There are two eternal paths for any living being after he leaves this body: the bright and the dark. God vouches to every ‘Jiva’ a golden opportunity to attain the supreme abode from which there is no return. On the other hand, the path which leads to Brahma is comparatively dark from where he returns to the mortal world i.e. he becomes a subject to birth and death once more.
There are few acts in life that are nobler than donating our organs. Donating our organs after we gone is the closest that we can come to giving life to another individual. Organ donation is a wonderful legacy we can leave behind. The eyes continue to see the wonders of the world and the heart continues to sing a new song. The organs that a single person donates can give a new lease life to many persons. Eye donation can give precious sight to two individuals. Besides these various other parts can help repair other organs. (It is possible for a single donor to donate organs and tissues that may help as many as 60 recipients).
What is “Gift of Life”?
When we lose the functioning of an organ like kidney or a tissue like bone and skin it is possible put another person’s organ or tissue and with modern surgical techniques and drugs; it can be made to work. This is gifting an organ after one ceases to need it any more. This known as transplantation and it is the “Gift of Life”.
How successful is this treatment by transplantation?
80 – 90% of patients who receive a kidney live for 5 years. Longest survivor is 34 years. Receiving this new lease of life means that the recipient will be free from continuous hospital visits to receive dialysis.
How long one can live waiting for a transplant?
In case of kidney failure, patient can be maintained on regular dialysis. During a dialysis treatment, the patient’s blood is filtered artificially. This treatment is time consuming and is repeated 2-3 times every week for life. In case of other organ failures like heart, lungs and liver; patients can be kept alive only a short time on drugs, unlike kidney failure patients; since there is no ‘dialysis like’ treatment for other organs.
Which are the organs and tissues can be used?
It is possible to transplant twenty-five different organs and tissues including cornea, heart valves, liver, kidneys, bone and cartilage, bone marrow, skin, pancreas, lung intestine and more.
Aren’t these organs and tissues required to be used immediately?
No. These vital organs need to be retrieved from a dead person immediately and can be preserved up to various lengths of time by preservation techniques. Heart and Lung can be preserved by 4-6 hours and kidneys 48 – 72 hours. Skin and bone may be preserved for 5 years or more.
Who requires these organs and tissues?
Each of us has a number of vital organs like brain, heart, kidneys, lungs, liver etc. Failure of any organ means certain death. Except for the brain all other organs can be replaced – which might be life saving. Besides organs – many tissues like cornea, heart valve, skin and bone may be used for repair and reconstruction.
Who can become a donor?
Any person in good health if dies suddenly, possibly through an accident or even other causes like brain hemorrhag and who has been declared ‘brain dead’ can be an organ donor. This is called the “cadaver donation” in contrast to “live donation” which is possible only in kidney and bone marrow.
What is brain death?
Normally the death is said to occur when heart stops. But with modern technology the heart and lungs canbe made to function through mechanical support even when brain function has completely and permanently ceased. Thus once brain death occurs; the person becomes a cadaver with a beating heart.
How does one diagnose ‘brain death’?
In 1959, Neurosurgeons in Lyons (France) found that deeply comatosed patients, who had sustained head injury, never regained consciousness. Although their heart continued to beat and kept their circulation going, these patients were clinically dead. If their breathing support machines were stopped, the heart also stopped. Thus a new definition of death emerged. As this death was under controlled circumstances (that is, in the intensive care unit of hospitals) it was possible to retrieve some of their organs such as kidneys, heart and liver after their relatives are consented. In the west, the transplantation of organs from brain dead patients is an accepted part of medical treatment for quite some time. The government of India has now accepted this new definition of death and has formulated the Human organs transplantation act 1994 and hence it is legal to diagnose and declare brain stem death.
How does brain death occur?
Brain death usually results from a severe head injury or bleeding in the brain that causes all brain activity to stop. This can happen after a major road accident or brain hemorrhage due to a stroke. This also can happen in brain tumour.
