THE PRESENT SCENARIO:
Approx 2,00000 Corneal Donations are needed annually. However only 50000 corneas are donated in India every year. 3 out of 4 people awaiting Corneal Donation remain visually impaired.
Approx 500000 people need an organ transplantation every year. By the end of each year many of them die due to lack of organs available for transplant. There is a gap of more than 75% between the organs available and the organs required.
India’s Organ Donation rate is perhaps one of the Lowest in the World . Not even 1% all those who died in India donated their Organs .
Organ Donation is the entire process of retrieving a human organ from a living or deceased person (Donor), and transplanting it into the recipient. Recipient in all circumstances would be a patient suffering from organ failure and will not survive unless he/she receives an organ replacement.
Deceased organ donors can donate: kidneys (2), liver, lungs (2), heart, pancreas, and intestines. In 2014, hands and faces were added to the organ transplant list. Living organ donors can donate: one kidney, a lung, or a portion of the liver, pancreas, or intestine. Cornea, bones, skin and veins can also be donated.
This is indeed miraculous and this progress of medical science is unparalleled. However, due to the prevalence of myths around the subject , organ donation is not a common practice. Pledging is however just the start of this journey, there is still lot of awareness required on how to actually donate the organs.
The Living Donation Process:
The Deceased Donation Process:
Law Governing Organ Donation In India:
The legislation called the Transplantation of Human Organs and Tissues Act was passed in India in 1994 to streamline organ donation and transplantation activities. Broadly, the act accepted brain death as a form of death and made the sale of organs a punishable offence.
Transplantation of Human Organs & Tissues Act is aimed at regulation of removal, storage and transplantation of human organs for therauptic purposes and for the prevention of commercial dealings in human organs.
Brain Death and Organ Donation:
A brain stem death results from a severe irreversible injury to the brain or hemorrhage which causes all the brain activity to stop completely. This leads to the person not being able to sustain his/her own life. With the help of medical science, the vital organs may be maintained by an artificial support system. The circulation to vital organs is maintained long enough to facilitate organ donation.
What happens once the Brain Stem Death is declared?
In India organ donations require prior consent from the donor’s family. The decision to donate the organs and tissues is in the hands of the next to kin. The family is then made aware of the option of donating organs and is given counseling for the same. The family has the right to refuse such transplant. But counseling if done effectively has on many occasions proved to be very effective in getting them to donate the organs of the loved one who is no longer alive. This process has to be performed in the interval between the diagnosis of brain stem death and cardiac death.
Inspite of the donor having pledged his/her organs, and also having a donor card, the entire process of taking the families consent has to be followed. The above may however facilitate the process of convincing the donor kin.
On consent from the donor kin, the vital organs are removed for transplantation. This process requires coordination between different teams operating almost simultaneously and sometimes may be in different locations. This may require getting surgeons from different specialties together for both donor and recipient surgeries.
In case of Medico-Legal Cases:
In medico legal cases, police NOC is prerequisite to proceed with organ donation. The same must be intimated to the designated forensic expert responsible for conducting the post mortem. The forensic expert can be present during the retrieval of the organs and conduct the post mortem simultaneously or the retrieving doctor may make notes of the retrieved organs which will form part of the post mortem report, and the body is sent to the forensic expert for completion of post mortem formalities.
How long can an organ survive inside and outside the body :
A deceased organ donor is kept on a ventilator after she / he has been declared brain dead. They will have to kept on the ventilator until the necessary approvals are taken and the organs can be retrieved. A brain dead persons organs may stay alive for a period of time that may range from a few days to a few weeks depending on numerous factors. The longer it takes to retrieve the organs, the more deterioration takes place inside the body. Therefore , the entire process of counseling the family, taking permissions etc should be quickly taken care of. Not only this , the retrieved organs cannot be kept without being transplanted for long. In such cases usually the family of the donor does not receive anything , and the recipient is thus not charged for the organs. The recipient will however have to pay for the transplantation to the hospital where they are being operated. Usually after consent for donation , the cost for the donor is borne by the hospital.
How is brain death established?
A series of tests establish and document the absence of brain stem function.
Brain death is defined as the irreversible loss of all functions of the brain, including the brainstem. The three essential findings in brain death are coma, absence of brainstem reflexes, and apnoea. An evaluation for brain death should be considered in patients who have suffered a massive, irreversible brain injury of identifiable cause. A patient determined to be brain dead is legally and clinically dead.
The diagnosis of brain death is primarily clinical. No other tests are required if the full clinical examination, including each of two assessments of brain stem reflexes and a single apnoea test, are conclusively performed.
In some patients, skull or cervical injuries, cardiovascular instability, or other factors may make it impossible to complete parts of the assessment safely. In such circumstances, a confirmatory test verifying brain death is necessary. These tests may also be used to reassure family members and medical staff.
Any of the suggested tests may produce similar results in patients with catastrophic brain damage who do not fulfill the clinical criteria of brain death. The confirmatory tests shall.
A lot of the above skewed statistics can be made right with very small actions we take. Awareness is already being created at various levels starting from schools, colleges, various organizations and the like for organ pledging for donation. This is a wonderful way of creating more pledges. But have we ever wondered, why more pledges and less actual donations? Why the thinking and doing do not match? Because the one who pledges and the one who donates is not the same person. The donor pledges , but the family donates. The family members of the donor have various reasons for not doing so. Some of them are enlisted below:
Thus, pledging only will not help. It only makes the promise. The promise needs to be fulfilled. A thorough counseling of the family members by the donor is absolutely essential. A clear mandate of how the things should be done, whom to contact and in how much time, should be given to the family members. Some gap can be bridged if this is followed. There can be no counselor better than the donor himself for his near and dear ones. This should be done very near to the pledging.
Last but not the least, do make this wish a part of your Will. Live On…even after you are Gone!!
(Compiled from various sources. OrganIndia has been a very inspiring read in this entire endeavour.)
CA Namita Lakhotia