UPDATES IN ORGAN

DONATION
Mrs Anusha Verghese
Medical Surgical Nursing
PIMS

OBJECTIVES
Delineate the criteria required to
qualify as a potential organ
donor
Explain factors influencing organ
donation process.
Explain the importance of a team
approach to family consent
Provide a general understanding
of the donation process

Organisation helping with organ donation

& Transplants programmes in India
MOHAN
MOHAN Foundation
Foundation (INOS)
(INOS) -- Tamil
Tamil Nadu,
Nadu, Andhra
Andhra
Pradesh,
Pradesh, Maharastra
Maharastra
236
236 Organs
Organs shared.
shared. (( 212-Kidneys,
212-Kidneys, 9-Hearts,
9-Hearts, 1515Liver
Liver ))
FORTE,
FORTE, BANGALORE
BANGALORE 32
32 Organs
Organs Shared
Shared
(( 32
32 -- Kidneys,
Kidneys, 11- Heart,
Heart, 11- Liver
Liver ))
ZTCC,
ZTCC, Mumbai
Mumbai 55
55 Organs
Organs Shared
Shared -- all
all kidneys
kidneys
ORBO,
ORBO, N.Delhi
N.Delhi Few
Few organs
organs shared
shared
SORT,
SORT, Cochin
Cochin 44 organs
organs shared
shared

TamilNadu Network for Organ Sharing

Share Organs Save Lives

Transplants So Far
Performance Report : From Oct 2008 to Oct 31, 2015

Dr.Amalorpavanathan,
Convener, Cadaver
Transplant Programme,
E-Mail :
organstransplant@gm
ail.com

Donors From TN

713

Heart
Lung
Liver
Kidney
Pancreas
Small Bowel
Total Major organs

164
80
665
1295
4
2
2210

Heart Valve
Cornea
Skin

632
1084
26

Blood Vessels
Total Organs

2
3954

Organ donation

Organ donation is the process

of removing tissues or organs
from a live, or recently dead,
person to be used in another.
The former is the donor and the
latter is the recipient.
People of all ages can become
donors.

ORGANS THAT CAN BE

DONATED

Factors Influencing Organ

Donation
Identification and Referral
Maintenance: DNR/Disconnection of Ventilator support
Pronouncement of brain death
Family Refusal to consent for donation
Setting: quiet, private area, near but out of the ICU .
Speaking to the family over the dead patients bed is disrespectful
and unacceptable.
Decoupling: The act of approaching a family for organ donation
must be done in the appropriate time, with due respect for their loss.
They must be given time to adjust to the loss of their loved one.
The first should involve the physcian and his explanation that
their loved one has died.
The second the transplant coordinator should go later to explain
about organ donation and obtain informed consent.

Identifying a Potential
Donor
1. Organ donors must be maintained
on a ventilator to keep life-saving
organs oxygenated.
2. The Glasgow Coma Scale must be
5
3. There must be a neurological
insult

Cardio-respiratory
death.
Loss of cardiac
function.
Loss of respiratory
function.
Potential tissue donor
Cornea, heart valves,
skin, long
bones,sapnenous
veins.

Non- recoverable
brain death.
Irreversible loss of
brain-stem function.
Potential organ and
tissue donor
Heart,lungs,kidneys
,
pancreas,liver,intesti
ne,
tissues

Identifying a Potential Donor

Heres a list of some types of patients who may
become donors:
gunshot wound
motor vehicle accident with closed/open
head injuries
cerebro-vascular accident
drug overdose
anoxic injury
hanging
drowning
cardiac arrest
primary brain tumor without mets

Definitions
Transplant Coordinator
A person appointed by a hospital
to coordinate all matters relating
to removal or transplantation of
human organs/tissues

ROLE OF TRANSPLANT COORDINATOR

1.DONAR
1.DONAR
IDENTIFICATION,
IDENTIFICATION,
REFERRAL,ONSITE
REFERRAL,ONSITE
RESPONSE
RESPONSE
2.CLINICAL
2.CLINICAL
ASSESSMENT,
ASSESSMENT,
DIAGNOSTIC
DIAGNOSTIC
TESTING(HLA
TESTING(HLA Tissue
Tissue
typing
typing and
and CrossCrossmatch),
match),
DONAR
DONAR
MANAGEMENT
MANAGEMENT

