Transcript Document

Dr. Rajesh Bharani
What is Organ donation?
Organ donation is the
process of removing
tissues or organs from a
live, or recently dead,
person to be used in
another.
The former is the donor
and the latter is the
recipient.
People of all ages can
become donors.
NEED OF THE HOUR
In India
10 Lakhs
need Organ Donation
Organ Donation
Type of donors
Some organs can be
donated by a living person
Almost all organs can be
donated by someone dead
but this has to reach the
recipient within a few hours
after the donor's death.
In case of live donation the
donor should give his
consent.
In case of cadaver donation,
relatives need to provide
consent.
Voluntary Donation
Organ Donation
Everywhere organ donation is
voluntary
Two voluntary systems include –
1.Opt In - Where the donor
gives consent
2.Opt Out - Where anyone who
has not refused is considered
as a donor
In India we have the Opt in
system, while many western
countries practice the opt out
system
Organs for Donation
Skin and Bones
Some of the organs that are commonly donated …,
Annual Number of kidney transplantations
per million population (pmp) per year USA -
52
Predominantly Cadaver Donors
Europe -27
Predominantly Cadaver Donors
Asia -
Predominantly Living Donors
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In last 10 to 15 years the rate of both kidney and liver transplants have
increased but heart has remained static. In 2000 approx. 15,000 kidneys
were transplanted in each region.
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Live
Majority
No waiting
Less time on dialysis
Needs from Family
members only
◦ Blood group
constraints
◦ In diabetics and
Family diseases
difficult.
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Cadaver
◦ Occasional
◦ In families with familial
disease and blood group
incompatibility this is the
solution
◦ Small families
◦ Will help many patients
who will otherwise live on
dialysis
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Living or Deceased Donor Kidney
Transplantation: A Comparison of Results and
Survival Rates Among Iranian Patients
◦ Living donor kidney transplantations showed
comparable graft survival and acute rejection rates
compared with those from deceased donors
Transplantation proceedings 2009: 41:2772-4
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10% of willing and affording renal failure
patients gets Transplant
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Non availability of donor.
1967 - First successful cadaver Kidney
Transplant in India at KEM Hospital, Bombay
1994 - First successful heart transplant done
at AIIMS, N.Delhi
1995 - First successful multi-organ
transplant done at Apollo Hospital, Chennai
1998 – First Successful Lung transplant,
Madras Medical Mission Hospital, Chennai
1999 – First Pancreas Transplant, Ahemdabad
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Types-
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Somatic death
◦ Home – Eyes, Skin
◦ Hospital- Eyes, Skin, Bone
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Brain death – Kidney, Liver, Heart, Lung,
Intestine, Pancreas
• BLOOD
• KIDNEY
• LIVER (1/4)
Body Donation V/S Organ Donation
Each Body Donation –
10-15 medical students benefited
Each cadaver organ Donor –
50 persons benefited
Community Problem
No Awareness of “BrainDeath” Concept, Misconcepts
Hospital problem
No efforts to identify &
maintain “Brain Dead” donors
Govt. Problem
No Funding for programme
No Interest
Spain has the highest number of brain death patients going
on to organ donation – 32 per million population
Dealing
with
community problems
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Mass education by all possible medium.
Media & Organ Donation
◦ The power of the press can also be demonstrated in the so-called
"Nicholas Green effect.“
◦ Nicholas was a 7-year-old American child, shot dead by bandits in
Italy in 1994
◦ His parents agreed to donate his organs
◦ Italian press reported it extensively
◦ The positives impact kick started the Italian cadaver programme
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Many donor relatives have stated that
donating their loved one's organs does not
make the pain of their death disappear
Bereaved families can experience comfort
that their loved one's gift gave another
person a second chance at life
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When the wishes of the deceased are not
known, only 50% of people will agree to
organ retrieval from their relatives
No disfigurement of body
Rituals possible
Encouraging people to speak about organ
donation and transplantation and to make
their wishes known to their relatives could
change the picture resulting in 93-94% of
people allowing donation
Initiation by Eye and Skin Donation
Hospital
and Doctors
related Problem
There is underreporting of brain death cases.
Neurologists and Neurosurgeons have to take lead
In Tamilnadu- Declaration of braindeath has been made
mandatory in medical colleges. G.O. No. 75 dated
03.03.2008.
Hospital Infra-Structural & Support Logistics
Adequate No. of Qualified
Intensivists in ICUs
Qualified
Trained transplant
Co-coordinators
Well qualified Surgeons to
undertake Retrieval & TX
Transport of organs –
between cities
Support Organisation
to Network
HLA Tissue typing and Cross-match
 The
Way Ahead
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Education of Doctors, Health care workers
regarding THOA
Education of Society regarding organ
donation and concept of Brain Death.
Media support
Government support
Strengthen the Transplant Network.
Transport facilities for organ donor
Establish a common programme.
