HUMAN ORGAN TRANSPLANTATION

WHAT IS ORGAN TRANSPLANTATION?

• Organ transplantation is the moving of an organ from one body to another or from a donor site on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be re-grown from the patient's own cells. Organs and tissues that are transplanted within the same person's body are called autografts. Transplants that are performed between two subjects of the same species are called allografts. Allografts can either be from a living or from a cadaver.

• Organs that can be transplanted are the heart, kidneys, eyes, liver, lungs, pancreas, intestine, and thymus. Tissues include bones, tendons (both referred to as musculoskeletal grafts), cornea, skin, heart valves, and veins. Worldwide, the kidneys are the most commonly transplanted organs, followed closely by the liver and then the heart.

HISTORY IN SHORT• Scientists have long thought about the

idea of replacing a diseased organ with a healthy one from a donor. The problem at first was that the human body is not particularly receptive to foreign tissue. Immune system sees it as a foreign invader.

• Eventually, scientists realized that the problem of rejection didn't occur when the organ donor and recipient were identical twins. The genetic similarity appeared to prevent the immune response.• Dr. Murray's surgery was a major breakthrough, but it wasn't a solution. After all, very few people have an identical twin they can rely on for organ donation. In the late 1960s, doctors figured out a way to perform transplants between nonrelatives by suppressing the recipient's immune response with drugs like cyclosporine.• By the 1980s, anti-rejection drugs had improved to the point where transplantation surgery became pretty routine and far less risky than it had been a few decades earlier. Survival rates rose. 

An Act to provide for the regulation of removal, storage andtransplantation of human organs for therapeutic purposes

and for the prevention of commercial dealings in human organs and for

matters connected therewith or incidental thereto.It applies, in the first instance, to the whole of the States of

Goa, Himachal Pradesh and Maharasthra and to all the Union territories and

it shall also apply to such other State which adopts this Act by resolution

passed in that behalf under clause (1) of article 252 of the Constitution.

TRANSPLANTATION OF HUMAN ORGANS ACT, 1994

THE Transplantation of Human Organs Act, 1994 is meant to "provide for the regulation of removal, storage, and transplantation of human organs for therapeutic purposes and for the prevention of commercial dealings in human organs.“

The Central Act illegalizes the buying and selling of human organs and makes cash-for-kidney transactions a criminal offence

The law establishes an institutional structure to authorize and regulate human organ transplants and to register and regulate, through regular checks, hospitals that are permitted to perform transplants. 

It recognizes, for the first time in India, the concept of brain-stem death, paving the way for a cadaver-based kidney transplant programme. 

FEATURES OF THE ACT

The Act defines two categories of donors. First, it permits a near relative, defined as a patient's spouse, parents, siblings, and children, to donate a kidney to the patient. Secondly, live donors who are not near relatives but are willing to donate kidneys to the due to attachment or any other reasons are permitted to do so, provided that the transplantations have the approval of the Authorization Committee, established under the Act. 

Section 19 of the Act states: "Whoever (a) makes or receives any payment for the supply of, or for an offer to supply, any human organ; (c) offers to supply organs for payment; (d) initiates or negotiates any arrangement involving the making of any payment for the supply of (e) takes part in the management or control of a body of persons, whether a society, firm or company, whose activities consist of or include the initiation or negotiation of any arrangement referred to in clause (d); or (f) publishes or distributes or causes to be published or distributed any advertisement shall be punishable with a term of imprisonment ranging from two to seven years or with a fine not less than Rs.10,000 and not greater than Rs.20,000." 

AMENDMENTS IN THE ACT1. To empower Union Territories, specially Government of NCT

of Delhi to have their own appropriate authority instead of DGHS and / or Additional DG (Hospitals).

2. To make the punishments under the Act harsh and cognizable for the illegal transplantation activities to deter the offenders from committing this crime.

3. To provide for registration of the centres for removal of organs from the cadavers and brain stem dead patients for harvesting of organs instead of registration of centres for transplantations only.

4. To allow swap operations between the related donor and recipients who do not match themselves but match with other similar donors / recipients.