How do doctors know a ‘brain dead’ patient is really dead?
Four doctors from a panel recommended by government, carry out a series of tests to confirm that a patient is “brain stem dead”. The standards are very strict and are accepted medically and ethically all over the world. The four doctors are of following category;
- Neuro Surgeon / Neuro Physician
- Treating doctor
- An other specialist as approved by State Appropriate Authority
- Medical Superintendent of the hospital.
Will the doctors do everything to save life if they know that a person is an organ donor and they can transplant these organs to others?
Doctors who treat patients in life and death situations have nothing to do with possible donation of their organs and tissues. Every effort is made to save that person’s life. Organ donation is not even considered till that person has died.
What is the difference between Brain Death and Cardiac Death?
Brain death occurs when person’s brain has permanently stopped. Cardiac death is said to occur when heart stops beating. Both are legal declarations of death. Brain death does not occur as often as cardiac death.
Are Coma and Brain death same thing?
No. Coma is decrease in brain function and thee is a chance that person may regain consciousness. Brain death is irreversible loss of brain function. There is no chance of recovery after brain death.
If someone is brain dead why does his heart keep beating?
As long as heart has oxygen, it continues to work. A mechanical ventilator provides enough oxygen to the heart to keep it working. Without this mechanical support it will stop beating. By giving brain dead patients oxygen making their heart beat with medication controlling their Blood Pressure, their organs continue to work. That is why brain dead patients can be organ donors. This donation of organs may not be possible if one dies out side the ICU. Without Intensive Care all brain death is followed by cardiac arrest within minutes. Only eyes, skin and other tissues can be donated after the cardiac death.
Will donation cause pain and inconvenience to one’s family?
Organ donation is often an immediate and lasting consolation. It is often comforting to the family that even though their loved one has died, one or more persons can live on through their gift of life.
In case organs are donated, can one still have normal funeral?
After someone dies, organs are surgically removed as if the person were still alive. Careful attention to incisions and scars is made so that he can still receive a traditional burial or cremation.
Is donating organs is against religious beliefs?
All major religious including Hinduism, Protestant, and Roman Catholic, Islam, Buddhism and others fully support organ and tissue donation.
Is there an age to donate organs?
Anyone is eligible to be an organ donor depending on doctor’s decision. Tissues and organs transplanted after death include corneas, heart, liver, kidneys, bone and cartilage, bone marrow, skin, pancreas, lungs and others. One can only donate kidneys and bone marrow as a live donor. As per the norms and guidelines of Government of Maharashtra organ donation can be done between 2 yrs to 65 yrs.
Can one donate while alive?
Yes – only for kidneys and bone marrow. God has given us two kidneys which are good enough for four people. But only the near and dear ones are allowed to donate and by law parents, siblings, son, daughter and spouse are treated as ‘near relatives’.
Can only ‘near relatives’ donate while alive?
Yes. That is the law. This law is to avoid exploitation of poor people who want to donate their kidneys for monetary benefits. However other relatives and friends can donate as an ‘altruistic’ measure.
The state authorization committee headed by DMER has to be satisfied that is it truly an altruistic donation and no commercial interests are involved.
Is it safe to donate while alive?
Yes. The potential donor is made to undergo rigorous evaluation before the person is accepted as donor. Doctors cannot guarantee the success in recipient but it is made sure that the donor comes to no harm. However complications are known to occur in 1in 1000 surgeries.
But does the donor have a healthy life afterwards?
As already mentioned one kidney is good enough to sustain two people. In World War II it was seen that a number of people who lost a kidney due to injury were observed for years without any long term problems. Now the live transplantation is being practiced all over the world since 1954 and donors have been observed for about 50 years without any ill effects.
Can anyone become a donor? What is the minimum requirement to become a donor?
The blood group should be non-interfering. If the recipient is blood group ‘O’ – only ‘O’ can be a donor; if the blood group is AB - any blood group O, A, B & AB can be a donor. This is for live kidney donation. Rh group (positive or negative is not considered at all.
