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Organ Donation

    • 1. Why should I become an Organ Donor?
      • In India, there are over 150,000 people currently in need of kidney transplants. The wait-list for patients with heart and liver failure is growing all the time as well. And each year, thousands of people die while waiting for a transplant, because no suitable donor can be found for them. The need for organ donors has never been greater. It can be hard to think about what's going to happen to your body after you die, let alone donating your organs and tissue. But being an organ donor is a generous and worthwhile decision that can be a lifesaver. All people can be considered as being potential organ and tissue donors after death. However, the presence of active cancer, active HIV, active infection (for example, sepsis) or Intravenous (IV) drug use would absolutely rule out donation. 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.

    • 2. How does Organ Donation help patients with organ failure?
      • For organ recipients, a transplant often means a second chance at life. Vital organs such as the heart, pancreas, liver, kidneys and lungs can be transplanted to those whose organs are failing. It allows many recipients to return to a normal lifestyle. For others, a cornea or tissue transplant means the ability to see again or the recovery of mobility and freedom from pain.

    • 3. What Organs/Tissues Can Be Donated?
      • Currently, the following organs can be donated and transplanted: Heart - A muscular organ that pumps blood through the body. Heart transplant is used to help those suffering from heart failure and babies born with heart defects. Liver - A large organ that secretes bile and is active in the formation of certain blood proteins and in the metabolism of carbohydrates, fats, and proteins. Liver transplant is used to treat various conditions which cause liver failure, such as cirrhosis or liver cancer. Kidneys - Pair of organs that maintain proper water and electrolyte balance, regulates acid-base concentration, and filters the blood of metabolic waste, which is excreted as urine. A kidney transplant may be recommended for those who have been diagnosed with chronic end stage renal disease. Lungs - A pair of spongy organs that remove carbon dioxide from the blood and provide it with oxygen. Lung transplants are recommended for those with severe lung disease. Sometimes there is a combined heart and lung transplant. Pancreas - Long, irregularly shaped gland which lies behind the stomach and aids in the digestion of proteins, carbohydrates, and fats. Pancreas transplant is indicated for those with insulin-dependent Type I diabetes.

        Tissues that can be donated are: Cornea - The outer curved transparent tissue covering the iris and pupils on the outside of the eye. Corneal transplant is a common procedure used to restore vision for those with eye diseases and corneal infections. Skin - A tissue which protects the body from infection and injury. Skin transplants, referred to as skin grafts, are used to treat severe burns, extensive wounds and skin loss due to infection. Heart Valves - Tissues that prevent the back flow of blood into the heart. Heart valve transplants are used to treat malfunctioning heart valves caused by infections, birth defects and aging. When an entire heart is not usable, heart valves are removed from the heart and are used for transplants. Bones - Connective tissues that are dense, semi rigid, porous, and calcified forming the major portion of the skeleton of most vertebrates. Bone transplantation is done –for reconstruction related to trauma, tumors, disease and fractures and fill defects. For the recipient, it restores mobility, decreases pain and prevents amputation and collapse of bone. Tendons - Tissues which attach muscles to bones. Tendon transplants are recommended for patients who have lost muscle function and due to nerve injury or damage to tendons. It improves the recipient’s life and makes it pain free.

    • 4. Can I sell my organs?
      • No. The Transplantation of Human Organs Act makes it ILLEGAL to buy or sell human organs and tissues. Violators are subject to fines and imprisonment.

Brain Death

    • 1. When is a patient declared dead?
      • A person may be declared dead due to Cardiac Arrest or due to Brain Death.

    • 2. When was brain death accepted as a form of death?
      • In 1959 two French physicians first recognized Brain Death in patients being ventilated in the intensive care units and called it coma depasse (a state beyond coma). In 1968, brain death was defined as irreversible coma with the patient being totally unreceptive and unresponsive with absence of all cranial nerve reflexes and no spontaneous respiratory efforts when disconnected from the ventilator. Since then brain death has been accepted as a form of death.

    • 3. Which doctors are responsible for the declaration of brain death?
      • In case of Brain death certification, two doctors from the hospital and two from the government approved panel will work together on conducting the tests for brain death. One of the doctors has to be a neurologist or neurosurgeon or intensivist.

    • 4. What tests are done to confirm irreversible damage to brain stem?
      • There are a series of tests listed in the Transplantation of Human Organs Act that the doctors perform. These tests are basically to confirm that there is irreversible damage to the brain stem and involve cranial nerve testing and apnea testing.

    • 5. Is the police department involved in any way for the declaration of brain death?
      • The police department has to be informed that a patient is brain dead if it is a medico- legal case, but the declaration of brain death is only done by a panel of doctors.

    • 6. Why can organs of a brain dead patient be used for transplantation and not those of a patient who has died of a cardiac arrest?
      • Solid organ donation (heart, lungs, liver, pancreas, kidneys) requires blood circulation to be maintained in these organs until retrieval. This is possible only in brain death where the functioning of these organs can be supported for some time.

Ethical Issues

    • 1. Is it possible to jump the waiting list if you are rich, well connected and influential?
      • No. In India, the allocation of organs to recipients on the waiting list is based on predetermined criteria which include date of registration and medical criteria. The wealth, race, or gender of a person on the waiting list has no effect on when and whether a person will receive a donated organ. The Transplantation of Human Organs Act of 1994 makes it illegal to buy or sell human organs in India.

    • 2. How do we know that the doctor advising the transplant is right?
      • The conscience, character and competence of a good doctor are sufficient to allow us to discuss and make decisions regarding transplantation. The basic ethical principles commonly followed in medicine are also applied to various aspects of organ donation and transplantation.

        These are a few of the main principles all doctors follow:

        · The health of a patient is the first consideration
        · The transplantation and/or organ donation is done with conscience and dignity
        · Considerations of religion, nationality, race, party politics or social standing will not intervene between duty and patient
        · To respect patient confidentiality

    • 3. How is a potential recipient identified? If my organs are donated, who decides who receives them?
      • In Kerala, the Kerala Network for Organ Sharing (KNOS) maintains and operates a state based computerized waiting list of patients with organ failure. The wait list is based various criteria such as time of registration, medical urgency and location. This system matches each wait-listed patient against a donated organ to see which patient is the best match based on factors such as body size, weight, and blood type of the donor and recipient, how sick the patient is, how long the patient has been waiting for a transplant. Each private hospital also has its own wait list based on independent hospital criteria and this is added on to the state list. Each transplant centre/ hospital has a turn at the common pool of organs.

Legal Issues

    • 1. Who certifies that a patient is brain dead?
      • The Government has specified that a panel of doctors will certify brain death and not a single doctor.

        The panel consists of:

        1. Doctor in charge of the hospital (medical superintendent)
        2. Doctor nominated from a panel of Doctors appointed by the appropriate authority
        3. Neurologist/neurosurgeon/intensivist nominated from a panel appointed by the Appropriate authority
        4. Doctor treating the patient.

        These four doctors carry out the tests together to certify brain death.

    • 2. Who can legally sign a consent form which allows doctors to retrieve a brain dead person’s organs?
      • A person legally in possession of the deceased person can sign the consent form. This is usually done by a parent, spouse, son/daughter, brother /sister.

    • 3. What are medico legal cases?
      • When an accident victim is brought to a hospital for emergency treatment, then an FIR has to be filed by the family in the nearest police station. Such cases are usually called medico-legal cases. Any medical treatment (for suicide, assault, poisoning or fall) which needs that the police should be notified becomes a medico-legal case.