Doctors Role

in Tackling Organ Trade

Bruno Mascarenhas JMA
Kidneys

When One Kidney fails . . .
The other kidney does the work
Rarely Symptomatic
When Both Kidneys Fail
Acute Renal Failure
Chronic Renal Failure
Acute Renal Failure

Chronic Renal Failure. . .
How to get the other Kidney
Relatives of a Patient whose Brain
Stem is Dead agree to donate the
patients kidneys
A Live Relative or Some one with an
emotional bond Donates one of his
kidney
A stranger sells for money (This is
ILLEGAL)

Unfortunately . . .
The least preferred route was being
widely used

http://photography.nationalgeographic.co.in/photography/enlarge/kidney-
donors_pod_image.html
Villivakkam kidneyvakkam
Not limited to one locality .
How to tackle this
Multidisciplinary Approach
Legal
Lawmakers
Judiciary
Police

From Health Point of View
Kidneys Needed
+ Patients with Renal Failures
Number of Kidneys Available
+ Kidneys donated by live donors
+ Kidneys donated from Brain Stem Dead
Patient
Rearrange this
Chronic Renal Failure = Live Donor +
Cadavers
Live Donors = Chronic Renal Failure -
Cadavers

Reduce Live Donors
Reduce the Need by reducing Renal
Failure
Increase Donation from Brain Stem
Dead Patients


Reduce Demand
Reduce Renal Failure
Life Style Modifications


What is meant by
Brain Stem Death
A Dead Brain stem in body whose
heart is still beating is what is
Brain Stem Dead in simple terms
This has become a reality because of
advancement in intensive care /
pharmacotherapy etc.


Brain Stem Death
Do all human beings who die pass
through this stage?
No. Only 1% of all death pass
through this stage
The state of brain Death is a brief
period in minutes
Donation from Brain Stem Dead
Patients . . . . . .

March 2007

March 2007
Four Working Groups:
Cadaver organ donation
Cadaver organ transplantation
Coordinating Organization for organ
sharing
Live donation and transplantation
33 recommendations for follow up
action.

Lack of proper mechanism for
identifying the recipients
Trauma Centres
Transplant Centres
Lack of Co ordination Mechanism

After March 2007
The participants felt that there were many
grey areas in the Transplantation of
Human Organs Act.
In particular, no guidelines on who will
get the donated cadaver organ
The Government followed up with a series
of consultative meetings held with groups
of doctors by Mr.P.W.C.Davidar

Series of Government Orders in
2008
Brain death Declaration of brain death
made mandatory in Government Medical
College Hospitals in Chennai Orders Issued.
Brain death Declaration of brain death made
mandatory in Government Medical College
Hospitals in Chennai Procedure for
declaration of brain death orders issued.
Health & Family Welfare Department Organ
Transplant Authorization Committee
Procedures Additional responsibilities
Detailed instructions orders issued.
Series of Government Orders in
2008
Health & Family Welfare Department
Organ Transplant Cadaver Organ
Transplant Program Procedure to be
adopted for cadaver transplant by the
Government and Private Hospitals
approved for organ transplant by the
Appropriate Authority orders issued.
Health and Family Welfare Department
Organ Transplant Responsibilities
of Transplant centers in hospitals
Detailed instructions Orders issued.
Cadaver Transplant Programme,
Government of Tamil Nadu
Prof Dr J Amalorpavanathan, Professor of
Vascular Surgery, MMC & RGGGH
appointed as Convenor, Cadaver
Transplant Programme in honorary
capacity
Office space provided at the Government
General Hospital
Advisory Committee headed by Health
Secretary, GoTN
Mr Davidar,
DMS, DME, TNMSC,
Police Dept, 2 NGOs, 1 Medical Ethicist,
3 Government Hospitals, 4 Private Hospitals


Tamil Nadu Network for Organ
Sharing
Initiatives for forming Tamil Nadu
Network for Organ Sharing and
maintaining a common online waitlist
for all potential recipients in all
hospitals who choose to come under
this network in Tamil Nadu and
allotment of organs by the Network
Common Waiting List (based Blood
Group) visible to all stakeholders
Allocation based on waiting List

Initiatives for Transplantation
from Deceased Donors
Transplant co ordinators
Elective Operation theatre to be
used at the Night Time and Odd
Hours for Organ harvesting and
Transplants

