By Dr Raghavendra Nayak
Consultant Nephrologist, A J Hospital
Mangaluru, Oct 4: Transplantation of organs and tissues such as liver, kidneys is one of the greatest achievements in modern medicine. From the mythological stories to the futuristic pages of sci-fi books, transplantation of organs from one human being to another has always been read about and debated.
Transplantation over the past few decades has gradually become the accepted treatment for a number of conditions where organs like the kidneys, heart and liver have irreversibly failed. For a patient with kidney failure an alternative such as dialysis is available till an organ becomes available, but for a patient with liver or heart failure; the only hope of living may be to have an immediate transplant.
These transplants save and improve lives of human beings. The success story of organ transplantation depends entirely on the generosity of donors and their families. Organ donors are living proof that death can bring life, that sorrow can turn to hope, and that a terrible loss can become the greatest gift. Most people donate the belongings of their loved ones after their death, organ donation also should be considered in the same spirit. It is the noblest of all donations and gives a fellow human being a second chance to live.
A patient who is brain dead is in an irreversible state and is totally dependent on ventilators and medications to keep the heart functioning and and to maintain the circulation.
A living person can donate perhaps one kidney or part of a liver and save only one life but after brain death a person can save many lives and donate all their organs and tissues and this includes heart, lungs, liver, kidneys, corneas and so on. A society that has rising number of organ failures due to rising incidence of diabetes and hypertension, a society where there is acute organ shortage, awareness programme regarding organ donation is necessary.
In nearly 40–50% of all fatal road accidents in the world, the cause of death is head injury. Even if 5% to 10% of all these deceased patients became organ donors, it would mean that there would be no requirement for a living person to donate an organ.
More recently, there has been a spurt of deceased solid organ donations making deceased donation a possible alternative to the living transplant program. If properly organized, the deceased organ donation program has the potential to take care of the majority of the demands of kidney, liver, and heart transplants. For thousands of ailing Indians, cadaver donation is the link between life and death.
The gap between the numbers of organs available and the number of patients joining the waiting list for a kidney transplant is widening globally. In India, the potential for deceased donation is huge due to the high number of fatal road traffic accidents. Few hospitals and committed NGOs (Mohan Foundation) in the country have shown that deceased donation as a feasible option.
'Mohan' is an acronym for Multi Organ Harvesting Aid Network and was formed to wipe away organ shortage by encouraging organ donation after death especially brain death.
Organ Donation in India
Organ donation from brain dead donors is gaining momentum in India and it is time to take this programme further to help thousands of patients with organ failure get a second chance at life.
Tamil Nadu and Andhra Pradesh were at the forefront in this with some hospitals and non-governmental organizations like Mohan Foundation taking the lead in setting up an organ sharing network in the year 2000.
With an organ donation rate of >1.15 per million population, Tamil Nadu is the leader in deceased organ donation in the country.
Organ Donation in Karnataka
The number of cadaver donations in Karnataka is on the rise. An increase in public awareness about the importance of organ donation has led to an increase in the number of cadaver donations.
It is also evident that the media and the Government have also realised the importance of the issue and help in creating awareness. Karnataka started deceased donor renal transplantation in 2007. In last 3 years total 74 donor organs were retrived and 133 patients received kidneys. Every year number of donations is on rise but not enough to fulfil requirement. Approximately >1500 patients are on waiting list of renal transplant, so there is a huge gap between the number of organs donated and the number of people waiting for a transplant.
Cadaver donation is still so uncommon in India that the wait for organs is often a futile one. For cadaver donation, if the deceased has not pledged to donate during his or her lifetime, the authority to give consent lies with the person lawfully in possession of the dead body. Relatives of only six people out of every 100 people who die (and whose organs can be saved) give consent.
One of the major reasons for this is that relatives are not convinced that brain death is irreversible. A person will never regain life if declared brain dead. Waiting for cardiac death would mean destroying the organs. The government stresses that steps are being taken to promote cadaver organ donation. A national registry of donors and recipients will be maintained, along with a registry of people on the waiting list.
Reason for low organ donation is medical professionals’ hesitation to declare a patient brain dead. One of the major reasons for organ shortage, is the failure to turn potential donors into actual donors. It is important to dispel myths surrounding organ removals, To convince relatives that the donation will not disfigure the body. Nor will it interfere with customary funeral arrangements.
As the act of donation not only transforms the life of the patients but also of their whole family, every one should pledge to donate organs and to create awareness .
Organ allocation - who gets the organ?
Organ allocation is an important aspect of a multi-organ deceased donation programme. No one institution can retrieve and possibly keep all organs for itself. The principles of sharing needs changes from time to time depending on the need of the programme.
The following are the guiding principles to establish a successful sharing network:
1. The principle of sharing should be based on the best matched organ goes to the most needy patient.
2. The larger the pool of waiting- list, better the matching of the organ.
3.. Organs should first be matched using blood group followed by HLA (especially for kidneys) along with age, gender .
4. Organs donated from children should generally go to paediatric age group .
Acceptable Ischemia time: Organs once removed should be transplanted within 4 hours for heart, 12 hours for liver and 24 hours for kidneys are acceptable cold ischemia time.
Waiting list: The kidney waiting lists are long and waiting period different for different blood group.
Transport logistics: Hearts are best shared within the same city. Livers and kidneys on the other hand can be shared between various states
Organ Sharing Network evolved by Mohan Foundation
General guidelines before putting patients on waiting list for cadaver organs
1. A Waiting list of recipients should be maintained on a centralized secure web-based system.
2. Before putting patients on waiting list the transplant clinician should ensure:
a. That patient is aware that merely by having the name on waiting list does not guarantee that the organs would be available.
b. The patients should be counselled about cadaver organ donation and transplant programme. They should ensure that they are contactable at any given time of the day or night and would be prepared to arrive at the transplant centre. Not complying would mean that they would lose their turn on waiting list.
c. If they are not available for a period of time they should inform the concerned hospital who should deactivate the patient. Not informing the hospital would mean them losing their turn on the waiting list.
d. The short and long term graft outcomes should be briefly discussed with the patients and their relatives.
Allocation Criteria
1. The retrieving hospitals get to keep one kidney, heart and liver if they have the recipient sharing and the one kidney goes to common pool.
2. If the organ is retrieved from a non-transplanting centres all organs come to the common pool and allocation goes as per the waiting list.
Also Read: