August 13: Organ Donation Day

August 13: Organ Donation Day

August 13, 2015

It has been estimated that 200,000 people in India are annually diagnosed with organ failure, needing transplantation the life-saving measure. A majority of these patients are young, whose only hope for life is through the transplantation of another’s organ in their bodies.

Organ Donation Day in India is celebrated on August 13 every year by the people, government organisations and medical professionals in order to motivate people to donate their organs after death as well as to make people understand the value of organ donation.

The Transplantation of Human Organs Act was passed in 1994 to stop the illegal and unethical ‘trade’ of vital organs like kidneys. It introduced the concept of brain death, an irreversible condition in which the brain stops functioning but the heart lingers on for a few days. Persons caught in such a limbo are the only ones who can donate organs such as heart, lungs, kidneys, liver, etc. for transplantation into patients suffering from organ failure.

Cadaveric transplants

However, cadaveric transplants (‘cadaveric’ is the adjectival form of ‘cadaver’, which means ‘a dead human body’), in which a brain-dead person's organs are retrieved and transplanted into an organ-failure patient, are still unheard of in most parts of India. In fact, the Indian Society of Organ Transplantation's website says that cadaveric organs account for less than 4% of the 21,000-odd kidney transplants performed (from 1971 to 2013).

But things are changing, slowly but surely. Cities like Mumbai and Chennai are doing well in this respect; such transplantation has been a regular feature for the past few years. In 2014, Chennai recorded 80 cadaveric transplantations and Mumbai, 71. Now, Kolkata, as well as West Bengal, are on their way to join that league too.

The thrust towards cadaveric organ transplantation is a much-needed one. It ensures a ready availability of organs, and because of this, it also has the potential for eliminating the illegal trade in organs, whose victims are mostly the poor. Hence, it has a big social role to play as well.

West Bengal: New initiatives

West Bengal is turning a new leaf in organ transplantation; it is making massive improvements in the infrastructure for the procurement and transplantation of different organs from dead bodies in the state-operated hospitals. At the same time, a set of rules is being encoded for keeping an eye on such transplantations in private hospitals as well.

Towards ending the lack of cadaveric transplantations, the West Bengal government has planned the creation of a State Organ and Tissue Transplant Centre. It is to come up either at RG Kar Medical College or at NRS Medical College in Kolkata. Also, a separate cell is being at up at Swasthya Bhawan, the state health headquarters, to promote cadaveric transplantation in the state.

Besides these measures, a 21-member committee is being set up by the state health department to monitor all aspects of such transplantation in the private hospitals of West Bengal.

Organ donation: The who, the what, the how

Anyone can be an organ donor, irrespective of age, caste, religion, community, or current or past medical condition. Children can also be organ donors after taking consent from their parents. 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 donate organs 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.

Vital organs like heart, liver, kidneys, intestines, lungs, and pancreas can be donated only in case of ‘brain death’. However, other tissues, like corneas, heart valves, skin, bones, etc. can be donated only in case of natural death.

Transplantation of human organs and tissues is regulated by certain guidelines in most countries. In India, Transplantation of Human Organs and Tissues Rules, 2014 is the guiding light. Read the full version here (both English and Hindi).

In May 2010, the World Health Organisation published a set of guiding principles intended to provide an orderly, ethical and acceptable framework for the procurement and transplantation of human cells, tissues and organs for therapeutic purposes. It is called WHO Guiding Principles on Human Cell, Tissue and Organ Transplantation.

Donor registry

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; then approaching the family for consent becomes easier. It also helps in saving crucial time in the process of organ donation.

The Indian Society of Organ Transplantation (ISOT) initiated the Indian Transplant Registry in 2005. It collects transplant-related data from various centres in the country and collates the data to derive various information.

The National Organ and Tissue Transplant Organisation (NOTTO) is a national-level organisation set up under the Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. It is the Centre’s nodal agency for organ donation.

Important to provide succour to donors’ families

While it is a life-saving act to donate organs, donors’ families often need to be convinced to donate the organ(s) of their loved ones. After all, they have just lost a person – one who may be a best friend, a close family member, the breadwinner and so on and so forth.

It is here that the role of transplant coordinators kicks in. They're the ones who take care of procedures (signing of papers), tie up loose ends (coordinate with police and doctors), and double as grief counsellors for families struggling to understand the concept of brain death.

Organ transportation – green corridors

Organ donation is one thing. But it also has to be ensured that there are a sufficient number of trained personnel to remove and transplant the organs in another’s body – doctors, paramedics, nurses, infrastructural setups, the creation of green corridors whenever required at al.

In the last few years, the concept of ‘green corridor’ is being implemented by many city and state administrations in India. A green corridor is a blockage-free channel, usually through roadways, for the fast movement of vehicles carrying organs from one hospital to another, from donor to recipient (the term is borrowed from wildlife conservation, where it implies a passage maintained for enabling wild animals to move/migrate freely from one patch of forest to another). These are created temporarily for the duration of the passage of the ambulance or other vehicle carrying the organ(s).

Written by Anushtup Haldar and Agnivo Niyogi for Team

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