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 later is the recipient. People of all ages can become donors. What is Organ donation?

NEED OF THE HOUR In India 10 Lakhs need Organ Donation

Historical Milestones IN INDIA In 1967 the first successful cadaver kidney transplantation in KEM Hospital, Mumbai was done. In 1994 the first successful heart transplant was done at AIIMS, New Delhi and in 1995 the first successful multi-organ transplant was done at Apollo Hospital, Chennai. Until 1997, only four hospitals in India were undertaking cadaver transplants. However, now more and more hospitals are taking up the programme. From 1995 to 2001 there have been a total of 426 cadaver transplants in India including kidney (377), heart (34), liver (12), pancreas (2), lungs (1). This averages to just over 50 cadaver organ transplants a year.

A country with a population of over 1 billion people, India lags behind in the implementation of a cadaveric donation programme. Annually, while over 100,000 Indians suffer from End Stage Renal Disease, only a mere 3,000 are recipients of a donor kidney, of which only a small percentage are cadaver organs. In fact, the total number of patients who have received cadaver kidneys in India from 1995 to 2003 is only 524, an abysmally small figure. The major problem now facing transplant surgery is a critical shortage of available organs.

Organ Donation Type of donors Some organs can be donated by a living person Almost all organs can be donated by someone dead but this has to reach the recipient within a few hours after the donor's death. In case of live donation the donor should give his consent. In case of cadaver donation, relatives need to provide consent.

Organ Donation Voluntary Donation E verywhere organ donation is voluntary Two voluntary systems include – 1.Opt In - Where the donor gives consent 2.Opt Out - Where anyone who has not refused is considered as a donor In India we have the Opt in system, while many western countries practice the opt out system

Organs for Donation Some of the organs that are commonly donated …,

KIDNEYS

EYES

HEART

LUNGS

LIVER

PANCREAS

SKIN

BONE MARROW

BLOOD

DONATIONS BEFORE DEATH BLOOD KIDNEY LIVER (1/4)

From each cadaver organ donor 50 persons will be benefited

Pre-Transplantation Evaluation Blood Type (A, B, AB, and O) Rh factor does not matter Human Leukocyte Antigen (HLA); antigens on WBC; familial matching can be or 0% Crossmatch Serology; for HIV, CMV, hepatitis Cardiopulmonary, cancer screening

Recepient Qualification Most cases <60 yr old Disqualified if: –Recent MI –Active infection –Malignancy –Substance abuse –Limited life expectancy from unrelated disease

Diagnosis of Brain Death Pt suffered irreversible loss of brain function (either cerebral hemisphere or brainstem) Establish cause that accounts for loss of function Exclude reversible etiology:

Brain Death Ancillary Testing to Include: – EEG – Nuclear scan – Angiography for absence of cerebral blood flow - Brain death determined after 6 hr with cessation of brain function, 12 hr without confirmatory testing - Documentation

In SPAIN, BELGIUM, AUSTRIA almost every Brain Death patient will donate Organs

Organ Donation after Cardiac Death Death declared on basis of cardiopulmonary criteria— irreversible cessation of circulatory and respiratory function.

Key Elements in the Process of Donation after Cardiac Death Withdrawal of life sustaining measures Pronouncement of death from time of onset of asystole (usually btwn 2-5 minutes); 60 sec is longest reported time of autoresuscitation Liver within 30 min and kidney within 60 min

Organ shortage - reasons Family consent, and negative attitude contribute towards organ shortage. This could be due to the following reasons – Religion Fear, ignorance and misunderstanding Legal aspects Media reports on scandals involving organ rackets

Improving Organ Donation Currently organ donation can be termed as a "crisis with a cure." The following are some ways to improve organ donation- Improved patient care to facilitate easier approach for organ donation, in case of patient death Trained transplant co-ordinators and grief counsellors Improved hospital infrastructure Qualified Intensivists and Surgeons contd..,

Improving Organ Donation Increased HLA typing and cross matching facilities Improved facilities in packing,transport and retrieval of organs Supporting organization for networking and registry maintenance Effective use of technology to facilitate organ donation

Role of society Society plays a crucial role in transplant programme especially in case of cadaver transplants. There is a urgent need for increased public awareness regarding organ donation and greater effort must be taken to dispel public concerns regarding the same. Organ donation can give a new twist to tragedy. Remember "organs wasted are lives lost".