Organ Donation in India

In 1994, the Government of India passed the Transplantation of Human Organs Act that legalized the concept of brain death and, for the first time, facilitated organ procurement from heart beating, brain dead donors. However, this concept has not caught on well in India for want of public education and awareness. This in turn is perpetuating the commercial sale of human organs due to the widening gap between the demand and supply. Thousands of lives are lost in India annually from heart and liver failure since transplantation of unpaired organs like heart, liver and pancreas is either difficult or impossible from living donors. This is only possible on a large scale if these organs are available from cadaver donors.

In the United States, in 2004, there were over 14,000 organ donors - an increase of 695 donors (7%) over 2003. During this time the number of cadaver donors grew by 11% to 7,152, the largest annual increase in deceased donors in the last 10 years. In 2005, the number of kidneys transplanted from cadavers was 9,914, while the number of patients who received transplants from living donors was 6,563.

Organ Transplantation Our Understanding

Medical Science is expanding its horizons by leaps and bounds and edging towards newer successes by unveiling God s miraculous mystery Human being & primarily human body. In case any of the organs of the human body fails of function, medical science can extend its functioning for some time, but when an end stage failure is reached, just like a machine whose parts are changed, the failed organ needs to be replaced. There are millions of needy patients all over the World who suffer from various end stage organ failures and whose lives can be saved only by the timely replacement of the failed organ. Human to human (allogeneic) transplantation of cell tissue and organs has become the best treatment and often the only for a wide range of fatal diseases. Transplantation has been increasing over the previous decades. However, the human origin of the therapeutic material entails the potential for safety and ethical violations. One of the miraculous discoveries of medical science has brought a ray of hope in the lives of these needy patients by transplanting these functioning organs from the bodies of brain dead patients to these patients. This is cadaver organ transplantation. Whenever there is an injury to the brain stem or an intracranial haemorrhage the patient goes

into coma. The brain is the utmost important organ of the body and an irreversible damage to the same leads to the death of the living being but other internal organs remain functional for some time aided by artificial respiration and various drugs. During this time even though the patient is dead, these organs which are kept viable artificially, can be transplanted to various needy patients and a gift of life can be given to them. One brain dead patient can donate both Kidneys, Heart, Liver, Pancreas, Lungs, Skin & both corneas to various needy patients

Organ donation process

The whole organ donation process can be, for convenience, divided into four distinct phases. The process of: 1. Identification 2. Certification 3. Screening 4. Maintenance of donor PRE REQUISITES for a GOOD, EFFICINET & EFFECTIVE O.P.C. (Organ Procuring Center) are: Proper coordination Motivated team Adequate and correct knowledge Mutual support/liaison with other agencies Within a span of 6 to 24 hours a team of 4 specialists examine the brain stem dead individual and certify brain stem death. Only after this various organs of an individual are used for transplantation to other waiting patients.

CONFIRMATION OF BRAIN STEM DEATH - Apnoea test: Apnea is established by showing that no respiratory movements occur during disconnection from the ventilator for long enough to ensure that the arterial carbon dioxide tension (PCO2) rises to a level of 50 mm Hg or more, capable of driving any respiratory center neurons that are still alive. Nothing can undermine the necessity for hurrying up the matters and the Need For Speed - After death, immediate action is needed. The Success of the whole process will depends on Motivation from - nurse, doctor, social worker presence of mind of relatives facility for organ donation The Work for the transplant coordinator starts right here between II Apnoea Test and certification in Form no. 6, 7, 8 and /or 9 here Legal issues are to be tackled DECLARATION AND CERTIFICATION OF BRAIN STEM DEATH is done after II Apnoea test has been confirmatory of brain death.