20th September, 2008

2008 : Turning Point
8 Government Orders
Noble Gesture of Dr. Ashokan (Alumni
of Chengalpet Medical College 1980
Batch) and Dr. Pushpanjali,
Thirukazhukundram,
More Brain Dead Certification
More Donation
More recipients benefited
From 2008
Convenor runs the CTP
Overseen and supported by the
Advisory Committee which keeps
watch and amends Guidelines as
needed
Participating hospitals to keep
providing inputs to improve the
Guidelines

CoTP - GoTN
Register willing transplant hospitals in
the organ sharing network
Keep them posted of the regulatory
framework
Convene meetings of the Advisory
Committee and take follow up action

CoTP - GoTN
Take calls 24X7 from donor hospitals,
allocate organs and co-ordinate till
transplants take place
Send periodic reports
Maintain database of cadaveric and
live donor transplants
Maintain website www.dmrhs.org
Convene meetings of hospitals for
ideas on improving the framework

CoTP - GoTN
Hospitals treating patients with End
Stage Organ Failure (Kidney failure or
liver failure or heart failure) register
those willing for transplant at the
online database www.tnos.org
Waiting List is maintained online and
is watched by all hospitals in the
programme

One Master List for each Blood
Group and based on it, lists for
Each hospital
All Government hospitals combined
All private hospitals combined and
All Hospitals Combined

Donated at Government
Hospital
1st priority - List of the Government Hospital
where the deceased donor is located, for liver,
heart and one kidney. The other kidney world be
allocated to:
2nd priority - combined Government Hospitals list
3rd priority - combined Private Hospitals list
4th priority - Government Hospitals outside the
State,
5th priority - Private Hospitals outside the State
Finally, if the organ(s) remains unutilized by the
above criteria, it may be offered to a foreign
national registered in a Government or Private
hospital within and then outside state. (This is to
ensure that there is no wastage of organs
donated)

Donated at Private Hospital
1st priority - the list within the Private Hospital
where the deceased donor is located, for liver,
heart and one kidney. The other kidney world be
allocated to:
2nd priority - the combined list of Government and
Private Hospitals
3rd priority - Government / private hospitals
outside the state
Finally, if the organ(s) remains unutilized by the
above criteria, it may be offered to a foreign
national registered in Government or private
hospital within and then outside the state,
provided earlier information and such a request
has been registered with the Advisory committee
/Convenor, Cadaver Transplant Program, Tamil
Nadu.

From 2008 Till Jul 31,2013
374 Donors From Tamil Nadu
58 Heart
24 Lung
339 Liver
689 Kidney
1110 Major organs
390 Heart Valve
578 Cornea
1 Skin
2079 Total Organs
689 Kidneys donated means
689 Patients with Chronic Renal
Failure have been benefitted
+
689 Healthy patients were not
operated
4 Heart Transplants in
RGGGH
Only State Government Hospital to do
Heart Transplants
And Totally Free of Cost
Liver Transplants in Stanley
Medical College Hospital
Only State Government Hospital to do
Liver Transplants
And Totally Free of Cost
10 times National Average
Deceased Donation (ie Donation from
Braid Stem Dead patients) Rate in TN
is 1.3/million/year which is 10 times
the national average
WHO
In July 2010, a 14 nation WHO meet
in Geneva to establish a blue print to
improve organ donation in UN
Countries, put in TN Experience as a
key point in the blue print prepared
Many states have followed TN Model
Hindu Op-Ed article,
25/10/2010
New lives out of deaths
V.K. Subburaj, P.W.C. Davidar, J.
Amalorpavanathan and C.E. Karunakaran Tamil
Nadu shows the way in organ transplantation.
If your liver has failed and you need a
functioning organ to be transplanted for
you to survive then go to Chennai: this is
the buzz among liver-failure patients across
India The State has done 110 deceased
donor liver transplantations in a period of
less than two years. All other States put
together have not done even half this
number.

