Organ Donation: An Act that Can Save Lives

• 29 Nov 2018
• Organ Donation

Geeta (named changed) lies listless and expressionless in the cardiac ICU of Medanta-The Medicity. All of 37, doctors say Geeta suffers from end stage heart failure and is in desperate need of a new heart. If she doesn’t receive a heart soon, Geeta could die. Doctors at the hospital overseeing Geeta’s treatment say they cannot discharge her because her heart will collapse without the life support systems plugged into her. So, for now she and her family are hoping and praying, someone agrees to donate their organs after death so that Geeta gets another shot at life. It is said the act of donating one’s organs after death saves at least 8 lives; people like Geeta who live on the brink of death every day.

According to the National Organ and Tissue Transplant Organization (NOTTO) set up under the Ministry of Health and Family Welfare, Government of India, every year, around 2,50,000 people need kidneys and approximately 1,00,000 people need corneas. There are about 80,000 people in need of a liver and 50,000 for a heart. It is said over 5 lakh people die every year due to the unavailability of organs.

How Organ Donation Helps

Vital organs for transplantation include the heart, liver, pancreas, intestine, kidneys, and lungs. Also, tissues can be recovered, including corneas, bone, skin, heart valves, tendons and veins.

Those in need of an organ transplant can be people suffering from end-stage diseases of the organs or may have damaged it due to serious injury. Diseases like acute kidney and liver failure, diabetes, terminal lung illness, heart failure, heart valvular disease, burns and corneal blindness can be treated through donated organs.

How Does It Work?

Organ donation can take place under two situations. In Living Organ Donation, if someone is 18 years or above, they can legally volunteer to donate a part of some of their organs. Living donors can donate a part of their liver or lungs, a segment of the pancreas and one kidney. This does not create health issues in the donor as one kidney is sufficient for the functioning of the body; the liver and lungs regenerate with time and a portion of the pancreas can perform pancreatic functions needed by the body.

There are three types of donors under living organ donation:

• Near-related donors: Immediate family members like parents, siblings, children, grandparents,  grandchildren and spouse are allowed to donate to a recipient.
• Other near-related donors: Anyone who is a relative or well-wisher of the recipient can donate their organs.
• SWAP donors: Often immediate family, relatives and well-wishers are unable to donate to the person in need due to reasons like blood group mismatch. This is when ‘swap donations’ happen, where two families come together and donate to each other. Donors are ‘swapped’ in such a scenario.

Deceased Organ Donation is possible if a patient is declared brain stem dead; a situation where the patient’s brain has stopped functioning and is dependent on life support systems to keep the other vital organs working. A person termed ‘brain dead’ is kept alive through a support system until their organs can be surgically removed to help those in need of organs.

The vital organs can only be donated if the person is in a hospital and a doctor has declared him/her to be brain dead. An organ transplant done from a deceased organ donor is commonly called a cadaveric transplant.

The organs must be removed from the deceased donor and transplanted to the recipient within the following time frame:

Source: NOTTO

While the organs can be kept alive in case of brain stem death, they die within a few minutes in case of a cardiac arrest. Nonetheless, a person who suffered a cardiac arrest can still donate their corneas and tissues like skin, veins, tendons, ligaments, blood stem cells and cartilage but these have to be harvested within a few hours.

Who Can be a Donor?

Anyone can be a potential donor irrespective of their age and health. However, NOTTO suggests some age limits for deceased organ donation.

A person cannot donate if they have active cancer in the body or a systemic disorder because these conditions might spread in a recipient’s body as well.

Those who want to register for organ donation can get a donor’s form from the NOTTO website. A printable donor card bearing the donor’s name, blood group, and the organs and tissues they would like to donate is issued shortly after the form submission. However, in India, family consent is the final deciding factor. If the family refuses permission (in spite of the deceased person registering to be a donor), doctors will not transplant any organ. When the time comes, a healthcare professional decides which organs or tissues are
suitable for transplant after going through the donor’s medical history.

A donor should remember to:

• Talk about the decision with close relatives so that processes can be put in place for a transplant in case of ‘brain death’. If the person dies in hospital, doctors and transplant coordinators (available in big hospitals) will begin the process of transplant after the family gives consent.
• If a person dies at home, the nearest government or big private hospital can be contacted. However, this needs to be done immediately. Only eyes and some tissues can be harvested if a person has died at home.
• Always keep the donor card handy.

Common Concerns

According to doctors, Indians have certain misconceptions about organ donation which they are trying to bust every day. Some of these include:

CONCERN: The religion one practices does not allow organ donation.

DOCTORS SAY: Talk to a spiritual or religious leader or advisor to verify this because according to them no religions bars people from donating their organs.

CONCERN: The body, especially the face, is disfigured after organ donation.

DOCTORS SAY: Today, techniques in modern medicine ensure that minimal external damage is caused when retrieving organs. Even corneas are removed without harming the external eye socket so the shape of the face is retained.

CONCERN: Medical treatment may be compromised if one is a registered organ donor

DOCTORS SAY: This is a completely wrong notion. A patient is treated in all possible ways even if they are registered donors. Only after two sets of doctors declare a patient as ‘brain dead’, do retrieval and transplant specialists come in to consult with the family regarding organ donation.

CONCERN: Funeral rites will be delayed if one has to donate organs.

DOCTORS SAY: Funeral rites cannot be immediately performed if organs are to be donated. The person has to be declared brain dead by two set of doctors within an interval of six hours. Each set of doctors carry out tests to confirm the death, after which the harvesting of organs begins. This could take another couple of hours. This means that families will need to be a little flexible about the timings of funeral rites.

CONCERN: Organs are sold in the black market.

DOCTORS SAY: As per Transplant of Human Organ Act (THOA), buying/ selling of organs in any way is punishable and has a significant financial as well judicial punishment.