What to do?? (A) Routine Cases After certification we can straight away go for harvesting organ (B) MLC Cases Clearance FROM THE Police Authorities is required!!!!! This clearance can be given on the basis of the following stipulated in TOHA: The person competent under this Act to give authority for the removal of any human organ from such dead body may, if he has reason to believe that such human organ will not be required for the purpose for which such body has been sent for postmortem examination

Eligibility for organ donation

There is no age limit for organ donation. The Donor Network has successfully procured organs from

donors as young as a few days to adults in their 90s. A patient's medical history is more important than the age of the donor. If a patient has a normal functioning organ and is in good health, then organ donation is certainly an option. Newborns as well as senior citizens have been organ donors. If you are under age 18, you must have a parent's or guardian's consent. If you are 18 years or older, you can show you want to be an organ and tissue donor by signing a donor card.

Understanding death before donation

UNDERSTANDING DEATH BEFORE DONATION Brain Death and Organ Donation: Most deceased organ donors are brain dead. They have suffered complete and irreversible loss of all brain function and are clinically and legally dead. Mechanical ventilation and medications keeps their heart beating and blood flowing to their organs. Brain Dead is Dead. There is No Recovery

Brain death can be confusing, particularly for families who are confronted with the sudden death of someone they love because a brain dead person on a ventilator can feel warm to the touch and can look "alive." The heart is still beating and the ventilator is pushing oxygen and air into the lungs making the person's chest rise and fall. When this happens, some families expect that the person they love can simply be kept on the ventilator in hopes that their condition will improve. But to be brain dead is to be dead, and no improvement or recovery is possible. Defibrillators used to "shock" a heart may get it functioning again within the first several minutes after it stops. But there is no such method to jump-start or revive a brain that has been deprived of blood and whose cells have died. How does brain death occur?

When the brain is injured, it responds in much the same way as an injury like a twisted ankle - it swells. Unlike the muscles and tissue of the ankle, however, the brain is in a confined space the skull and has no room to swell. A head trauma, bleeding in the brain from a stroke or aneurysm, or prolonged cardiac arrest that deprives the brain of oxygen will cause the brain tissue to swell. The action of the brain swelling inside a

closed space and the build-up of pressure is what can ultimately lead to brain death. Documenting Brain Death Declaring someone brain dead involves no subjective or arbitrary judgments. Brain death is a clinical. To avoid even the smallest chance of mistake, most hospitals require that two physicians sometimes hours apart each conduct a range of tests in search of even the slightest indication of brain activity. None of these physicians can have anything to do with organ donation and transplantation; they probably do not even know whether the patient is a would-be donor or how the family feels about donation. No One Pulls the Plug Once a person is declared brain dead, families are not asked to "pull the plug" or to take someone "off of life support" because such actions would be impossible: the person they love has already died. Debates about whether to "pull the plug" or discontinue support on someone who is in a coma or in a persistent vegetative state have nothing to do with organ donation; such people still have brain function, and are not dead. Organ and Tissue Donation after Cardiac Death Typically when a person suffers a cardiac death, the heart stops beating. The vital organs quickly become unusable for transplantation. But their tissues such as bone, skin, heart valves and corneas can be donated within the first 24 hours of death. However, in a return to where organ donation began 40 years ago, before the acceptance of brain death, some patients are becoming organ donors after suffering cardiac death. The medical community refers to this as "non-heart beating donation." Some people with non-survivable injuries to the brain never become brain dead because they retain some minor brain stem function. If such individuals made the decision to be donors or their families are interested, organ donation may be an option. The option of donating organs after cardiac death or "non-heart beating" donation may be presented to these families after it is clear that their loved one cannot survive. Donation in such cases entails taking the patient off the ventilator, typically in the operating room. Once the patient's heart stops beating, the physician declares the patient dead and organs can be removed. Today, organ donation after cardiac death has increased the donation of life-saving organs mostly kidneys and livers by as much as 25 percent in a few areas of the country

How to Donate Organs

HOW TO DONATE?

