JEEVANDAN, Life Ahead

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.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.

Normally the death is said to occur when heart stops. But with modern technology the heart and lungs can be 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.

Any individual whose brain stem, an important part of a central nervous system is irreparably damaged is declared brain dead. Brain stem dead individual cannot regain his consciousness andbreathing as brain stem has the centre for both. The heart can continue to function due to ventilator and other support for a maximum time of 36 to 72 hrs. As the blood supply to organscan be maintained for few hours, it is during this period the organs can be retrieved after obtaining consent from the close relative. This death can occur only in Intensive Care Unit.

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

Brain death is declared by the brain death committee which involves team of four doctors recognized by the Govt. and who are not involved in performing the transplant surgery. The team has to perform the brain stem death tests twice at the gap of 6 hrs. This death is declared in the hospitals recognized for transplantation. Brain death is accepted worldwide and the brain death certificate is issued to the relatives.
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. An other specialist as approved by State Appropriate Authority
4. Medical Superintendent of the hospital.

No. Brain dead individual is declared dead and cannot come back. There is no question of survival of the individual as the set of tests done by the experts’ leave no possible doubts of the diagnosis of brain death.

Brain death has nothing to do with mercy killing; the organs are taken only after the person is declared brain dead. There is a difference between comatose patients and brain dead individuals. The comatose patients are not dead whereas brain death is the stage beyond coma and individual is declared dead. Organs are never taken at the cost of donor’s life.

Brain death occurs when person’s brain has permanently stopped. Cardiac death is said to occur when heart stops beating. Both are legal declarations of death. Brain death does not occur as often as cardiac death.

No. Coma is decrease in brain function and there 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.

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.

Yes. In India, The Human Organ Transplantation Act was passed in 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. 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. 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.

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

No. The name and address of the recipient is not given to the donor family and vice versa.

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.

Yes. All the religions in India consider it as the noble act.

NO. It is pure donation and hence it becomes the noble act. However, the family is not charged for the investigations after the consent for organ donation is given.

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.

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.

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.

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.

All of us can be organ donors, irrespective of age, caste, religion, community, current or past medical condition. Children can also be organ donors after taking consent for organ donation from their parents. 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.

However active cancer, active HIV, active infection (for example, sepsis) or Intravenous (IV) drug use are some of the contra-indications. Patients who have Hepatitis C may still donateorgans 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.

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.

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.

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.

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.

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.

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.

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.

An organization is formed to improve organ donations, procurement and transplantation system in the city, state and the country. Thus in Sep. 1998; ZTCC (Zonal Transplant Co-ordination Center) was formed in city of Mumbai. Subsequently the same model will be adopted all over Maharashtra.

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.

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.

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 ablind 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 whole country.

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.

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. At present, we do not have a central registry in India. Through this initiative we intend to make the government of India create one.

Yes. You can contact us on: info@jeevandanlifeahead.org. Let your family know you have changed your mind and tear up your donor card.

Yes. Blood is taken from all potential donors and tested to rule out transmissible diseases and viruses such as HIV and hepatitis. The family of the potential donor is made aware that this procedure is required.

Yes, in most circumstances. Having a medical condition does not necessarily prevent a person from becoming an organ or tissue donor. The decision about whether some or all organs or tissue are suitable for transplant is made by a healthcare professional, taking into account your medical history.

There are only two conditions where organ donation is ruled out completely. A person cannot become an organ or tissue donor if they have been diagnosed with HIV or have, or are suspected of having, CJD.

Yes. You can specify which organs you would wish to donate. Simply tick the appropriate boxes on the Organ Donor Register form or on the donor card, and let those close to you know what you have decided.

Inform the healthcare professionals who are involved either with your relative's care or are helping you in the immediate period following their death (this could be a member of the hospital staff, a police officer, coroner's officer, Procurator Fiscal or GP) that they wanted to donate. The earlier you are able to tell staff, the more likely it is that donation can take place.