In cadaver organ donation the blood group match is strictly adhered. This is an ethical issue and ‘O’ group being an universal donor will always donate to all the recipients of any blood group and the ‘O’ group recipient will waiting for ever.
Is there any other matching between donor and recipient besides the blood grouping?
Blood Grouping is the most important for solid organ transplantation like kidney, heart or liver. The tissue matching and cross matching have finer implications in the long term graft survival.
What are the steps of donation after death?
Once patient is admitted; all efforts are made to stabilize the patients. If all efforts fail, patient is pronounced brain-dead after evaluation, testing and documentation. Consent from the family is obtained to proceed with donation and organ procurement organization (OPO) is informed. Consent from coroner/legal authorities is obtained. In the mean time the organ donor is maintained on ventilator, stabilized with fluids, medications and undergoes numerous laboratory tests. Recipients are also identified for placement of organs.
Surgical team are mobilized and coordinated to arrive at hospital removal of organs and tissues. Donor is brought to the operating room. Multiple organ recovery is performed with organs being preserved through special solutions and cold packing. Ventilator support is discontinued. Donor’s body is surgically closed and released.
What is organ procurement organization?
An organization is formed to improve organ donations, procurement and transplantation system in the city, state and the country. Thus in Sep. 1998; ZTCC (Zonal Transplant Co-ordination Center) was formed in city of Mumbai. Subsequently the same model will be adopted all over Maharashtra.
What does ZTCC do?
- It helps in effective cadaver organ procurement.
- Increase patient access to state of art transplant technology.
- To improve system of sharing renal and extra renal organs. This is done by;
a) Donor and recipient matching by specific criteria established for each organ.
b) Improve transplant outcome.
c) Provide a system by which immonologically sensitized patients offered best possible opportunities.
d) Decrease the wastage of organs.
- Assure quality control by collection analysis and publication of data on organ donation and transplants.
- Maintain and improve professional skills of those involved in organ procurement and transplantation.
- To have immunosuppressive drug bank.
- To increase public awareness.
What constitutes ZTCC?
ZTCC as organization was composed of every recognized transplant institution of Mumbai. This includes 16 recognized hospitals including 3 municipal medical colleges, 1 government medical college, 1 central government Hospital (INHS Asvini) and 11 private corporate hospitals.
How does one become a donor?
Once you have decided to become a donor, the most important step is telling your family. Even if you sign the ‘donor card’ – your family still has to consent before organs are gifted.
Is it normal to get nervous when you become a donor? What are the chances of actually donating?
An average male will live for 75 years and female 80 years. The chances of becoming an organ donor in real are quite small. Mumbai with a population of 1.2 crores; about 600 deaths are due to vehicular deaths i.e. 1 in 20,000. If whole of the city become willing donors – then may be there will be 300 – 400 suitable donors.
Why do we keep hearing about ‘kidney trade every few months? Is it because the doctors are greedy?
In India most of the transplants are from live donors since cadaver donation is still in infancy due to lack of public awareness. Hence there are a large number of patients who have no suitable donor and hence look for commercial donors.
All of such transplants are discouraged. But patients in a situation of life and death do manage to convince the doctors and the authorization committee. Occasionally doctors do turn a blind eye in order to save life.
Thus only long term solution to this problem of ‘kidney racket’ is to have a viable cadaver transplant program in the while country.
Why are so few cadaver transplants in the country?
No cadaver transplant programme can be successful unless there is time bound co-ordination amongst intra hospital, inter hospital and the society at large. Cadaver transplant activity is a hospital based activity with participation of all strata of society. The core group, which makes the donor organ functional in recipient, is the transplant surgeons and the Nephrologists. They in turn are dependant on entire hospital i.e. on intensivists, neurosurgeons, neurologists, administrators, anesthesiologists in addition to service branches like pathology, microbiology, imaging services.
The role of Transplant coordinator is of paramount importance; since coordinator is the first person coming in contact with the grieving family.