PROPOSED AMENDMENTS1. The current age limit of 60-years should be removed for cadaver donors. Improved

health and longer life expectancy means some older people could be suitable donors, upping the organ donor count to an extra 10 or 12 a year.

2. It has also been proposed that paired matching should be permitted i.e. if patient A's donor does not match A and likewise for patient B, then donor switch should be allowed, if it results in a match. Swaps or exchanges between families unable to fulfill the need of their family member in need of a transplant due to incompatibility, are known to take place. However, this is not legal and is mostly done under cover. The proposed amendment seeks to convert the de facto into de jure, encouraging more families to swap organs amongst themselves, to be vetted by an authorization committee.

3. Direct costs should be given to donors for a donation, including indirect losses like lost earnings and future expenses. The compensation framework should be in line with international and local ethical recommendations.

4. Higher penalties should be imposed for deterring organ trading syndicates and unscrupulous middlemen.

IMPACT OF TRANSPLANTATION ON PATIENTS Infections

Attempts to suppress the immune response to avoid graft rejection and GVHD weaken the ability of the body to combat infectious agents (bacteria, viruses,

fungi). More rarely, the donated organ may be infected and transmit the agent to the recipient. Tuberculosis, rabies, syphilis, hepatitis B, HIV, and several other diseases have been transmitted in this way. Potential organ donors are now

routinely tested for evidence of infection by HIV, HTLV, hepatitis B and C (HBV, HBC), human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) as well as by

Treponema pallidum (syphilis). Cancer

Suppressing the host's immune responses also increases the risk of cancer. (Evidence supporting the theory of immune surveillance.)

Hypertension Hypertension, or high blood pressure, is common immediately after transplant.

Certain anti-rejection medications, as well as the original disease, all can contribute to hypertension.

Shingles People with weakened immune systems, such as transplant recipients treated

with immunosuppressive drugs, risk developing shingles. Shingles is a painful infection of the central nervous system caused by the Varicella virus that causes a blistering rash and severe burning pain, tingling or extreme sensitivity to the skin

and is usually limited to one side of the body. Diabetes

Some anti-rejection medicines are known to cause high blood sugar. Although it is typically a temporary condition after transplantation, it is more common in

patients who have a family history of diabetes and patients who are over weight.

INDIAN POSITIONEthical Issues

The ethics of transplantation can be expressed in three requirements:1. Medical integrity: Patients and the public must be able to trust their doctors not to sacrifice the interest of one to that of another. Individual may make that sacrifice, but not their doctors. 2. Scientific validity: the basic biology and technology must be sufficiently assured to offer a probability of beneficial outcome, case by case.3. Consent: Consent based upon information adequately presented, weighted and understood, and unforced.

 Unregulated medicine practice Medical councils and organizations have played a passive role on ethical

issues. They have failed to make their stand public or take action even in obvious malpractice. Although the press has been publishing explicit details on rackets in kidney transplantation in various cities no medical body has thought it fit to even conduct an investigation into them.

 Illegal organ trade India's slums are a gold mine for organ traders, full of poor people

desperate enough to sell their organs. But with a healthy kidney fetching approximately 30000 rupees, most donors only make enough to pay off their debts -- and end up even poorer in the long term.

   

SCANDALS This is the list of top five countries where

organs are illegally traded and harvested:

Moldova China Egypt Pakistan India

CONCLUSION

Organ transplantation is linked with organ donation. It is a worldwide campaign which urges people to donate. According to unos.org ( United network for organ sharing) the number of donors in January-July 2011 were 8132, transplants in the same period was 16,416 and as per yesterday the waiting list of patients who require organ transplants has 112,309 people on it.

When a person in your family, relative, friends expire.. all you need to do is call the donor bank, and they come to your place, take 5 minutes time, issue a certificate, and two people get eyesight... how difficult is that???Please keep the telephone number of your city handy.

Call Toll Free number across India for any information on organ donation or to donate organ at: 1919

THANK YOU

ANURAG KHUNGERARJUN KRISHNANHEER KHANTKRITI KRISHNANSAACHI KANJANI