A successful
transplantation (moving of an organ from one body to another) is the most durable option for a
patient suffering from end stage organ failure.
With first successful kidney transplantation in 1953 the medical world has
moved into a new orbit which is now contemplating limb and face
transplantation. Organ transplantation has
evolved through years with people undergoing transplantation leading a near
normal life with safe and affordable medications. Kidney, liver, pancreas, heart, intestine and
eye (cornea) are the routine organs that are transplanted. Though not a solid
organ, bone marrow (stem cell) transplantation is another domain in the world
of transplantation, mainly done for various hematologic conditions.
Availability
of donors/organs, affordability of medications, general health and proactive
nature of patients are important aspects of successful transplantation. Even in
the developed world despite having advanced health care delivery systems, there
is significant demand-supply deficit in transplantation. In developing
countries like India the proportion of needy patients undergoing
transplantation is deplorably low. If one looks at kidney failure, the cost and
effort involved in doing dialysis which is the alternative treatment for renal
failure is so high that we can do a renal transplantation with the expense
involved for two years of dialysis. Promoting organ transplantation
is the need of the hour for end stage organ failures in developing countries. In
brief, transplantation gives best outcome in the most cost-effective way.
Who can donate
organs ?
There are
two types of donors, living and brain-dead. Living donors are normal healthy
volunteers who can donate God- given organs that could be spared. Only kidney,
liver and bone marrow could be donated by a living donor. Living donation has been taking place around the globe for last
60 years. All available studies show that with present evaluation methods for donation
is safe and causes no morbidity or mortality due to donation. Advantage of
living donation is that we can avoid wait time and do a planned surgery without
uncertainties of an emergency surgery.
Brain-dead donors are patients who had the misfortune
of suffering from non treatable, irreversible brain damage due to accident or
disease. Brain dead patients would not have any meaningful function of the
brain and would not be able to breathe by self, but they would have a
functioning heart which would be pumping blood to all organs. Their
"life" would be supported on ventilator. A brain dead patient's heart
would stop eventually within 2-3 days of becoming brain-dead and the patient
would be pronounced clinically dead. It is this window of 2-3 days that gives
an opportunity for the bereaved family to donate vital organs from a
humanitarian standpoint. Once brain dead, there are only two reasons to
maintain life on life support system like ventilator, first being to consider
organ donation and secondly for buying time for the bereaved family to arrange
for last rites of the patient. All transplantable organs can be procured for transplantation
from a brain dead donor.
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FACTS
ABOUT BRAIN DEATH
Brain death is a clinical diagnosis and no advanced investigations actually needed.
Panel of minimum 4 doctors
independently certify brain death. None of the doctors would be from the
transplant team.
Brain death is accepted as
legal form of death by Government of India since 1994.(TRANSPLANTATION OF HUMAN ORGANS ACT (THO) 8th July 1994)
Head injury due to different
reasons commonly account for brain death. In India road traffic accident is
the most common cause for brain death.
Brain-dead patient would be
invariably in ICU and on
ventilator for oxygenation
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DEFINITION OF BRAIN DEATH
Irreversible and complete loss of
- Consciousness
- Capacity to breathe
- Integrated neurological function
BRAIN DEATH IS NOT COMA
A person can recover from a coma,
but brain death is death.
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Brain- dead organ
donation - the current status in India
Death
following brain-death accounts for less than 5% of total deaths in a
population. In India due to its phenomenal population, even this small fraction
can provide as tremendous resource of organs for the needy patients. The organ
donation rate in western world from brain- dead donor’s amounts to 30 donors
per million population per year, where as in India it is only less than 0.5
donors per million population per year. It is believed that if we increase our
organ donation rate to 5 donors per million population per year, we might be
able to meet many organ requirements of even our neighboring countries.
There are
many reasons cited for poor brain-dead organ donation in India. Lack of public
awareness, lack of government initiative, lack of infrastructure, religious
restrictions and lack of trust in proper utilization of the donated organs are
the most commonly cited reasons for poor brain dead organ donation in our
country.
Common
Misconceptions About Organ donation
Without ignoring the medical implications one
can say that organ donation is purely a social act to save fellow human being.
Only when the society understands and pushes for it, the medical fraternity is
going to wake up and do it. Blood donations have become routine standard of
care and eye donation is becoming more acceptable across all strata of society.
There is no reason the civilized and
caring society of our country should not accept the concept of donation of organs
like kidney, liver and heart of whose failure thousands are dying daily in
India. It is important that the society has clarity on this important social
issue.
Following
are the common doubts that an individual would
have when the topic of brain-dead organ donation is made aware to
him/her.
Q. Is brain death reversible or is there in any chance of recovery once
patient is brain dead ?
A. Brain death is totally
irreversible . Once brain death happens, within 3 days usually heart would also
stop functioning and final death ensues.
Q. What is the benefit I
get if my kin donates an organ?
A. Donating an organ is nothing short
of donating a life. In many organ
failures patient is going to die if not transplanted soon enough. There is no
doubt that the biggest help you can do to any fellow being is to save his life.
