Cadaver transplant of Human Organs. Dr. Rajesh Bharani. 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.
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Cadaver transplant of Human Organs
Dr. Rajesh Bharani
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.
What is Organ donation?
NEED OF THE HOUR
need 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.
Voluntary Donation Everywhere 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 donorIn India we have the Opt in system, while many western countries practice the opt out system
Organs for Donation
Skin and Bones
Some of the organs that are commonly donated …,
Annual Number of kidney transplantations per million population (pmp) per year -
USA- 52 Predominantly Cadaver Donors
Europe -27 Predominantly Cadaver Donors
Asia - 3 Predominantly Living Donors
In last 10 to 15 years the rate of both kidney and liver transplants have increased but heart has remained static. In 2000 approx. 15,000 kidneys were transplanted in each region.
Transplantation proceedings 2009: 41:2772-4
Need of hour
1967 - First successful cadaver Kidney Transplant in India at KEM Hospital, Bombay
1994 - First successful heart transplant done at AIIMS, N.Delhi
1995 - First successful multi-organ transplant done at Apollo Hospital, Chennai
1998 – First Successful Lung transplant, Madras Medical Mission Hospital, Chennai
1999 – First Pancreas Transplant, Ahemdabad
Body Donation V/S Organ Donation
Each Body Donation –
10-15 medical students benefited
Each cadaver organ Donor –
50 persons benefited
Community Problem No Awareness of “Brain- Death” Concept, Misconcepts
Hospital problem No efforts to identify & maintain “Brain Dead” donors
Govt. Problem No Funding for programme
Spain has the highest number of brain death patients going
on to organ donation – 32 per million population
Media & Organ Donation
There is underreporting of brain death cases.
Neurologists and Neurosurgeons have to take lead
In Tamilnadu- Declaration of braindeath has been made mandatory in medical colleges. G.O. No. 75 dated 03.03.2008.
Hospital Infra-Structural & Support Logistics
Adequate No. of Qualified Intensivists in ICUs
Well qualified Surgeons to undertake Retrieval & TX
Support Organisation to Network
Transport of organs –between cities
HLA Tissue typing and Cross-match
MOHAN Foundation (INOS) - Tamil Nadu, Andhra Pradesh, Maharastra
236 Organs shared. ( 212-Kidneys, 9-Hearts, 15-Liver )
FORTE, BANGALORE – 32 Organs Shared
( 32 - Kidneys, 1- Heart, 1- Liver )
ZTCC, Mumbai – 55 Organs Shared - all kidneys
ORBO, N.Delhi – Few organs shared
SORT, Cochin – 4 organs shared
“society remains a crucial aspect in a transplant programme”
The presence of family during brain stem death testing. Doran M. Intensive Crit Care Nurs. 2004 Feb;20(1):32-7
Current organ donation rate - India is 0.05 per million population per year
If in India - 1 per million donation rate we would have 1100 organ donors – 2200 kidneys,1000 hearts, 1100 Livers, 2200 Eyes
At 3 per million Donation rate we would have 3300 organ donors – 6600 kidneys,3300 hearts, 33001 Livers, 6600 Eyes
At 10 per million donation rate- 11,000 organ donors
22,000 kidneys, 11,000 hearts, 11,000 Livers, 22,000 Eyes
20 per million donation rate - 22,000 organ donors
44,000 kidneys, 22,000 hearts, 22,000 Livers, 22,400 Eyes
Source: Indian Transplant Newsletter Issue no.19 Feb 2006
What is Required
Need of time
Formation of state level coordination committee to streamline project
SOP for declaration to transplantation
Common waiting list of patients
Common lab for Cross match of tissue
Proper format for unbiased distribution of organ.
Committee should decide for best possible recipient for said organ
All center should work under committee
Cadaver Transplant - Conclusion
Organ Shortage is a Crisis, however the Crisis has a Cure
In my end is my beginning - T.S.Eliot, Four Quartets