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Organ Donation
 

Organ Donation

 

Why should I become an Organ Donor?
In India, there are over 150,000 people currently in need of kidney transplants. The wait-list for patients with heart and liver failure is growing all the time as well and each year, thousands of people die while waiting for a transplant, because no suitable donor can be found for them. The need for organ donors has never been greater. It can be hard to think about what's going to happen to your body after you die, let alone donating your organs and tissue. But being an organ donor is a generous and worthwhile decision that can be a lifesaver.

All people can be considered as being potential organ and tissue donors after death. However, the presence of active cancer, active HIV, active infection (for example, sepsis) or Intravenous (IV) drug use would absolutely rule out donation.

Patients who have Hepatitis C may still donate organs to a patient who also has Hepatitis C. The same is true for Hepatitis B — but this happens in very rare cases. Most cancer patients may donate corneas.
How does Organ Donation help patients with organ failure?
For organ recipients, a transplant often means a second chance at life. Vital organs such as the heart, pancreas, liver, kidneys and lungs can be transplanted to those whose organs are failing. It allows many recipients to return to a normal lifestyle. For others, a cornea or tissue transplant means the ability to see again or the recovery of mobility and freedom from pain.
How do families of deceased donors cope with their loss?
The act of organ donation has the ability to comfort grieving families. It is always difficult to lose a loved one. Many grieving families of organ donors draw comfort from the fact that their loss may help to save or improve the lives of others.

Studies carried out to understand how a family’s heals have shown that the support from family members helps a person to overcome grief. The support of friends and religious and cultural beliefs also help donor families. Most of the donor families agreed to donate organs because they felt that it was the only positive outcome from their loss.
What organs and tissues can be donated?
Currently, the following organs can be donated and transplanted:

Heart - A muscular organ that pumps blood through the body. Heart transplant is used to help those suffering from heart failure and babies born with heart defects.

Liver - A large organ that secretes bile and is active in the formation of certain blood proteins and in the metabolism of carbohydrates, fats, and proteins. Liver transplant is used to treat various conditions which cause liver failure, such as cirrhosis or liver cancer.

Kidneys - A pair of organs that maintain proper water and electrolyte balance, regulate acid-base concentration, and filter the blood of metabolic waste, which is excreted as urine. A kidney transplant may be recommended for those who have been diagnosed with end stage kidney disease.

Lungs - A pair of spongy organs that remove carbon dioxide from the blood and provide it with oxygen. Lung transplants are recommended for those with severe lung disease. Sometimes there is a combined heart and lung transplant.

Pancreas - A long, irregularly shaped gland which lies behind the stomach and aids in the digestion of proteins, carbohydrates, and fats. Pancreas transplant is indicated for those with insulin-dependent Type I diabetes.



Tissues that can be donated are:

Cornea - The outer curved transparent tissue covering the iris and pupil on the outside of the eye. Corneal transplant is a common procedure used to restore vision for those with eye diseases and corneal infections.

Skin - A tissue which protects the body from infection and injury. Skin transplants, referred to as skin grafts, are used to treat severe burns, extensive wounds and skin loss due to infection.

Heart Valves - Tissues that prevent the back flow of blood into the heart. Heart valve transplants are used to treat malfunctioning heart valves caused by infections, birth defects and aging. When an entire heart is not usable, heart valves are removed from the heart and are used for transplants.

Bones - Connective tissues that are dense, semi rigid, porous, and calcified forming the major portion of the skeleton of most vertebrates. Bone transplantation is done for reconstruction related to trauma, tumors, disease and fractures and to fill defects. For the recipient, it restores mobility, decreases pain, prevents amputation and collapse of bone.

Tendons - Tissues which attach muscles to bones. Tendon transplants are recommended for patients who have lost muscle function due to nerve injury or damage to tendons. It improves the recipient’s life and makes it pain free.

Who can be organ donors?

Either in the case of brain death, or when an individual suffers a cardiac arrest, individuals may share the gift of life with others through solid organ and tissue donation.

You may pledge to donate your organs by signing and carrying a Donor Card (available on MOHAN Foundation website). It's also important to tell your family that you want to be a donor. Even if there is documentation that a person was a designated donor, the consent of the family is essential for the organs or tissues to be donated. Hospitals seek consent from the next of kin before taking any action.

If you are not an adult (less than 18 years old), then your parents’ consent is required for organ donation. So if you want to become a donor, it’s important to tell them that you wish to donate. Children too are in need of organ transplants, and they usually need organs smaller than those an adult can provide.

The Transplantation of Human Organs Act (1994) and its Amendment (2011) allows the donation of organ and tissues for therapeutic purpose only. The Form 5 of the THO Rules 1995 is the donor card. And Forms 6 and/or 9 are consent forms that the next of kin has to sign before organs/tissues can be retrieved.