By helping an individual you would be changing the lives of a family and
generations to come. There is no monetary benefit at any level to any person
involved in brain death organ donation.
Q. Does anyone get any
monetary benefit?
A. There is no monetary benefit at
any level to any person involved in brain death organ donation. This is an act
of the society for the society.
Q. Will I have to spend
any money if I agree for my kin's organ donation?
A. The relatives of donating
patient's family would not have to pay anything with regard to organ donation.
Any expenses after the family consents for organ donation would be borne by
hospitals, recipient families and government.
Q. Does organ donation surgery
/ procedure cause any disfigurement to patient's body?
A. Not at all. All organs are
procured by standard surgical techniques worldwide. Eye donation also does not
produce any disfigurement.
Q. Who is supervising the
organ donation program ?
Brain death as a death criteria was
accepted by Indian Parliament in 1994. All states have transplant authorities
responsible for transplant activities. In Kerala there is a dedicated body to
supervise the Brain- dead organ donation program call Mrithasanjeevani. Any
organ donation in Kerala takes place under their permission and supervision
only. It is chaired by Government
officials , doctors and responsible individuals from different sections of the
society.
Q. Who decides that which
patient is going to get the donated organ ? Can the donor family get involved
in the recipient selection process ?
A. The patients who have organ
failure and want a transplant are listed in a wait list according to their
seniority based on the duration of illness. The wait list and organ allocation
is supervised by the supervising state authority. The family of donor can
definitely recommend a relative or acquaintance with organ failure as potential
recipient, but his or her candidacy can be accepted based on medical fitness of
the patient.
Q. Who decides on which
all organs could be donated ?
A. It is the prerogative of the donor
family to decide on which all organ to be donated. Family can consent for a one
organ or multiple organs.
Q .Would organ donation affect
our funeral plans?
A. Organ donation surgery can take an
additional 4 to 6 hours for arrangements and procedure. The timing of organ
procuring procedure could be done to facilitate any special requests of the
patient's family. But if post-Morten examination is needed it would take its
normal course.
Q. Can the privacy of
donor's identity be protected ? Can the donor family know who is getting the organ ?
A. Donor's and recipient's identity
would be protected. Without consent neither identity would be revealed by
authorities concerned.
Q.
Is my religion against organ donation ?
A.
Virtually no major religion is against organ donation. Two fundamental
principles on which all religious thoughts converge are - monitory benefit
should not be the motive or end result of organ donation program and the
deserving patients should get the benefit of the whole exercise.
RELIGIONS
AND ORGAN DONATION
HINDUISM: believe in transmigration of the soul and
reincarnation, whereby the deeds of an individual in this life will
eventually determine its fate in the next. An important tenet of Hinduism is to help those who are suffering, and Daan, or selfless giving, ranks third among its Niyamas (virtuous acts). Physical integrity of the
dead body is not seen as crucial to reincarnation of the soul.
ISLAM : altruism is also an important principle of
Islam, and saving a life is placed very highly in the Qur'an—'Whosoever saves
the life of one person it would be as if he saved the life of all mankind'
(Holy Quran ; chapter 5:32). In Kingdom of Saudi Arabia - 25% of the
transplantation is from brain-dead donors.
CHRISTIANITY: Most Anglican, Catholic and Protestant scholars
seem to agree that organ donation is an act of selflessness and endorse
transplantation. Popes Benedict XVI
and John Paul II has publiclyendorsed organ donation.
JUDAISM: Saving a life is a fundamental value in Judaism (pikuach nefesh). In fact,
Jewish law demands that one should violate almost all other commandments to
save a life (except for the prohibitions of murder, idolatry and illicit
sexual relations).
SIKHISM: Sikhs believe in life after death, and a
continuous cycle of rebirth. In Sikhism, the physical body
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The task ahead for
our society
With present day medications and facilities the
option of transplantation is the best way forward to have a normal life for a
patient with end stage organ failure. Dearth of matching donor is one of the
major impediments in facilitating transplant option beyond a point in our
society. Brain dead donor organ is a grossly underutilized option in our
country, but what the developed world has been successfully doing for the last
four decades. Our society needs to motivate ourselves and facilitate brain-
dead organ donation. Government has made declaring brain-dead status mandatory
in hospitals. This would help to identify and initiate discussion about
potential organ donation when a patient becomes brain dead. Our families,
friends, colleagues and all platforms should be utilized for awareness.
Everybody should use government authority and other expert organizations
associated with transplantation to
clarify their queries and concerns regarding organ donation. One should be
aware of misinformation propaganda floating in the society due to ignorance
about this complicated and multidisciplinary program. Ultimate happiness and
sense of achievement is attained when we see patients leading a successful
normal life after transplantation which otherwise would have been impossible
without organ donation.
"What loss do I suffer to give an unwanted organ after my death to
give another person life?"
(Dr Desmond Biddulph, Chairman of The Buddhist Society)
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