British Medical Journal

HOW DECEASED DONOR TRANSPLANTATION
IS IMPACTING A DECLINE IN COMMERCIAL
TRANSPLANTATION - THE TAMIL NADU
EXPERIENCE TRANSPLANTATION JOURNAL

Yuvaram N V Reddy(1), Milly Matthew(1), Saravanan S(1),
Amalorpavanathan(3), Georgi Abraham(1,2), Sunil Shroff(4)
Abstract
India with a population of 1.2 billion has a renal transplantation rate
of 3.25 per million population. The major cause of chronic kidney
disease is hypertension and diabetes. The crude and age adjusted
incidence rates of ESRD are estimated to be 151 and 232 per million
population respectively in India. There was a remarkable lack of
knowledge in the public about deceased organ donation until a
decade ago. However, the role played by the media and Non
Governmental Organizations in partnership with the government has
emphasized and implemented deceased donor transplantation in
certain states in India - to mention particularly, the Tamil Nadu
model. In the last two years, deceased organ donation has reached
1.3 per million population in Tamil Nadu thereby effectively
eliminating commercial transplantation. There is no religious bar for
organ donation. A central transplant coordinator appointed by the
government oversees legitimate and transparent allocation of
deceased organs both in the public and private facilities as per the
transplant waiting list. This model also takes care of the poor
sections of society by conducting donation and transplantation
through government run public facilities free of cost. In the last two
years, deceased donor transplantation has been performed through
this network procuring organs such as the heart, heart valves, lung,
liver, kidneys, cornea and skin. The infrastructural lack of
immunological surveillance - including donor specific antibody
monitoring, HLA typing, panel reactive antibody except in a few
tertiary care centres - prevents allocation according to the
immunological status of the recipient. This private-public partnership
promoting deceased donor transplantation has effectively eliminated
commercialization in transplantation in the state of Tamil Nadu with
a population of 72 million which is a model for other regions of South
Asia and developing countries.

CADAVER TRANSPLANT PROGRAM, TAMIL NADU
News Articles
CADAVER TRANSPLANT PROGRAM, TAMIL NADU
Take Home Message
Any Surgery Carries a Risk,
Lets not subject a healthy human to
a risk by being a donor
Discourage Live Donors
Encourage Registration in TNOS
and wait for Cadaver Donor

Take Home Message
Deceased Donor Transplant will eradicate
women slavery where more than 90% of
living related Kidney Donors are women
This is a social responsibility of the
Doctors for the Society from which they
should not shy away
Though Tamilnadu is way ahead other
states in Deceased Donor Transplant we
still have to work hard to move forward in
other states and centres


We gratefully acknowledge
Extremely dedicated Neuro
consultants
Intensivists who are willing to
manage the patients with severe
Brain Stem Dysfunction
Anaesthesiologists who are willing to
do Apnea testing
Administration who are willing to
support this programme


We gratefully acknowledge
The contributions made by all the
patients
The relatives who took the noble,
valiant, gallant decision of donating
the organs of the deceased

We gratefully acknowledge
Officials in Government
Thiru.V.K.Subburaj I.A.S.,
Secretary to Government, Health and Family Welfare
Department, Government of Tamilnadu

Dr.GIRIJA VAIDYANATHAN, I.A.S.,
Secretary to Government, Health and Family Welfare
Department, Government of Tamilnadu

Dr.J. RADHAKRISHNAN, I.A.S.,
Secretary to Government, Health and Family Welfare
Department, Government of Tamilnadu

Thiru.P.W.C.Davidar IAS,
Principle Secretary, P & AR, GoTN

Dr.J.Amalorpavanathan
Convenor, Cadaver Transplant Programme

Prof.Dr.K.Deiveegan MS MCh
Professor of Neurosurgery and Head, Institute of
Neurology, Madras Medical College and Rajiv Gandhi
Government General Hospital

Prof.Surendran MS MCh
Former Professor of Surgical
Gasteroenterology, Stanley Medical College

NGOs





Dr.Shroff Mr.CE Karunakaran
Future . . .
Split Liver : Single Liver for an Adult
and one more child
Utilize More Hearts
Study the Outcome of Transplant
Recipients
Increasing awareness of whole body
donation
One of the Oldest Hospitals . .

Road Safety
Government General Hospital
Established in 16 Nov 1664
Road Safety
Now in its 350
th
Year
Now named Rajiv Gandhi Government
General Hospital
06-Jan-2012 Road Safety 66

67
Madras Medical College
Established in 1835
Road Safety
Now in its 179
th
year