Well in my opinion, signing an organ donor card or eye donation card is not of much use; what is more important is that you make sure to let your family know that they know of your wish. Educate them about these topics; make sure that their myths are cleared and try bringing up the topic again & again in discussions with family & friends; so that it is not forgotten. This is because even though one may have signed a card; what is actually required is that family takes the initiative to get the donation through after a donor s demise. Otherwise if the family doesnt call up an eye bank for eye donation / give consent for organ/eye donation; it cannot be done. Another thing - a friend of mine pointed out that the donor form (for India) requires a signature of 2 witnesses & hence has to be couriered - to Delhi. A lot of us on the group may not want to go through the hassel; and he is right - a lot of us I am sure will put it behind because of this. But think about it - there is no point filling a form and submitting it online - as that way your family will not know of your will - by getting it signed, you ensure that they know & remember to donate your organs - if god forbid, something happens - coz its something u cannot communicate uppon death - then it will be too late. Secondly - couriering.. ya, i agree it seems a bit of a hassel - but think about it - is it really that big a deal compared to the number of lives you could be saving?? Today courier companies or post boxes are at every street of this country.. its not that big a problem! So if we want to make a change, we have to take the initiative, we have to shed our laziness and we must go ahead, fill the form, get it signed - if possible, get ur friends & family to sign these forms - and courier or post them togethe

India - Contact Information

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 Imp numbers for Delhi & Mumbai (using MTNL) 1. Information Service on Eye Bank is 1919 2. Centralized Accident & Trauma Service 1099 3. Information Service on Blood Bank is 1910

4. Dial a Doctor 1911 If you need to know for any other particular city, please tell us which one, we shall find out and let you know. And anyway, we are trying to get together the latest numbers for all cities, shall publish in this website once we collected them all.

Eye Donation Important facts of eye donation

IMPORTANT FACTS 1. 1 donation = 2 people getting eyesight. TWO Corneally blind persons can get sight due to a single person's eye donation. 2. Persons of any Age/Sex can donate their eyes 3. Persons who have undergone surgery for Cataract, Glaucoma or using Spectacles can also pledge and donate their eyes. 4. Eyes should be donated preferably within SIX hours after the death. 5. Nobody is charged for making eye donation. The only cost to encounter is one local telephone call. 6. Face will NOT get disfigured after eye donation. As per the new procedures, only Cornea portion is removed and hence face disfigurement does not happen. 7. Immediate family members or relatives can donate the eyes of the deceased even if the deceased had not pledged for eye donation during his/her life time.

About eye donation

Eye banks obtain, evaluate and distribute eyes donated by humanitarian-minded citizens for use in corneal transplantation, research and education. To ensure patient safety, the donated eyes are evaluated under strict medical standards. Donated eyes that are not suitable for corneal transplantation are used for valuable research and education purposes.

The cornea is the clear, transparent dome in front of the black portion of the eye. It is also the main focussing surface, which converges light rays as they enter the eye to focus on the retina. It is thus the most important part of the optical apparatus of the eye. Loss of transparency directly results in loss of vision. A corneal transplant is an operation that replaces the opaque cornea with a clear cornea obtained from a human donor eye. A cornea may become opaque owing to infection, injuries, iatrogenic causes such as malpractice and improper post-operative care, malnutrition, or congenital-hereditary reasons. Practically anybody from the age of one can be an eye donor. There is no maximum age limit. Poor eyesight and age make no difference. Those who wear spectacles, those who have had cataract surgery, diabetics and those who are hypertensive can donate eyes. Even a person who is blind from retinal or optic nerve disease can donate eyes, provided the cornea is clear. Those who have died of unknown causes, or due to infectious rabies, syphilis, infectious hepatitis, septicemia, and AIDS cannot be donors. One can bequeath eyes by taking a pledge, resolving to donate them after death. But it requires the help of relatives or friends to carry out the pledge and desire. The next-of-kin can give consent for a donation even if the deceased family member has not signed a pledge form. The eyes need to be collected within six hours, and so the eye bank has to be called as early as possible. After making the call, both eyes will need to be closed and covered with moist cotton. Any overhead fans should be turned off. If possible, antibiotic eye drops may be periodically instilled in the eyes in order to reduce chances of infection. The head end of the body could be kept raised by about 6 inches in order to reduce any bleeding during eye removal. The removal will leave no visible signs that would interfere with common funeral arrangements and practices. There is no religious conflict involved. The donation actually gives a gift of life or sight to others. As such, it is consistent with the beliefs and attitudes of all major religious and ethical traditions. The whole eye cannot be transplanted, only the cornea can be. The rest of the eye is used for therapeutic use, research and education. The ultimate decision about usage for transplantation will be made after evaluation. A living person cannot donate eyes. A recipient is not told who donated the eye: the gift of sight is made anonymously. At the eye bank, the donor corneas are strictly evaluated by means of various procedures including slit lamp examination, serology examination, and specular microscopic evaluation by specialists. The chosen corneas are removed from the eyeball and preserved in special storage solutions that can keep the cornea healthy for 14 days. Good quality corneas are used for corneal transplant procedures. The donor corneas are used for various types of keratoplasty procedures including multiple procedures. The donor sclera is preserved in absolute alcohol and used for surgical procedures concerning glaucoma, ocular trauma and oculoplasty. The remaining parts of the donor eye ball are used for research by the research units of Microbiology, Biochemistry, Ocular Pathology, and Molecular Biology . The following steps will aid the noble cause. Dial the eye bank soon after the unfortunate death of a