3.
3.
COLLABORATION
COLLABORATION
WITH
WITH HEALTH
HEALTH
CARE
CARE TEAM
TEAM

44 .EDUCATION
.EDUCATION
5.CHECK
5.CHECK PATIENT
PATIENT
HAEMODYNAMIC
HAEMODYNAMIC
SUPPORT,VENTILATOR
SUPPORT,VENTILATOR
SUPPORT
SUPPORT

7.OPERATION
7.OPERATION
ROOM
ROOM
SCHEDULING
SCHEDULING
,COMMUNICATION,
,COMMUNICATION,
PREPARATION
PREPARATION
99 .PATIENT
.PATIENT
FOLLOW-UP
FOLLOW-UP

6.FAMILY
6.FAMILY SUPPORT
SUPPORT
,, COMMUNICATION,
COMMUNICATION
CONSENT
CONSENT
8.ORGAN
8.ORGAN
ALLOCATION
ALLOCATION
AND
AND
SURGICAL
SURGICAL
RECOVERY
RECOVERY

ORGAN
PROCUREMENT

ORGAN
TRANSPLANT

NUCLEAR SCAN

GAMMA CAMERA AND ISOTOPE.

TC 99 HMPOA COST RS 3500
TIME 20MINS
FAMILY CAN STAY WITH PATIENT
DURING PROCEDURE AND
EXPLANATION OF PATIENT
PROGRESS DONE WITH
DISPLAYING PICTURES

MANAGEMENT OF BRAIN DEAD DONOR

INTENSIVE CARE MANAGEMENT FOR THE

POTENTIAL ORGAN DONOR

Rules of 100s. :Maintain Heart rate

< 100 beats/min
Maintain B/P at 100 systolic,
Maintain urine output at 100cc per
hour,
keep PO2 at 100 mmHg.
Place Central line and Arterial line
HYPOTHERMIA -Maintain normothermia
with warming/cooling blanket (97-98).
check CVP (8-12 mm of hg)

INTENSIVE CARE
MANAGEMENT
HYPOTENSION:Keep MAP > 75 MM OF HG
The following drugs will not adversely affect
organ recovery:
ISOTONIC FLUID BOLUS(NS/RL)
DOPAMINE
DOBUTAMINE
NORADRENALINE
ADRENALINE
VASOPRESSIN
COLLOIDS
PACKED RED CELLS

ENDOCRINE SUPPORT
METHYPREDNISOLONE 15MG/KG
BOLUS,1GM/DAY
TRIODOTHYRONINE(T3) 4 MCG
BOLUS,3MCGS/HR
THYROXIN T4 ,20MCGS BOLUS,10
MCGS/HR
VASOPRESSIN 0.5-2.4 UNITS/HR
INSULIN INFUSION ,1
UNIT/HR(TITRATE BLOOD GLUCOSE
AT 150 MG/DL 180 MG/DL)

HORMONAL SUPPORT
IMPROVES ORGAN DONATION
AND GRAFT SURVIVAL.
INCREASES TISSUE
OXYGENATION AND DONAR LUNG
RECOVERY.
IMPROVES CARDIAC
FUNCTION(INCREASES
ABP,CARDIAC OUTPUT,LV
FUNCTION).
DECREASES INOTROPE

AIM

To maintain
haemodynamic
stability for optimal
organ perfusion until
organs are retrieved
from brain dead patient

ORGAN DONATION PROCESS

Liver transplant

HEART TRANSPLANT

HEART TRANSPLANT

HEART TRANSPLANT

Lung Transplantation

Kidney transplant

AMENDMENTS

The Transplantation of Human

Organs (Amendment) Bill, 2011
September, 2004 - Review
Committee set up to examine
provisions of THO Act and the Rules.
The Transplantation of Human
Organs (Amendment) Bill, 2011
Drafted by Ministry of Health.

THO ACT TO COVER BOTH

ORGANS & TISSUES
Regulation of removal, storage
and transplantation of human
organs and tissues for
therapeutic purposes
Prevention of commercial
dealings of human organs and
tissues

REQUIRED CONSENT
REQUEST
Mandatory for ICU doctor, in consultation
with transplant coordinator to request
relatives of brain dead patients for organ
donation.
Record of all brain dead patients and that
of the next of kin who are approached to
be kept.

