Organ Transplantation Awareness Program

- Resident Medical Officer Community Medicine

Not an uncommon sight…

Outcome

Common unfortunate outcome

Outcome Can be Changed

OutlineNeed of organ donationTypes of Organ DonationWhich Organs can be DonatedConcept of brain deathCommon conditions leading to brain deathDiagnosis of brain deathMyths related to organ donationReligious views towards organ donation

What is need?

Corneal blindness is very common in India.

More than 3 million cases in India.

60% are <12 years age group.

Only 1.5 lakh/year corneal donations in India.

What is need?1.5 Lakh new Kidney disease patient every

year and only 750 benefitted with renal transplant.

More than 5 million patients suffering from liver diseases

50,000 patients dying due to heart diseases

India is diabetes capital (2nd in world)

Skin DonationLife saving for burn patients.It makes wound healing FAST.Skin is removed using specialized

knife and preserved like a roll.Skin is taken from un exposed parts of

the body: No Disfigurement of body after Skin Donation

There is a provision of SKIN BANK to preserve donated skin.

Situation in INDIA Annually 1.6 lakh people die due to Road Traffic Accidents.

67% death occurs usually due to Brain stem death.

It means that there are 93000 potential organ donors every year.

But in reality, only 0.05 people donate their organs per 1 lakh

population.

The rate of organ donation is highest in Spain (35 per 1 lakh

population)

In India, Tamilnadu ranks first among all states.

What Can be Donated by living donor?

Kidney

Blood

Lungs

Part of liver Liver

Part of Pancreas

Living Donor

Bone marrow

2 eyesLungsHeartLiverPancreasAll Bones & tendonsBlood vessels2 KidneysIntestineMuscles & ligamentsCartilagesSkin & FasciaLarynx2 handsPenis20 Fingers

What can donated after BSD?

Great scarcity of the organs

VSWastage

of cadaveric organs

Real Problem

Deceased Donors Per Million Population

24.2521.721.6521.5

2018.1

13.1512.96

12.1810.62

6.14.3

2.70.75

0.120.05

33.68

0 5 10 15 20 25 30 35

SpainAustria

PortugalBeligium

USAFrance

ItalyCanada

United KingdomGermanyAustralia

HKSingapore

TaiwanKorea

PhilippinesJapan

de Villa VH, Chen CL, et al. Transplantation 2003; 75:S2 (Modified from)

You choose…

Understanding concept

Identify brain-dead patients

Promote Organ Donation

Solution

Concept of DeathUltimate reality of lifeSomething fearful and unwanted No discussionEnd point Clinically cessation of cardio-

respiratory function

Cardio-respiratory Arrest

Complete Cessation Of Breathing And

Circulation

Death

Concept of Brain Stem Death

Common Causes of Brain Death

Head injuryIntra cerebral

hemorrhageIschemic brain

damageTumorHangingDrowning

Diagnosis of Brain stem death(According to Harward criteria)Unreceptivity and unresponsivityNo movements or breathingNo reflexesOnly in ICU settings

HOTA act-1994Brain death a legally accepted formEstablish criteria for brain death declarationTwo independent teams to declareTwo brain death declarations with 6 hr intervalDonation only with consent of next of kinSale of such organs are prohibited

After amendment in 2013, it is called as TOHO (Transplantation of human organs) & Tissue act

Some recent Amendments in LAWSWAP donation permitted.Grand parents and grand children

included in NEAR RELATIVES.To prepare separate regional level

and State level Waiting list of Organ Recipients.

Provision of Appropriate Authority in case of Donor if Living.

Government control

ZTCC

•Maintains list of hospitals registered for organs retrieval and transplantation.•Maintains waiting list of patients who are desirous for organs.• carries fair distribution of organs based on waiting list.• waiting list is prepared on the basis of- Age- Severity of disease- Prognosis/expected survival after transplant

Organ Retrieving Hospitals

Organs Transplanting hospitals

Multi-organs transplant centres

Government control(As per HOTA act-1994)

ZTCC

No hospital can transplant organ without prior information or permission of ZTCC.

1. Today's date there are 55000 waiting for OD.2. At every 16 minutes, new one is added to

the list.3. 10 die daily from the list without the organ.

Tamilnadu is the leading state in India in OD.

New concept of SWAP donation is also emerging out

HLA matching is mandatory for all OD except Cornea, skin, bones.

Some Facts

In Maharashtra, First tissue bank was started in Tata memorial hospital Mumbai

Rates of OD-

India- 0.16/million population

USA – 22/million population

Spain- 36/million population

More than 50 organs can be donated after Brain Stem Death

Exclusion Criteria (for Deceased Donor)Absolute

◦ Age>70 Yrs◦ Renal disease ◦ Malignancy ◦ Hypertension & infective heart diseases◦ Intravenous drug abuse ◦ Seropositive◦ Rabies

Relative◦ Age <6years or >60 years◦ Mild Hypertension◦ Early Diabetes

Problems in Promoting Organ Donation

Religious mythsProfessional Ignorance Apathy to the cause Shy/afraid of discussing donation Don’t know –what to do???? Scared of bad reputation Fear of litigation Poor communication

Religious Views: HinduismBelieve in rebirth of the soulBody is cremated after deathHuman form is the highest in the

order of re-births before the soul reaches the creator

Sacrifice to the fellow humans considered equivalent to service to god

Religious laws and scriptures do not prohibit organ donation

Religious Views: IslamUntil early 90s the religious leaders

failed to approve of organ donationMid 90s the religious leader in saudi

(mecca) passed a fatwa, making organ donation after death permissible under islamic law

Religious Views: ChristianCatholics view organ donation as an

act of charityEthically and morally acceptable to

the vaticanPope john paul ii has given his support

to organ donationProtestant groups generally endorse

organ donation

Overall Religious Views

All other major religions such as Sikhism, Buddhism and Jainism do not oppose organ donation and share similar views as that of hinduism

LIFE IS AMAZING… PASS IT ON…!!!

Positive Changes

Aishwarya Rai, Amitabh Bachhan, Jaya Bhachhan, Rajnikanth, Amir Khan and many other film

personalities have pledged their Eyes at different times on media

Anil Kumble, Sunil Shetty, Yukta Mukhi, Revathi Menon and Madhavan have endorsed their views on multi-organ donation

You don’t need to be DOCTOR to save LIVES !!!

I am an ORGAN DONOR…Are YOU….???

THANK YOU…