ORGAN DONATION, AN INSIGHT

Jeena Uska Jeena Hae

Jo Auro Ko Jeewan Deta Hae

Above lyrics from famous song of late 70 is true to every aspect of life. On the occasion of World Health Day let us see how this lyric is translated in reality.

Our country is rocked with scams involving trade of Human Organs. This trade has evolved only because we as individuals are failing to understand the importance of invaluable gift, nature has bestowed on us.

Dr Kailash Jawade, President of DOST ( Dhanwantry Organization for Social Transformation ), a transplant surgeon himself, sheds light on various facets of Organ Donation in an e-mail interview with apli apulki

Tell us something about origin of organ transplantation.

As we know, routes of golden future of something lies in its past; organ transplantation, though

developed in last hundred years but its routes goes back to many thousand years up to the

mythical era. Very first example of organ transplantation is mentioned in mythology. It is transplantation of elephant head by Lord Shiva to rejuvenate Lord Ganesha. In Greek mythology

there are similar examples. Transferring spiritual body from one person to another person and

many more things are described in mythical era. In 800 BC father of Indian Surgery, Sushruta, grafted new nose created from skin flap. This is the first reported case of reconstructive grafting. In 300 AD Saint Cosmos & Domain from Turkistan successfully grafted whole leg from dead Ethiopian to a devoted member of Church whose leg was affected by cancer.

Era of modern organ transplantation started in 1905 by Eduard Zirm of Austria who did first

successful corneal transplant. Kidney is the first vital organ to be transplanted successfully. First

successful kidney transplant from one identical twin to another without ant rejection drugs was

performed by Dr Joseph Murrey at Brigham and Women’s Hospital Boston, US in 1954. In 1963

Dr James Hardy of University of Mississippi Medical Centre, US did first lung transplantation. In 1966 first simultaneous kidney pancreas transplantation was performed in United States. In 1967 Dr Thomas Starzl of University of Colorado Health Science Centre performed first

successful liver transplantation. In same year Dr Christian Barnard of Groate Shure Hospital

South Africa performed first successful heart transplantation.

Which all parts of human body can be used for transplantation while alive and after death?

While alive; one of the kidneys, part of liver, one of the lung, part of pancreas, and skin can be

used for transplantation. When person is brain dead many parts of his/her body can be used for transplantation. Such transplantation is called as deceased donor transplantation. We can retrieve two kidneys, complete liver and pancreas, heart, two lungs, two corneas, muscle tendons, vessels, bones and skin from the body of brain dead person. Single brain dead person can thus help maximum of 55 people suffering from various end stage organ and tissue diseases. From totally dead individual we can retrieve corneas, skin and bones to use for diseased individuals but if such body is donated for academic purpose it can used for training medical graduates to learn anatomy.

What are time spans for retrieval of organs after death?

In case of brain dead person all above mentioned organs could be retrieved as long as patient is in physiologically stable condition and free from multi organ failure. Once he develops

complications limited organs can be retrieved. In some situations organs can be retrieved after

stoppage of heartbeats but it should be done very fast. After death corneas should be retrieved within four hours and skin needs be retrieved within 12- 24 hours.

What is difference between death and brain death?

Many dictionaries define death as "the extinction or cessation" of life or as ceasing to be. Thus

death is the irreversible loss of function of the whole organism, that is, each and every component. In other words, it is the irreversible loss of function of the organism as a whole; that is loss of the ability to exist as a meaningful and independent biological unit. It is now realized and accepted that death is a continuous ongoing process and not an isolated event. It is also realized that death of different organs like the heart, the brain and so on occurred rapidly within seconds one after other. A few decades ago technology was not available to keep some organs alive even though others were dead. French physicians, Mollart and Goulon described the Concept of Brain Death for first time. They termed it as coma depasse (a state beyond coma). It is now proved that person cannot remain alive after the death of brain stem, which has control centres for heart and lung. Thus brain stem death is equivalent to death of individual. But it is also true that with modern techniques such person can be kept alive for few days to weeks in such condition.

Deaths do take place in every family, yet there is long list of patients in need of organs, what prevents relatives from offering their organs?

There are many factors responsible for this, these are

Lack of awareness

Lack of acceptance

Lack of complete knowledge of these concepts in medical practitioners

Religious and cultural issues

Fear of humiliation

Lack of motivation

Poor media support

Avoidance of responsibility by medical community

Lot of work needs to be done in this field.

Under what circumstances organ donations cannot be accepted by medicos?

There are few conditions in which we cannot accept organs from the donor, these are

Presence of active infection eg. Hepatitis B, C infection,HIV/ AIDS, Septicemia

Presence of malignancy

Dysfunction of organ to be donated

Unstable patients

Enlist the formalities for donation and how is retrieval effected?

In living related donation formalities are more-

Complete health check-up of prospective donor, which included clinical examination,

Blood investigations, cardio-respiratory evaluation, to rule out malignancy and psychological

evaluation.

Next step is to complete committee clearance- each transplant programme has ethical

committee, which look in to medico legal aspects of organ donation.

Last step is to evaluate organ to be donated and immunological check up

In case of brain dead donor formalities are minimal and main aspect is consent from the donors

family-

Confirmation of brain death by clinical, laboratory and radiological tests

Certification of brain death by neurologist

Taking consent from the donor family

Evaluation of brain dead patient to rule out medical contraindication

Selecting and calling suitable recipients

Evaluation of recipient

Once all above things are done and brain dead patient is still in haemodynamically stable

condition he/she is taken up for surgery and organs are retrieved.

Assistance/helpline nos.

ORBO

Organ Retrieval Banking Organisation

All India Institute of Medical Sciences

Ansari Nagar, New Delhi- 1100 29

Phone: 1060 (Special 24 hrs. helpline)

26588360, 26593444

Fax: 91- 11- 26588402

E-Mail: info@orbo.org

orboindia@yahoo.com

MOHAN Foundation

(Multi-Organ Harvesting Aid Network),

Chennai

E-Mail: admin@webhealthcenter.com

Sir Ganga Ram Hospital,

Rajinder Nagar, New Delhi 110060, INDIA

Tel: 011 42251101 Fax: 25861002

Email: HODR@sgrh.com

Indraprastha Apollo Hospital

Sarita Vihar, Delhi Mathura Road,

New Delhi - 110076 (India)

Tel.: +(91)-11-26925858 / 26925801

Fax: +(91)-11-26825563

E-mail: helpdesk_delhi@apollohospitals.com