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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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’.
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.
All major religious including Hinduism, Protestant, and Roman Catholic, Islam, Buddhism and others fully support organ and tissue donation.
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.
rgan 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.
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.
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.
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.
Any person in good health if dies suddenly, possibly through an accident or even other causes like brain hemorrhage 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.
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.
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.
It is possible to transplant many different organs and tissues including cornea, heart valves, liver, kidneys, bone and cartilage, bone marrow, skin, pancreas, lung intestine and more.
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.
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.
One of the major achievements in the field of transplantation in the last ten years has been a major reduction in the risk of death. Currently at this hospital, the risk of death in the first year after a kidney transplant is about 3 – 5%, occurring primarily in high risk patients, particularly those over 60-65 and, to a less extend, those with juvenile diabetes. This includes death from any cause, whether or not related to the transplant. This risk is not significantly different from that sustained during a year of dialysis. During your transplant evaluation, any risk factors you may have that will increase your risk for transplantation will be identified and discussed with you.
The success rate following transplantation depends upon the closeness of the tissue match between donor and recipient. A kidney from a brother or sister with a “complete” match has a 95% chance of working gat the end of one year. A kidney from a parent, child or “half-matched” sibling has an 85% chance of working for at least one year. Finally a cadaver donor kidney has an 80% chance of working at least one year.
If you are having a repeat transplant, the success rate will b3 10%-15% less. These kidneys are not immortal, however, with 50% of cadaver kidneys declining over 6 – 10 years, a rate faster than the relatively stable success of related kidneys.
The success rate following transplantation depends upon the closeness of the tissue match between donor and recipient. A kidney from a brother or sister with a “complete” match has a 95% chance of working gat the end of one year. A kidney from a parent, child or “half-matched” sibling has an 85% chance of working for at least one year. Finally a cadaver donor kidney has an 80% chance of working at least one year.
If you are having a repeat transplant, the success rate will b3 10%-15% less. These kidneys are not immortal, however, with 50% of cadaver kidneys declining over 6 – 10 years, a rate faster than the relatively stable success of related kidneys.
It is possible to transplant many different organs and tissues including cornea, heart valves, liver, kidneys, bone and cartilage, bone marrow, skin, pancreas, lung intestine and more.
Potential living related donors usually are identified in discussions with your family and your doctor. Tissue typing is then scheduled; the required tests include blood group typing, HLA typing, and a mixed lymphocyte culture. Based on these tests it is frequently possible to identify the donor most likely to result in a successful transplant. Choosing the donor is best done in consultation with your doctor and the transplant team.
The selected donor is then scheduled for admission to the hospital for a donor evaluation. This evaluation is primarily on an out-patient basis and involves a wide variety of tests to ensure the health of the donor. Included in these tests is an arteriogram, an x-ray procedure in which dye is injected into the arteries supplying the kidney. This test allows the surgeon to decide which kidney would be best to remove. After completion of all tests, the physician responsible for the donor evaluation, who is not a member of the transplant team, will discuss the results with the potential donor privately. Only donors who are healthy and have two completely normal kidneys will be accepted.
A number of factors enter into this decision, including success rates following transplantation and the availability of donors. The best results following transplantation are obtained with HLA – identical (6 antigen matched) living related donors, which almost always come from a sibling, rarely from a cadaver.
A major advantage of living donor transplants is the ready availability of the donor. This allows the transplant to be performed without a long waiting period, as thee are currently more potential recipients than available cadaver donors. For this reason, we encourage living related donation whenever the family situation is appropriate, and, if circumstances are correct, donations for spouses.
There are three sources of kidneys for transplantation: living related, living unrelated, and cadaver donors. Living donors are usually members of the recipient’s immediate family, such as siblings, parents or children. Only such close relatives are likely to have an acceptable tissue match, although recent data suggests that success with living unrelated kidneys is closer to recent data suggests that success with living unrelated kidneys is closer to that of related grafts than that of cadavers. This may be due to better state of the donor and less storage time. Cadaver donor kidneys are removed from victims of brain death, usually the result of an accident or a stroke.
In transplantation, a healthy kidney is put inside the body to do the work of failed kidneys. Although a transplant eliminates the need for dialysis and some of the dietary requirements, a commitment to take care of yourself and take some important medications is required following a transplant. The decision to undergo a kidney transplant is a personal choice of the surgeon who specializes in kidney disorders.
Dialysis does not do everything that a kidney does; people on all types of dialysis require special diets and medications. For example, healthy kidneys produce a hormone called erythropoietin, which helps the body to produce red blood cells, which are important for carrying oxygen from the lungs to all parts of the body. When the kidneys fail, the number of red blood cells drops causing anemia, a condition characterized by fatigue. Dialysis does not cause the kidneys to produce erythropoietin and therefore, people on dialysis will require synthetic erythropoietin injections. Additionally, dialysis does not affect or maintain an appropriate nutritional balance. Dialysis patients have very strict diet requirements for protein, potassium, sodium, and phosphorus. Because certain foods are limited in theses patients, a physician may recommend special vitamins.
Sign an organ donor card. Share the wish with the close relatives as their consent is required before retrieving the organs even if the donor has signed a donor card. The donor card has to be kept with the person who has signed it.
Yes. All the religions in India consider it as the noble act.
No. The organs are removed carefully by taking the donor to the operation theatre and there is no disfigurement. There is cut on the body which is sutured just like any other surgery performed on the living person.
No. The name and address of the recipient is not given to the donor family and vice versa.
No. As per the priority criteria like age, blood group, waiting period, Clinical status of the recipients the organs are given to the most needy and suitable recipient. In Maharashtra the Govt. has given guidelines to give the priority score to all the waiting recipients to distribute the organs. Money, race, religion are not the criteria for distribution
Yes. The body is given back to the relatives to perform the last rites after the retrieval of organs. The organs are retrieved only for therapeutic purposes. This is different than body donation where the whole body is given to the anatomy dept. of the Medical College for the research purpose.
Yes. In India, The Human Organ Transplantation Act was passed inn 1994 which mainly covers 3 areas.
*It recognizes brain stem death.
*It regulates removal, storage and transplantation of organs for therapeutic purposes.
*It prevents commercial dealings in human organs. No human organ can be bought or sold.
Yes. As Brain death can occur only in ICU, one who becomes organ donor dies in ICU of the hospital. No vital organs can be retrieved if the death occurs at home. However, eyes can be retrieved up to 6 hrs. after the heart stops beating hence this could be done even if the individual dies at home.
The vital organs like heart, liver, two kidneys, pancreas, intestine, lungs etc. can be donated if we die a brain death. However cornea [eyes], skin and other tissues can be donated after cardiac death.
The living person can donate limited organs like kidneys [as we have two kidneys] or part of the liver and only to his/her close relative. The other vital organs can be retrieved only from brain dead individual.
Human organ transplantation is the achievement of the modern medical science where through surgical procedure the healthy organ from a living or dead person is transplanted on an individual suffering from end stage organ failure. This is established surgical treatment available for the needy patients.
Organ donation is a noble act which gives us an opportunity to save many lives after our death. The donated organs are transplanted into patients who are suffering from end stage organ failure. As many patients suffer from end stage disease of various organs, the organ donation is the only ray of hope for them.