- Upto 100 years : Corneas, skin
- Upto 70 years : Kidneys, liver
- Upto 50 years – Heart, lungs
- Upto 40 years – Heart valves

What is the value of carrying a donor card when the decision to donate rests with the family after my death?

- Donor card works as a bridge of communication - otherwise do you think anyone would discuss organ donation in their drawing room or with next of kin
- Donor card serves as an emergency card in the wallet
- It make you an advocate for the cause
- It is partly a legal document and if the doctor finds one in your purse - they will not hesitate in approaching the family
- Taking consent from next of kin is to ensure safety of the donor - more so with all the corruption sometimes you may have in the system

If the hospital knows that I have pledged my organs, will it adversely affect my treatment?

Doctors will only focus on saving your life - not somebody else's. You'll be seen by a doctor whose specialty most closely matches your illness. Whether you have pledged to donate your organs or not, there will be no difference in the medical treatment given to you. Organ donation can only occur after brain death has been declared by physicians who are not in any way connected with organ retrieval or the transplant teams. The doctor in charge of your care has nothing to do with transplantation

In India why is the family so important in case of organ donation?

In many western countries an adult is asked to make a choice if he/she wants to be a donor. In India, this final choice is left to the family. In case of brain death of a person carrying a donor card, the family still needs to approve the donation of organs. Family consent is essential.

Will my family have to pay for the donation?

No. The family of an organ or tissue donor is never responsible for costs related to donation. Your family will be only charged for the cost of all final efforts to save your life.

A road traffic accident is the most common cause of brain death in India. The victim is taken to the emergency ward and then into ICU. The cost of the treatment during these crucial times is charged to the patient. Once brain death has been certified and the patient’s family has given consent for organ donation, the costs incurred towards organ retrieval do not go to the patient.

How does my age and health affect organ donation?

The decision to use organs is based on various medical criteria, not age alone. It may be that a few organs are suitable for donation, while others are not. The doctors will decide at the time of death whether a person’s organs and tissues are suitable for transplantation.

A few guidelines with regard to age and organ donation:
- Upto 100 years - Corneas
- Upto 70 years - Kidneys, liver, skin
- Upto 50 years - Heart, lungs
- Upto 40 years – Heart valves

Why do I need to tell my family of my decision if I have already recorded my wish to become a donor?

The death of a loved one is a very traumatic time for a family, and knowing the wishes of the deceased makes it easier for them to decide about or accept organ donation. If your family is asked for consent, telling them about your decision to be a donor is the best way to ensure that your wishes are carried out.

The Transplantation of Human Organs Act (THOA), 1994, and its Amendment (2011) allow the donation of organ and tissues for therapeutic purpose only. The Act states that it is mandatory that the next of kin (parents, spouse etc) should agree to donate the organs of a brain dead family member. In order for a deceased organ donation to take place, specific forms are filled and signed. The Form 5 of the THOA Rules is the donor card. Forms 6 and 9 are consent forms that the next of kin has to sign before organs/tissues can be retrieved.

Can I sell my organs?

No. The Transplantation of Human Organs Act makes it ILLEGAL to buy or sell human organs and tissues. Violators are subject to fines and imprisonment.

What is the importance of a donor registry?

A registry is an essential part of understanding who and where potential donors are. A registry gives a planner enough information to devise strategies to get more public cooperation and commitment towards organ donation. Having a registry in place allows doctors and transplant coordinators to check if a brain dead person wished to donate and then approaching the family for consent becomes easier. It helps in saving crucial time in the process of organ donation.

Brain Death - FAQ

 

When is a patient declared dead?

A person may be declared dead due to Cardiac Arrest or due to Brain Death.

What is the structure and function of brain stem?

The lower extension of the brain where it connects to the spinal cord is called the brain stem. Brainstem functions include those necessary for survival (breathing, digestion, heart rate, blood pressure) and for consciousness (being awake and alert).

Brain stem is the place of origin of the cranial nerves. It is the pathway between the peripheral nerves and the spinal cord to the higher centres of the brain.

What part of the brain stops functioning and why during brain death?

The main causes of brain death are tumor in the brain, trauma, and intra-cerebral hemorrhage. The brain stem which is at the base of our brain stops functioning. This means that the person cannot breathe on his own and his heart will stop beating.

Which doctors usually treat patients with head injury?

In the emergency room of a hospital the doctor on duty will treat the patient initially. Depending upon the criticality, the patient will then be shifted to the Intensive Care Unit (ICU) for treatment. In the ICU, neurologists, neurosurgeons and intensivists will take care of the patient.

Which doctors are responsible for the declaration of brain death?

In case of Brain death certification, two doctors from the hospital and two from the government approved panel will work together on conducting the tests for brain death. One of the doctors has to be a neurologist or neurosurgeon or Intensivist.

Is there is any separated protocol for certifying the brain death for non organ transplant purpose or is it the same as that in organ transplantation protocol?