Initiatives to promote concept and making some
changes as done by Tamilnadu government
◦ Start sharing organs that are not used locally
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Employing and training more transplant
councilors-coordinators.
Regular Courses to impart expertise to the
councilors-coordinators
Training and sensitizing ICU staff on braindeath.
Proactive steps to promote Programme.
Help in educating public by all means.
Think beyond business
MOHAN Foundation (INOS) - Tamil Nadu, Andhra Pradesh,
Maharastra
236 Organs shared. ( 212-Kidneys, 9-Hearts, 15-Liver )
FORTE, BANGALORE – 32 Organs Shared
( 32 - Kidneys, 1- Heart, 1- Liver )
ZTCC, Mumbai – 55 Organs Shared - all kidneys
ORBO, N.Delhi – Few organs shared
SORT, Cochin – 4 organs shared
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Pre-mortem – via Donor Cards, Driving
License
Consent of his family following death
Some form of a combination of the two are
necessary
‘Supererogatory permission’ - Underlying
premise of such a consent would be that
“organs of dead people are public goods”,
and donation must be considered “similar to
other compulsory civil obligations” within
society
◦ The permission is a moral rather than a legal
requirement
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For cadaveric donation “society remains a crucial aspect in a
transplant programme”
Strategies to decrease refusal rates by
families include efforts at education ◦
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the general population,
Religious heads & opinion leaders
health care workers individually
through the mass media
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At the time of issuing driving license, filling
form for other government schemes like
Adhar Card.
Government help and determination needed
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Study shows that blood donors have better
knowledge of organ donation and are more
willing to donate their organs and sign an
Donor card than general public.
It would be useful to design promotion
programs to facilitate blood donor and
families of Skin and Eye donors
participation in organ donation.
Social Appreciation for donors and their
families
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Most families faced with brain stem death of a
relative find the concept difficult to
understand and have trouble in accepting that
their relative is actually dead
Family members were given choice to be or
not to be present during brain stem death
testing
It is suggested that presence of family
members during brain stem death testing not
only helps families to accept this concept of
death but also promotes the grieving process
The presence of family during brain stem death testing.
Intensive Crit Care Nurs. 2004 Feb;20(1):32-7
Doran M.
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Requires that formal request for organ donation be
made of the families of all potential donors in the
ICU.
◦ The rationale is that a statutory approach would
overcome hesitancy by healthcare professionals
at a time of such emotional distress.
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Required Request Law has been introduced into
many states in India by legislation to improve
organ donation.
Current organ donation rate - India is 0.05 per million
population per year
If in India - 1 per million donation rate we would have 1100 organ donors
– 2200 kidneys,1000 hearts, 1100 Livers, 2200 Eyes
At 3 per million Donation rate we would have 3300 organ donors – 6600
kidneys,3300 hearts, 33001 Livers, 6600 Eyes
At 10 per million donation rate- 11,000 organ donors
22,000 kidneys, 11,000 hearts, 11,000 Livers, 22,000 Eyes
20 per million donation rate - 22,000 organ donors
44,000 kidneys, 22,000 hearts, 22,000 Livers, 22,400 Eyes
Source: Indian Transplant Newsletter Issue no.19 Feb 2006
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This can be performed only at centers
approved for Transplant surgery.
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Retrieval time -2 to4 hours
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Problem◦ Need to shift brain death person from one hospital
to other.
◦ Loss of organs from small center and peripheral
centers.
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Tamilnadu government introduced a law by
which they approved all hospitals in state
with bed more than 25 an OT and ICU as
NON TRANSPLANT ORGAN RETRIVEAL
CENTRES ( NTORCs)
NTORC works in collaboration of Transplant
center for all procedures from declaration
of brain death to removal of organs.
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Standardize retrieval
techniques
CD be made on kidney
Retrieval to be circulated
to all the hospital.
Packing of organs being
standardised for
transportation
Education and training of
coordinators and
What is Required
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NGO or Groups involved in Organ donation
in any part of the M.P. have to tackle
various issues in the field of cadaver organ
donation and transplantation
simultaneously
More Support groups with common
objectives are needed
More resources necessary to Kick start such
an Initiative like cross match lab
Need of time
Formation of state level coordination committee to streamline project
SOP for declaration to transplantation
Common waiting list of patients
Common lab for Cross match of tissue
Proper format for unbiased distribution of organ.
Committee should decide for best possible recipient for said organ
All center should work under committee
Cadaver Transplant - Conclusion
Organ Shortage is a Crisis, however the Crisis
has a Cure
 In india we need to Network and start thinking
of sharing resources, expertise and organs
 Set up Collaborative projects
 Use Media for Promotion
 Get Religious heads to Participate
 Have Transparency in programme
 Set up regional Transplant co-ordinators
Forums
Social appreciation of donor family.
THANK YOU
In my end is my beginning
- T.S.Eliot, Four Quartets