Special Provision for Removal of

Corneas
Technician possessing such
qualifications and experience, as may
be prescribed, may enucleate an eye.

Certification of Brain
Death
Expansion of certifying panel of experts.
In addition to neurosurgeon / neurologist,
surgeon / physician and an
anesthetist/ intensivist nominated from
a panel already approved by the
Appropriate Authority.

Foreign Nationals
Authorisation Committee to prohibit
organ transplantation where recipient
is a foreign national and donor is an
Indian national.
Approval of Authorisation Committee
required - Donor and / or recipient
being near relatives are foreign
nationals.

Minors
No human organs or tissues to be removed
from living minor for transplantation.
Exceptions
Familial donation of regenerative cells
(when a therapeutically comparable adult
donor is not available)
Kidney transplants between identical twins
(Ensure no genetic disorder present. No
immunosuppression required for recipient
twin).

Mentally challenged
No human organ or tissue to be
removed from the body of a mentally
challenged person before his death
for the purpose of transplantation.
Mental illness like dementia,
schizophrenia
Mental retardation

Transplant Coordinators
Mandatory for hospitals, prior to
registration as a transplant centre, to
appoint a Transplant Coordinator.

Appropriate Authority
Single member body
Central Government for Union
Territories - Director General of
Health Services, Government of India
State Government for States Secretary (Health) or the Director of
Health Services of the State
Government concerned.

Powers of the Appropriate

Authority
To grant registration to a hospital for
the removal, storage and
transplantation of any human organ.
To suspend or cancel such
registration.
To enforce standards for hospitals
engaged in the removal/ storage or
transplantation of human organs.

Powers of the Appropriate

Authority
To investigate any complaint or
breach of any provision of the Act or
the Rules.
To inspect hospitals periodically for
examination of the quality of
transplantation and follow-up medical
care to the recipients as well as
donors.
Power to summon persons, seek
production of documents, issue
search warrants.

Advisory Committee
To assist Appropriate Authority in the
discharge of its functions
Constituted for a period of two years
Representation from an NGO working
in the field of organ or tissue
donation

Authorisation
Committees
Hospital level Authorisation
Committees
State or District level Authorisation
Committees
Central Government to prescribe
composition of Authorisation
Committees to ensure uniformity
Actual appointments made by
respective State Governments / Union
Territories.

Hospital Authorisation
Committee
Hospital does more than 25
transplants annually
Medical director/superintendent
Two doctors not part of transplant
team
Two members from society
Director/secretary of health services

National Registry
Central Govt. to development and
maintain national registry of recipients.
Evaluation of scientific and clinical status
of organ transplantation.

National Organ Retrieval, Banking

and Transplantation Network
Organ Retrieval & Banking Organisation
(ORBO) set up at AIIMS in New Delhi.
Establishment of a nation-wide network, to
include:

All transplant centres

All retrieval organisations
All certified HLA testing labs
In future all trauma centres, all dialysis
centres, all hospitals with ICUs

National Organ Retrieval, Banking

and Transplantation Network
Maintain waiting list of patients awaiting
transplantation.
Different lists for different organs.
Facilitate matching of organs through a
computerized database.

Offences & Penalties

Enhancement of Penalties
Removal of human organ without authority
Imprisonment - Up to 10 years
Fine - Up to Rs.20 lakh
Removal of human tissue without authority
Imprisonment - Up to 3 years
Fine - Up to Rs.5 lakhs 20 lakhs
Live unrelated organ donation false
documents
Imprisonment 5 to 10 years
Fine Rs.20 lakh to Rs.1 crore

Offences & Penalties

Penalties for doctors
First offence name struck off from
State Medical Council for three
years
Second offence name struck off
permanently

Power to Make Rules

Expand rule-making powers of Central
Government to provide for:
Qualification and experience to be
possessed by a technician to be eligible for
enucleating a cornea.
Conditions for an anesthetist/ intensivist
and surgeon/ physician for being included
on the medical board for certification of
brain death.
Qualifications and experience required for
the position of transplant coordinator.
The composition of Authorisation
Committees.

Donar app

THANK YOU
In my
end
is my
beginni
ng

T.S.Eliot, Four
Quartets