per cent of kidney
transplants are related donor transplants or unrelated (emotionally related)
person.
Globally, the liver is the second most transplanted major organ after the
kidney. In India, the first transplant was carried out only after the 1994
Human Organ Transplant Act made it possible to use cadavers as donors.
Of the approx. 300 procedures carried out since then, most have been
cadaver-donors. Although Mumbai hospitals can handle at the least 25-30
cases a year, they are only averaging 6-10 transplants.
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PROCESS
The whole organ donation process can be, for convenience, divided into four
distinct phases.
The process of:
1. Identification
2. Certification
3. Screening
4. Maintenance of donor
PRE REQUISITES for a GOOD, EFFICINET & EFFECTIVE O.P.C. (Organ
Procuring Center) are:




Proper coordination
Motivated team
Adequate and correct knowledge
Mutual support/liaison with other agencies
Within a span of 6 to 24 hours a team of 4 specialists examine the brain
stem dead individual and certify brain stem death. Only after this various
organs of an individual are used for transplantation to other waiting
patients.
CONFIRMATION OF BRAIN STEM DEATH - Apnoea test
Apnea is established by showing that no respiratory movements occur
during disconnection from the ventilator for long enough to ensure that the
arterial carbon dioxide tension (PCO2) rises to a level of 50 mm Hg or more,
capable of driving any respiratory center neurons that are still alive.
Nothing can undermine the necessity for hurrying up the matters and the
Need For Speed - After death, immediate action is needed.
The Success of the whole process will depends on
– Motivation from - nurse, doctor, social worker
– presence of mind of relatives
– facility for organ donation
The Work for the transplant coordinator starts right here between II Apnoea
Test and certification in Form no. 6, 7, 8 and /or 9
• here Legal issues are to be tackled
DECLARATION AND CERTIFICATION OF BRAIN STEM DEATH is done after
II Apnoea test has been confirmatory of brain death.
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What to do??
(A) Routine Cases
• After certification we can straight away go for harvesting organ
(B) MLC Cases
• Clearance FROM THE Police Authorities is required!!!!!
This clearance can be given on the basis of the following stipulated in TOHA:
The person competent under this Act to give authority for the removal of
any human organ from such dead body may, if he has reason to believe
that
“such human organ will not be required for the purpose for which
such body has been sent for post-mortem examination………”
A paradox of shortage in the face of plenty
This noble purpose requires public awareness on a large scale. In western
countries where organ donation has become very common, people carry
voluntary organ donation cards routinely. Even in India, these cards are
freely available.
Bridging the Shortfall - Broad Strategy & Activities
The organ shortage is not due to a lack of potential donors but rather
to a failure to turn potential donors into actual donors
There is an imperative need to strategise PR campaigns, seeking to create a
pro and receptive environment amongst its key audiences through
sustainable activities that will ultimately result in increased awareness
amongst the medical fraternity, hospital staff and the masses. In order to
reach the end goal, we can devise a two-pronged approach with the help of Media Activities & Non-media Activities like Media Networking Sessions,
CME’s and Workshops, Events, Patient Forum, Online Discussion Forum/ Blogsites etc
ORGAN DONATION – NOBLE DONATION a gift of life
Written, sourced and compiled by:
Dr Atul Adaniya
MBBS, MHA, PGDMLS, Diploma Family Health
Asst Medical Director
Sir H N Hospital & Research Centre
Reliance Industries Limited
Mumbai 400 004