ORGAN DONATION AWARENESS

What is Organ donation

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.

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
Almost 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 donor

In India we have the Opt in system, while many western countries practice the opt
out system.

Organs for Donation

 Kidneys

 Eyes (cornea)

 Heart

 Lungs

 Liver

 Pancreas

 Skin

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
 Role of society

Society plays a crucial role in transplant programme especially in case of

cadaver transplants. There is an urgent need for increased public awareness
regarding organ donation and greater effort must be taken to dispel public
concerns regarding the same.

Organ Donation in India

Almost 1.5 lakh people in India need a kidney, however only 3000 of them receive one.

Only 1 out of 30 people who need a kidney receive one

90% of people in the waiting list die without getting an organ.

India’s annual liver transplant requirement is 25,000, but we manage only about 800.

70% liver transplants are taken care of by a live donor, but 30% are dependent on
cadaver donations
.

Different Age criteria for organ donation

(poor eyesight not a
Corneas 0 100 years
contraindication)
(Heart Attack not a
Heart Valves 0 60 years
contraindication)
Trachea 15 60 years
Skin 16 85 years
(Paediatric donors are
Kidneys 0 75 years assessed according to weight
and size)
(size matching is usually
Liver 0 70 years
recommended)
(if unsuitable heart valves may
Heart 0 60 years
be donated)
(individual assessment of each
Lungs 0 60 years
lung performed
Ramachandra Protocol

Virology Screen for Brain Dead Patient When Organ Donation is Being Considered
 Testing for HIV, Hep B & C on all donors.
 Additional tests for syphilis, cytomegalovirus and toxoplasmosis may be necessary
 Virology testing is performed after the completion of brain stem death tests but
before the ventilator is discontinued.
 Virology screening is done after consent from next to kin.
In fact, the year 2012 has been the best yet for deceased organ donation in India. A total of
530 organs were retrieved from 196 multi-organ donors in 2012 resulting in a national organ
donation rate of 0.16 per million population
FAQ on Organ Donation
Which are the organs and tissues can be used?
It is possible to transplant twenty-five different organs and tissues including cornea, heart
valves, liver, kidneys, bone and cartilage, bone marrow, skin, pancreas, lung intestine and
more.
Aren’t these organs and tissues required to be used immediately?
No. These vital organs need to be retrieved from a dead person immediately and can be
preserved up to various lengths of time by preservation techniques. Heart and Lung can be
preserved by 4-6 hours and kidneys 48 – 72 hours. Skin and bone may be preserved for 5
years or more.
Who requires these organs and tissues?
Each of us has a number of vital organs like brain, heart, kidneys, lungs, liver etc. Failure of
any organ means certain death. Except for the brain all other organs can be replaced –
which might be life saving. Besides organs – many tissues like cornea, heart valve, skin and
bone may be used for repair and reconstruction.

Who can become a donor?

Any person in good health if dies suddenly, possibly through an accident or even other
causes like brain haemorrhage and who has been declared ‘brain dead’ can be an organ
donor. This is called the “cadaver donation” in contrast to “live donation” which is possible
only in kidney and bone marrow.

What is brain death?

Normally the death is said to occur when heart stops. But with modern technology the
heart and lungs can be made to function through mechanical support even when brain
function has completely and permanently ceased. Thus once brain death occurs; the person
becomes a cadaver with a beating heart.
How does brain death occur?
Brain death usually results from a severe head injury or bleeding in the brain that causes all
brain activity to stop. This can happen after a major road accident or brain hemorrhage due
to a stroke. This also can happen in brain tumour.
How do doctors know a ‘brain dead’ patient is really dead?
Four doctors from a panel recommended by government, carry out a series of tests to
confirm that a patient is “brain stem dead”. The standards are very strict and are accepted
medically and ethically all over the world. The four doctors are of following category;

