A Public Forum on ‘Organ Donation’ is being organised by the Department of Hepatology, PGIMER, Chandigarh on 7th April, 2012 at 2.30 PM in the Lecture Theatre – 1 to create awareness among doctors, paramedical staff including nurses and technicians, students, patients, patients’ relatives and the general public.
1. ORGAN DONATION IN INDIA
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.
Organ donation takes healthy organs and tissues from one person for transplantation into another. Experts say that the organs from one donor can save or help as many as 50 people. Organs you can donate include: kidneys, heart, liver, pancreas, intestines, lungs, skin, bone and bone marrow, cornea, etc.
Donating these organs can be life saving because life is not possible without proper functioning of these organs. Donating these organs after the brain-death to needy-ones is equal to ‘Donating a Life‘ to someone to whom you even do not know.
Problem of Organ Shortage
Organ shortages are a global problem, but Asia lags behind much of the rest of the world. The organ donation rate from dead bodies in India is estimated to be a minuscule 0.5 per lakh people, although India has among the world’s highest number of deaths from road accidents. Hong Kong’s organ donation rate is less than 50 per lakh, while it’s 250 per lakh in the United States and 350 per lakh in Spain. The situation is likely to get worse. As India’s population lives longer, organ diseases and problems like diabetes, obesity and hypertension – the main causes of kidney and liver failure – are expected to rise, creating even greater demand for organ donations.
Misconceptions and Myths that Surround Organ Donation
For years, myths and misconceptions have prevented people signing up as donors.
Myth: The organ donor’s doctors will not try as hard to save them in an emergency situation.
Fact: The number one priority of the doctor is to save your life not somebody else. Also, the doctor taking care of you will have a specialty where he has no affiliation with the transplantation team.
Myth: The doctor will take out your organs before you are actually dead.
Fact: This is not true and the doctors actually have to take more precautions to see if donors are dead. There are guidelines that are followed before taking organ and tissue donations. These guidelines do not apply if you are not an organ donor.
Myth: If you are an organ or tissue donor you will not be able to have an open casket funeral.
Fact: Organ and tissue donation does not interfere with having an open casket funeral. The organs and tissues from a deceased donor are removed during an operation in an operation theatre and then the incisions are closed. The deceased body is treated with respect and guidelines are followed.
Myth:Organ donation is against my religion.
Fact:All major faiths support organ donation as a humanitarian act. Organ donation is not against any major religion. This includes Hinduism, Catholicism, Protestantism, Islam, and most branches of Judaism. Also, all major religions view organ donation as an act of charity. Hinduism and Buddhism also foster the spirit of selfless giving. Nothing in Hinduism prohibits a person from donating his or her organs.
Myth: The family of the deceased donor will have to pay all expenses towards organ donation.
Fact: Hospital does not charge towards expenses related to organ or tissue donation.
2. WHAT IS BRAIN DEATH?
The legal definition of brain death is as follows: “An individual who has sustained either 1) irreversible cessation of circulatory and respiratory functions, or 2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made with accepted medical standards.
3. DECLARATION OF BRAIN DEATH
Presently, the Act requires 4 doctors to diagnose brain death on 2 occasions at an interval of at least 6 hours. Perhaps, we could follow the western model of requiring only 2 doctors to do so and the interval could be shortened to 2 hours. None of these physicians can have anything to do with organ donation and transplantation; they probably do not even know whether the patient is a would-be donor or how the family feels about donation. In adults, there are no published reports of recovery of neurologic function after a diagnosis of brain death using the criteria reviewed in the 1995 American Academy of Neurology practice parameter.
4. WHO CAN BE A ORGAN DONOR ?
Types of Organ Donation
Most people can be organ donors. Many people donate an organ upon their death or when they are brain dead. These people are called ‘deceased organ donors’. But a person can donate certain organs while he or she is still living. These people are called ‘living organ donors’.
Deceased Organ Donor
Most deceased organ donors are brain dead. These people have suffered complete and irreversible loss of all brain functions and thus are clinically and legally dead. Mechanical ventilation and medications keeps their heart beating and blood flowing to their organs. Deceased donor can donate any organ that is medically suitable for transplantation into a recipient.
