Cadaver transplant of Human Organs
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Dr. Rajesh Bharani
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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.
What is Organ donation?
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NEED OF THE HOUR
In India
10 Lakhs need Organ Donation
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Organ DonationType of donorsSome 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.
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Organ Donation
Voluntary 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
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Organs for Donation
Some of the organs that are commonly donated …,
Skin and Bones
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Annual Number of kidney transplantations per
million population (pmp) per year -
USA - 52 Predominantly Cadaver
Donors
Europe - 27 Predominantly Cadaver
Donors
Asia - 3 Predominantly Living DonorsIn 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.
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
Non availability of donor.
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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-
Somatic death
◦ Home – Eyes, Skin
◦ Hospital- Eyes, Skin, Bone
Brain death – Kidney, Liver, Heart, Lung,
Intestine, Pancreas
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• BLOOD
• KIDNEY
• LIVER (1/4)
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Each Body Donation –
10-15 medical students benefited
Each cadaver organ Donor –
50 persons benefited
Body Donation V/S Organ Donation
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Community Problem No Awareness of “Brain-
Death” 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
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Dealing with community problems
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Mass education by all possible medium.
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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
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Hospital and Doctors related Problem
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There is underreporting of brain death cases. 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.
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Transport of organs –between cities
Transport of organs –between cities
Adequate No. of Qualified Intensivists in ICUs
Adequate No. of Qualified Intensivists in ICUs
Well qualified Surgeons to undertake Retrieval & TX
Well qualified Surgeons to undertake Retrieval & TX
HLA Tissue typing and Cross-matchHLA Tissue typing and Cross-match
Qualified
Trained transplant
Co-coordinators
Qualified
Trained transplant
Co-coordinators
Support Organisation to Network
Support Organisation to Network
Hospital Infra-Structural & Support LogisticsHospital Infra-Structural & Support Logistics
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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 brain-death.
Proactive steps to promote Programme. Help in educating public by all means. Think beyond business
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MOHAN Foundation (INOS) - Tamil Nadu, Andhra Pradesh, Maharastra
236 Organs shared236 Organs shared. ( 212-Kidneys, 9-Hearts, 15-Liver )
MOHAN Foundation (INOS) - Tamil Nadu, Andhra Pradesh, Maharastra
236 Organs shared236 Organs shared. ( 212-Kidneys, 9-Hearts, 15-Liver )
FORTE, BANGALORE – 32 Organs Shared
( 32 - Kidneys, 1- Heart, 1- Liver )
FORTE, BANGALORE – 32 Organs Shared
( 32 - Kidneys, 1- Heart, 1- Liver )
ZTCC, Mumbai – 55 Organs Shared - all kidneysZTCC, Mumbai – 55 Organs Shared - all kidneys
ORBO, N.Delhi – Few organs sharedORBO, N.Delhi – Few organs shared
SORT, Cochin – 4 organs sharedSORT, 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 - ◦ 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. Doran M. Intensive Crit Care Nurs. 2004 Feb;20(1):32-7
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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.
Required Request Law has been introduced into many
states in India by legislation to improve organ
donation.
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If in India - 1 per million donation rate we would have 1100 organ donors – 2200 kidneys,1000 hearts, 1100 Livers, 2200 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 donors44,000 kidneys, 22,000 hearts, 22,000 Livers, 22,400 Eyes
Current organ donation rate - India is 0.05 per million population per year
At 3 per million Donation rate we would have 3300 organ donors – 6600 kidneys,3300 hearts, 33001 Livers, 6600 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.
Retrieval time -2 to4 hours
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
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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
What is Required
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Need of time
Formation of state level coordination committee to streamline project
Common lab for Cross match of tissue
Common waiting list of patients
Proper format for unbiased distribution of organ.Committee should decide for best possible recipient for said organ
All center should work under committee
SOP for declaration to transplantation
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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 ForumsSocial appreciation of donor family.
Cadaver Transplant - Conclusion
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THANK YOUTHANK YOU
In my end is my beginning -
T.S.Eliot, Four Quartets