The protocol of brain death declaration to proclaim death is the same - organ donation or no organ donation. Time of death is second apnoea test.

In many instances of brain death declaration, organ donation does not take place despite getting consent from the family for organ donation.

What tests are done to confirm irreversible damage to brain stem?

There are a series of tests listed in the Transplantation of Human Organs Act that the doctors perform. These tests are basically to confirm that there is irreversible damage to the brain stem and involve cranial nerve testing and apnea testing.

What is the role of a transplant coordinator in case a patient is declared brain dead?

The transplant coordinator has to be with the grieving family, make them comfortable and broach the subject of eye donation and later on solid organ donation.

If the family gives consent for organ retrieval, then the coordinator has to inform the Cadaver Transplant Programme office, coordinate with the ICU staff to maintain the patient and organize organ retrieval. The coordinator has to ensure that all paperwork is correctly done and that the family receives the body as soon as possible.

Is the police department involved in any way for the declaration of brain death?

The police department has to be informed that a patient is brain dead if it is a medico- legal case, but the declaration of brain death is only done by a panel of doctors.

Who explains to the family about the brain death?

The doctor (Intensivist/ neurologist/neurosurgeon) who is treating the patient will explain to the family about brain death.

Why can organs of a brain dead patient be used for transplantation and not those of a patient who has died of a cardiac arrest?

Solid organ donation (heart, lungs, liver, pancreas, kidneys) requires blood circulation to be maintained in these organs until retrieval. This is possible only in brain death where the functioning of these organs can be supported for some time.

FAQ

 

Who can be a donor?

Anyone from a child to an old person. Even if you have had a serious illness in the past, you can still become a donor under the right circumstances.

Can people buy or sell organs?

No. The "Transplantation of Human Organs Act" prohibits any commercial dealings in organs and makes this a punishable offence.

Who will receive the organs?

Recipients are chosen on the grounds of need, longest waiting time and by blood group and if necessary, by tissue characteristics. There is a waiting list for organ transplants because demand exceeds supply.

After the brain death has been declared and the family decides to donate the organs, who bears the subsequent cost of maintaining the donor until organ removal?

Certain hospitals would bear the cost. Apparently some of the hospital pass the charges on to the recipients.

Are there any religious objections to organ donations?

Most of the religious groups support the concept of organ donation. However if you have any doubt you can discuss it with your spiritual or religious leader.

How does the brain death occur?

Brain death usually results from a severe brain injury or brain haemorrhage which causes all the brain activity to stop. This can happen after a major road accident or a bleeding in the brain due to stroke.

What are the options facing the family of a brain dead person?

A series of tests have to be completed before brain death is declared by a panel of medical experts. During this period the patient's vital organs are kept functioning using support systems. The decision to disconnect them lies with the family. However, opting to donate eyes, kidneys, liver, pancreas, heart and heart valves to those in dire need of them can turn tragedy into triumph. By giving another life a second chance.

How quickly should organ transplant take place?

Time is of critical Importance because the vital organs start collapsing within hours of brain death. Hence it is very important that organs be transplanted from the donor to the recipient as quickly as possible. Once the donor family gives their consent, the cost of keeping the organs working, removing them and transplanting will be borne by the recipient.

Can organs also be donated by healthy living people?

Anybody who meets the medical criteria can donate their organs by signing a donor card that states their wish. This signed donor card is a legal document and doctors can retrieve organs and tissues after death provided there is no objection on the part of close relatives. Which is why it is so important to let your family know your feelings regarding this.

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.

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

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 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:

1. Neuro Surgeon / Neuro Physician
2. Treating doctor
3. Another specialist as approved by State Appropriate Authority
4. Medical Superintendent of the hospital.

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

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 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.

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.

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.

How to prevent kidney failure?

Prevention is better than cure lost of cost is involved in treatment of ESRD.

General Measures

Following are the tips to improve the health status no matter what is your state.

- Eat healthy diet.
- Eat food that is fresh and low salt avoid fatty, refined food.
- Stop smoking.
- Exercise regularly.
- Check blood pressure regularly.
- Avoid stress, strain

Whom can you contact for organ donation?

The only organisation in Karnataka through whom organ donations and transplants are co-ordinated is JEEVASARTHAKATHE (old name-Zonal Coordination Committee of Karnataka For Organ Transplantation). Jeevasarthakathe is a non-profit medical service working with centresrecognised by the government for cadaveric transplantation and co-ordination for the same. A list of patients awaiting transplant is maintained. On receiving information about potential donors, Jeevasarthakathe will assess suitability for organ donation. Based on the blood group and other criteria for the organ matching, the recipients will be selected, brought into hospital and prepared for the operation. A team of surgeons will perform the organ retrieval from the donor. In medico-legal cases,Jeevasarthakathe will help the family with the formalities involved