Living Organ Donor
To be a living donor, a person must be in good health and must also be physically fit. He/she should be free from long-term diseases such as diabetes or high blood pressure, free from mental health problems and should be between the ages of 18 and 60. Living donors can donate akidney, a lobe (part) of alung, half of aliver(It will grow back to normal size in both the donor’s and in the recipient’s body over time), a section of intestine or a part of pancreas. There are Laws governing acceptability of a living donor in our country.
How Can You Be an Organ Donor?
If you are 18 years of age or older, you may become a donor by signing the donor card in the presence of two witnesses and carrying it with you at all times. If you are under 18, you may become a donor if your parent or legal guardian gives consent.
5. TRANSPLANT COORDINATOR
The needs of patients seeking transplants are diverse and complex, and best met by a multidisciplinary team. Collaboration is essential for a thorough evaluation and comprehensive care of the patient. The transplant coordinator is responsible for ensuring that all elements of evaluation and postoperative process are in place. Transplant coordinators take a central role and act as liaison among other team members. The goal is that the evaluation process is thorough, and the postoperative period uncomplicated.
6. LEGISLATION AND REGULATION
The Transplantation of Human Organs & Tissues Act, 1994 (amended upto 2011) regulates the removal, storage, and transplantation of human organs and tissues for therapeutic purpose. The said Act prohibits and prevents commercial dealings in human organs.
7. DRIVING LICENSE: OPTION FOR ORGAN DONATION
World Health Organization (WHO) in its first ever Global Status Report on Road Safety in 2010 revealed that India registered over 1,30,000 roadside deaths annually; the country has overtaken China and now has the worst road traffic accident rate worldwide. In India alone, the death toll rose to 14 per hour in 2009 as opposed to 13 the previous year, according to the latest report of National Crime Records Bureau or NCRB. While trucks and two-wheelers were responsible for over 40 per cent of deaths, peak traffic during the afternoon and evening rush hours is the most dangerous time to be on the roads.
Any citizen of India should be allowed to opt driving license as a mean to express their desire to be an ‘Organ Donor’. They should only be allowed to get new driving licence unless they answer a question about whether they want to donate their organs after death (Yes/No). This may not only improve awareness about organ donation but also ‘Organ Donation’ per se.
8. ORGAN TRANSPLANTATION – A SUCCESS STORY
The first successful human renal allograft transplant was performed by Dr Murray in 1954 between identical twins. This led to development of a completely new field of organ transplant surgery in medical sciences. Not only this development has saved thousands of lives, it has also improved our understanding of immune mechanisms & infections, concept of death, organ preservation etc.
The kidney was the first and remains the commonest organ to be transplanted but with the passage of time, there has been an ever increasing list of organs which have been used successfully for transplantation. This list now includes liver, heart, lungs, pancreas, small intestine, bone marrow, face, limb, joints, ovaries etc. The main reason for this evergrowing list is the success of the transplantation. With the advent of modern immunosuppressive drugs, the one year survival rates of most solid organ transplants exceed 90% and there are patients who have survived more than 30 years after heart transplant and kidney transplant. Majority of these patients are in the prime of their life. Along with the survival benefit, transplant also provides them freedom from the restrictions imposed by their medical illness and allows them to lead a normal productive life. These excellent survival rates and improved quality of life after transplantation has led to an explosive demand for organs which has not been matched by supply of organs. In US alone, there is a huge waiting list of 1 lakh patients awaiting transplants and the poor availability of organs remains the Achilles heel of transplantation. Unfortunately, the organs have to be obtained from humans and most of them can only be obtained after brain death before the cessation of circulation so that organs are in a healthy & usable condition. In future, organs might be grown in the lab or it might be possible to use organs from some animals but till that time, transplantation remains dependent of the altruistic act of organ donation.
In short, organ transplantation has made rapid strides in the last 60 years and changed its status from an experimental procedure to a well established treatment modality.