ORGAN DONATION ... How to do'.-'
How to do?
Solid organs can be donated only after the brain death.
The brain death recognition, certification can only be done in Intensive care units where patient is on
support system like respirator, cardiac support etc.
Since brain death is recognized for organ transplantation procedure as per TOHA 1994, the ICU must
have recognition I approval by State Appropriate Authority.
In Mumbai following hospitals are recognized by the SAA and only
Public Hospital
LTMG Hospital
KEM Hospital
Nair Hospital
Kothari Hospital
Private Hospital
Nanavati Hospital
H.N. Hospital
P.D. Hinduja Hospital
Jaslok Hospital
Lilavati Hospital
NHS Aswini Hospital
Breach Candy Hospital
Bombay Hospital
The situations where brain stem death can occur are;
1. Severe Head Injury due to;
Road traffic accident
Railway accident
Fall from height
Assault to head
Bullet injuries etc
2. Due to any other medical causes of intra cranial (inside the skull) bleed.
3. Post neuro surgical operation,
4. Any other post operative or intra operative anoxia leading to brain edema and later on
death.
All of these patients will be in ICU with breathing through respirator along with cardiac
support system. When the injury to the brain is so sever that it is irreparable damage to
brain leading to brain death, which is diagnosed by certain bed side tests.
The clinical diagnosis of brain stem death.
This involves 3 steps:
1. Ensure that certain specific precondition are laid down by law are fulfilled.
2. Ensure that reversible causes of brain stem death (such as primary hypothermia, drug intoxication
etc ruled out).
3. Establishing (by clinical bed side tests) that comatose patient is truly incapable of
Pre Conditions:
Patient must be comatose with evidence of irreparable brain damage.
Patient must have been maintained on ventilator for long enough to ascertain that brain
damage is irremediable. The condition should be considered irremediable only after
vigorous efforts have been made to remedy it.
EXCLUSIONS:
Drug intoxication, primary hypothermia and metabolic distribution like diabetic coma etc are probably
reversible causes and hence the law TOHA 1994 which is based on U.K. Code recommends not to
consider these patients for a diagnosis of brain death.
CLINICAL TESTING:
Done at bedside in ICU
These are;
Absent brain stem reflex.
Apnea test (To demonstrate failure of spontaneous breathing inspite of giving maximum stimulus to
brain stem.
HENCE IT IS CLEAR THAT THE BRAIN STEM DEATH IS DIAGNOSED ONLY IN ICU AND ORGAN
DONATION, which has to be done after the brain stem death can be done only at ICU.
Once brain stem death is declared and certified the screening for organ donation is done.
Screening for organ donor:
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Age limit > 2 yrs. and < 65 yrs. extended criteria permits till the age of 70 yrs.
Should not be suffering from cancer except intra cranial tumour (brain tumour) and nonmelanoma skin malignancy which hardly has any metastasis.
No history of untreated hypertension, diabetes mellitus.
No evidence of:
1. Primary kidney disease
2.Generalised viral, bacterial infections.
Acceptable urine analysis (minor abnormalities attributable to terminal illness ignored)
Pre terminal Urine output > 1 ml / kg/ hour
Normal BUN creatinine
Worm eschemia, less than 60 min.
Negative serological tests for HIV and hepatitis B & C
After certifying that patient is brain dead and screened he can be organ donor the family is counselled for
organ donation.
Without the consent of the family members the organs are never removed.
Economic Aspects Of Organ Donation:
Organ donation is purely donation and it is a humanitarian gesture by the family of the deceased.
Since there is no relegion, which prevents organ donation, all civilized society must practice organ
donation.
It is very evident that after the death the body is either cremated or buried hence timely consent for organ
donation will save many lives who are otherwise miserable with END STAGE ORGAN FAILURE
Once there is consent from the family for organ donation cost of cadaver screening
Maintaining of cadaver, the cost of organ retrieval surgery etc. is not paid by the family of the deceased.
Every
LEGAL ASPECTS:
 Even in medico legal cases organ donation can be done.
 Organ donation does not prevent post mortem in required cases.
How long one can wait after death for giving consent?
Though in a standard good ICU the young cadaver can be maintained for about 24 to 48 hrs. it is not a
rule in every situation. It involves a tremendous amount of cost and other resources. And even the quality
of organs will also deteriorate.
Hence only a timely early decision by the family for organ donation will lead to successful cadaver
transplant programme.
How to become organ donor?
Making known ones wish to their family members that "God forbid if ever I have brain death donate my
organs to needy recipients".
Signing a donor card and carrying it in the wallet, purse etc.
How to make cadaver organ donation as a successful programme?
By convincing oneself, their family and friends.
Using all platforms to spread the awareness in the society.
By supporting cadaver organ donation.
By increasing cadaver organ transplantation unrelated kidney transplantation will automatically become
less which will reduce other social evils like kidney selling, exploitation of poor, kidney bazaar etc.