1. Neuro Surgeon / Neuro Physician

2. Treating doctor
3. An other specialist as approved by State Appropriate Authority
4. Medical Superintendent of the hospital.
Will the doctors do everything to save life if they know that a person is an organ
donor and they can transplant these organs to others?
Doctors who treat patients in life and death situations have nothing to do with possible
donation of their organs and tissues. Every effort is made to save that person’s life. Organ
donation is not even considered till that person has died.
What is the difference between Brain Death and Cardiac Death?
Brain death occurs when person’s brain has permanently stopped. Cardiac death is said to
occur when heart stops beating. Both are legal declarations of death. Brain death does not
occur as often as cardiac death.
Are Coma and Brain death same thing?
No. Coma is decrease in brain function and thee is a chance that person may regain
consciousness. Brain death is irreversible loss of brain function. There is no chance of
recovery after brain death.
If someone is brain dead why does his heart keep beating?
As long as heart has oxygen, it continues to work. A mechanical ventilator provides enough
oxygen to the heart to keep it working. Without this mechanical support it will stop
beating. By giving brain dead patients oxygen making their heart beat with medication
controlling their Blood Pressure, their organs continue to work. That is why brain dead
patients can be organ donors. This donation of organs may not be possible if one dies out
side the ICU. Without Intensive Care all brain death is followed by cardiac arrest within
minutes. Only eyes, skin and other tissues can be donated after the cardiac death.
Will donation cause pain and inconvenience to one’s family?
Organ donation is often an immediate and lasting consolation. It is often comforting to the
family that even though their loved one has died, one or more persons can live on through
their gift of life.
In case organs are donated, can one still have normal funeral?
After someone dies, organs are surgically removed as if the person were still alive. Careful
attention to incisions and scars is made so that he can still receive a traditional burial or
cremation.
Is donating organs is against religious beliefs?
All major religious including Hinduism, Protestant, and Roman Catholic, Islam, Buddhism
and others fully support organ and tissue donation.
Is there an age to donate organs?
Anyone is eligible to be an organ donor depending on doctor’s decision. Tissues and organs
transplanted after death include corneas, heart, liver, kidneys, bone and cartilage, bone
marrow, skin, pancreas, lungs and others. One can only donate kidneys and bone marrow as
a live donor.
Can only ‘near relatives’ donate while alive?
Yes. That is the law. This law is to avoid exploitation of poor people who want to donate
their kidneys for monetary benefits. However other relatives and friends can donate as an
‘altruistic’ measure.
Is it safe to donate while alive?
Yes. The potential donor is made to undergo rigorous evaluation before the person is
accepted as donor. Doctors cannot guarantee the success in recipient but it is made sure
that the donor comes to no harm. However complications are known to occur in 1 in 1000
surgeries.
Can anyone become a donor? What is the minimum requirement to become a
donor?
The blood group should be non-interfering. If the recipient is blood group ‘O’ – only ‘O’ can
be a donor; if the blood group is AB - any blood group O, A, B & AB can be a donor. This is
for live kidney donation. Rh group (positive or negative) is not considered at all.
In cadaver organ donation the blood group match is strictly adhered. This is an ethical issue
and ‘O’ group being an universal donor will always donate to all the recipients of any blood
group and the ‘O’ group recipient will waiting for ever.
Is there any other matching between donor and recipient besides the blood
grouping?
Blood Grouping is the most important for solid organ transplantation like kidney, heart or
liver. The tissue matching and cross matching have finer implications in the long term graft
survival.
What are the steps of donation after death?
Once patient is admitted; all efforts are made to stabilize the patients. If all efforts fail,
patient is pronounced brain-dead after evaluation, testing and documentation. Consent
from the family is obtained to proceed with donation and consent from legal authorities is
obtained. In the mean time the organ donor is maintained on ventilator, stabilized with
fluids, medications and undergoes numerous laboratory tests. Recipients are also identified
for placement of organs.
Surgical team are mobilized and coordinated to arrive at hospital removal of organs and
tissues. Donor is brought to the operating room. Multiple organ recovery is performed with
organs being preserved through special solutions and cold packing. Ventilator support is
discontinued. Donor’s body is surgically closed and released.
How does one become a donor?
Once you have decided to become a donor, the most important step is telling your family.
Even if you sign the ‘donor card’ – your family still has to consent before organs are gifted.
Is it normal to get nervous when you become a donor? What are the chances of
actually donating?
An average male will live for 75 years and female 80 years. The chances of becoming an
organ donor in real are quite small.
Why do we keep hearing about ‘kidney trade every few months? Is it because
the doctors are greedy?
In India most of the transplants are from live donors since cadaver donation is still in infancy
due to lack of public awareness. Hence there are a large number of patients who have no
suitable donor and hence look for commercial donors.
All of such transplants are discouraged. But patients in a situation of life and death do
manage to convince the doctors and the authorization committee. Occasionally doctors do
turn a blind eye in order to save life.
Thus only long term solution to this problem of ‘kidney racket’ is to have a viable cadaver
transplant program in the whole country.
Why are so few cadaver transplants in the country?
No cadaver transplant programme can be successful unless there is time bound co-
ordination amongst intra hospital, inter hospital and the society at large. Cadaver transplant
activity is a hospital based activity with participation of all strata of society. The core group,
which makes the donor organ functional in recipient, is the transplant surgeons and the
Nephrologists. They in turn are dependent on entire hospital i.e. on intensivists,
neurosurgeons, neurologists, administrators, anaesthesiologists in addition to service
branches like pathology, microbiology, imaging services.
The role of Transplant coordinator is of paramount importance; since coordinator is the first
person coming in contact with the grieving family.