near and dear one. Give your consent to donate the eyes of your close relatives and friends. Motivate the family members of anyone who has died in your area. Spread information about eye care and eye donation. Institutions of eye care strive to create a positive impact, and comprehensive and quality eye care has become the core objective of one among them, the Chennai-based Sankara Nethralaya. The Department of Medical Sociology of the Nethralaya frequently organises public health education programmes in schools, colleges, and industrial establishments in collaboration with non-governmental organisations, where issues relating to eye care and eye donation are explained. The author and his associates can come and deliver a lecture in Tamil or English, with interactive sessions, if you could organise a seminar or awareness programme in your area, office, club, flat association, school and so on. You can sponsor stickers with messages on eye donation and other publicity material and distribute them to the public with the help of the eye bank. Make yourself a friend of the Eye Bank.

Myths about eye donation

MYTHS 1. Some people think that if they donate their eyes, it will leave holes in the place where their eyes existed. WRONG. Only the Cornea portion of the eye is removed and hence the appearance of the face of the deceased remains the same. 2. Some other people are of the opinion that if they donate their eyes in this life, they shall be born blind in the next life. WRONG. There is no written rule about this and nobody has experienced this! Eye donation is truly a good deed and a good deed always begets good. All religions and their institutions support eye donation and consider it as one of the best donation a person can make. 3. Some people hesitate to pledge their eyes for donation worrying about how their relatives will react. Such people should keep in mind that a little resistance should not hinder the good deed that one is performing. In fact, they should try to motivate their relatives and friends for donating the eyes, by describing the good effects of this donation movement 4. Person with eye problem like Cataract or Glaucoma cannot donate their eyes. Also, the person is very old and hence cannot donate his/her eyes. WRONG WRONG A Person who HAS Cataract or Glaucoma CANNOT donate their eyes, But a person OPERATED for Cataract or Glaucoma can BE considered for eye donation. Also, Age will not come into picture while

donating the eyes. As long as the person or his/her family/friends have a good mindset of doing some good to blind, can donate their eyes.

Procedure in eye donation

PROCEDURE When consent is given for eye donation, it means that the eyes will be removed within a few hours after death by a trained professional. Verbal consent from the senior available next-of-kin is sufficient. If the death has occurred at the hospital, it will be done there; if at home, all one has to do is call the number of the nearest eye bank, and they will come and take care of everything. The body is not required to be taken anywhere, and the procedure takes a few minutes. There is absolutely no cost to the donor family. It is illegal to buy or sell human eyes, organs, and tissues. Any costs associated with eye donation are absorbed by the Lions Corneal Donation Service. Great care is taken to preserve the donor's appearance. The gift of sight is made anonymously. Specific information about the donor family is not available to the recipient. The Lions Corneal Donation Service will convey a recipients thanks to the donor family and if asked facilitate anonymous correspondence.