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Cadaver organ donation in India

Parul Chopra, DoctorNDTV

Cadaver organ donation in India

Organ donation takes healthy organs and tissues from one person for transplantation into another. Experts say that the organs from one donor can save or help as many as 50 people. The organs that can be donated include: 

  • Internal organs: kidneys, heart, liver, pancreas, intestines, lungs
  • Bone and bone marrow
  • Skin
  • Cornea
Human-to-human transplantation of organs has been accepted by doctors worldwide as the best line of treatment and often the only one for a wide range of fatal diseases such as End Stage Renal Disease (kidney failure). Organ transplantation has been one of the greatest advances of modern science that has resulted in many patients getting a renewed lease of life. A living person can donate organs, after natural death or after 'brain death'. After natural death only a few tissues can be donated (like cornea, bone, skin and blood vessels) whereas after brain death almost 37 different organs and tissues can be donated including critical organs such as kidneys, heart, liver and lungs.

Human organ donation is fast developing into a major treatment protocol. However it is yet to make any significant dent in India. 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.

Transplantation of human organs act, 1994

An Act was passed by the Government in 1994 to streamline various organ donations and transplant activities in the country. The aims of this act was to: 
  • Regulate removal, storage, and transplantation of human organs for therapeutic purposes.
  • Prevent commercial dealings in organs.
  • Accept brain death and make it possible to use these patients as potential organs donors.
The Human Organ Transplantation Act has legalised the concept of brain death for the first time in India. Since the passing of the legislation in India, it has become possible to undertake organ transplants from brain dead donors. Furthermore, relatives need to be educated about the futility of keeping brain dead accident victims 'alive'. A good motivator is needed to encourage people to donate organs.

Historical milestones

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.

Problems with cadaver organ donation 
  • Legal Problem - the present form has certain pitfalls and streamlining is required
  • Hospital problem - efforts to identify & maintain brain dead donor
  • Community problem - lack of awareness of brain-death concept
  • Government problem - no funding
Organ donation awareness

The successful implementation of organ donation hinges on the education of the masses and having more trained transplant co-ordinators. What is needed is a proactive attitude towards cadaveric organ donation, counselling for relatives for organ donation in the event of brain death, adequate hospital infrastructure, matching and distribution of the organs and co-ordination amongst hospitals. The Indian society, mired in traditional beliefs, is not very amenable to the idea of cadaver organ transplants, as they want the last rites to be performed without any damage to the bodies at all. What they fail to realise is that in a country with a long waiting list for transplants, they are spoiling the chance of somebody to lead a normal life for, say another few years, just because they want to consign the whole body to flames.

The government could make it compulsory to donate organs of brain dead patients so that the wastage of organs, and thereby shortage, is solved. One brain dead patient can help seven patients in critical stages to lead normal lives. According to cardio-thoracic surgeons the heart of a cadaver can be kept alive for five hours and can even be flown from one city to another if needs be and transplanted. Cadaver organ donation ennobles the dead through the living.

Others measures -
  • Enlarge panel of doctors who can certify brain death education at school and college level
  • Free air time on television channels for films on organ donation
  • Tax exemption for documentaries on organ donation
  • Honouring cadaver donor families
  • Indirect incentives to donor families
Support groups

Organisations helping out with networking hospitals in their own location who have made some difference to the programme- 

FORTE - Bangalore
MOHAN and TANKER - Chennai and Tamil Nadu
NKF, ZTCC and Narmada, MOHAN - Mumbai
ORBO, HOPE, DONATE (Delhi Organ Procurement Network and Transplant Education) - Delhi
MOHAN - Hyderabad

Source: MOHAN Foundation

Wednesday, 24 March 2010
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