Common Myths & Facts

Myth 1: I am too old to be a donor

Fact : In the case of cornea and some other tissue, age does not matter. For
other organs it is the person’s physical condition, not age, which is the deciding
factor. Specialist health care professionals decide in each case which organs and
tissue are suitable. Organs and tissue from people in their 70s and 80s are
transplanted successfully

Myth 2 : My organs might not go to those who’ve waited the longest or

are the neediest
Fact : The rich and famous aren’t given priority when it comes to allocating
organs. It may seem that way because of the amount of publicity generated
when celebrities receive a transplant, but they are treated no differently from
anyone else. The organ allocation system is blind to wealth or social status.
Factors such as race, gender, age, income, celebrity status are never considered
when determining organ recipients In fact, what really counts is the severity of
illness, time spent waiting, blood type and other important medical information

Myth 3 :If I donate my organs it will cause delays to my funeral arrangement

Fact : Yes there is a possibility. However, given the altruistic nature of this
donation, families usually accept this and take it as part of the process of
donation

Myth 4 : Organ donation will leave my body disfigured

Fact: Organs are always removed with the greatest of care and respect for the
person. This takes place in a normal operating theatre under sterile conditions
by a team of specialized doctors. Afterwards the surgical incision is carefully
closed and covered by a dressing in the normal way. The operation is carried out
by specialist health care professionals who always ensure that the donor is
treated with the utmost respect and dignity

Myth 5 : My family will not get to see my body after donation

Fact : Families are given the opportunity to spend time with their loved one
after the operation if they wish. Arrangements for viewing the body after
donation are the same as after any death

Myth 6 : I am declared brain dead I might still have some chances of coming
back to life
Fact : No. brain death is an irreversible condition that results from a severe
brain injury or haemorrhage which causes all the brain activity to stop When an
individual is declared brain dead, a ventilator keeps the body supplied with
oxygen which enables the heart to continue to beat and circulate blood. Once
the ventilator is turned off the heart will stop beating within a few minutes

Myth 7 : My decision to be an organ donor will affect my medical care

Fact : No. It is the duty of a doctor to look after a patient and make every
possible effort to save the patient’s life. This is their first duty. If, despite their
efforts, the patient dies, organ and tissue donation can then be considered but
implemented only after a family gives consent

Myth 8 : My religion does not support the idea of organ donation

Fact : None of the major religions in India object to organ donation and
transplantation. If you have any doubts, you should discuss them with your
spiritual or religious adviser

Myth 9 : It is enough if I have a donor card

Fact : No. Just having a donor card is not enough. You need to carry it at all
times and also inform your relatives about your wishes so that they honour your
wish at the moment of truth

Myth 10 : Once I become an organ donor I can never change my mind

Fact : You always have the option to change your mind. You can withdraw your
registration, tear up your organ donor card and let your family know that you
have changed your mind

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