COMDENT 2022
Guided by- DR. R GANESH MDS, PGCOI; DR. B SELVAMANI MDS
Secured 1st place in TAMILNADU state level conference
- NAVEEN GOKUL R
BDS IV – PRIYADARSHINI DENTAL COLLEGE & HOSPITALS, PANDUR, TAMILNADU
HOW FAR ARE WE IN THE DONATION OF ORGANS IN INDIA? – A REVIEW
ABSTRACT
Organ Donation Day is observed every year on 13th day of August. Due to lack of awareness and widespread idea about the organ donation, there are myths and fears in peoples’ mind about donating the organs. The aim of this day is to motivate fellow human beings to pledge and donate the organs after death and to create awareness about the importance of organ donation. Indian Transplantation of Human Organs Act (THOA) 1994 & 2011 - was enacted to provide a system of removal, storage and transplantation of human organs for therapeutic purposes and for the prevention of commercial dealings in human organs. THOA is now adopted by all States except Andhra and J&K, who have their own similar laws.
Organ Donation is the process of surgically donating a donor's organs like heart, liver, kidneys, intestines, lungs, and pancreas, after the donor dies for the purpose of transplanting them into another person who is in need of an organ. According to a survey in India every year about 500,000 people die because of non-availability of organs, 200,000 people die due to liver disease and 50,000 people die because of heart disease.
Brain Stem death is recognized as a legal death in India under the THOA like many other countries, which has revolutionized the concept of organ donation after death. After natural cardiac death only a few organs/tissues can be donated (like cornea, bone, skin and blood vessels) whereas after brain stem death almost 37 different organs can be donated including vital organs such as kidneys, heart, liver and lungs. Despite a facilitatory law, organ donation from deceased persons continues to be very poor. The organ donor can play a big role in saving other’s life.
To increase the awareness about organ donation to general public and health care professionals, the Central Government of India made - NOTTO: National
Organ and Tissue Transplant Organization, ROTTO: Regional Organ and Tissue Transplant Organization and National Organ Transplant Programmes along with various public health programmes incorporating the role of public health professionals all across the country.
Keywords: Attitude; Directed tissue donation; Health personnel; India; Knowledge; Organ transplantation; Students; Tissue and organ procurement; dental.
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HOW FAR ARE WE AHEAD IN DONATION OF ORGANS IN INDIA? – A REVIEW
1. Master Title
COMDENT’ 22
Secured 1st Place
TN STATE LEVEL PUBLIC HEALTH
DENTISTRY CONVENTION (Thai
Moogambigai Dental College)
HOW FAR ARE WE AHEAD IN
ORGAN DONATION IN INDIA? -
REVIEW
- NAVEEN GOKUL R
BDS IV YR
PDCH, TN
2. Master Title
WHAT IS ORGAN DONATION ?
• Organ Donation is the process of surgically donating a
donor's organs like heart, liver, kidneys, intestines, lungs,
and pancreas after the donor dies for the purpose of
transplanting them into another person who is in need of
an organ.
• According to a survey in India every year about 500,000
people die because of non-availability of organs, 200,000
people die due to liver disease and 50,000 people die
because of heart disease.
2
NAVEEN GOKUL R, BDS IV, PDCH
3. Master Title
WHAT IS ORGAN DONATION ?
• Organ donation can provide treatment of end-stage
organ diseases as it offers a better quality of life and has
a better long-term survival benefits.
• Organ Donation Day is observed every year on 13th
day of August.
• The aim of this day is to motivate fellow human beings
to pledge and donate the organs after death and to
create awareness about the importance of organ
donation
3
NAVEEN GOKUL R, BDS IV, PDCH
4. Master Title
INDIA - NOTTO: NATIONAL
ORGAN AND TISSUE TRANSPLANT ORGANIZATION
EVERY INDIVIDUAL GETS CHANCE TO DONATE AND SAVE
LIVES 4
NAVEEN GOKUL R, BDS IV, PDCH
5. Master Title
ORGAN DONATION IN INDIA
• Indian Transplantation of Human Organs Act (THOA)
1994 & 2011 - was enacted to provide a system of
removal, storage and transplantation of human organs
for therapeutic purposes and for the prevention of
trafficking of human organs.
• THOA is now adopted by all states except Andhra and
J&K, who have their own similar laws.
5
NAVEEN GOKUL R, BDS IV, PDCH
6. Master Title
ORGAN DONATION IN INDIA
•Despite a facilitatory law, organ donation from
deceased persons continues to be very poor.
•To increase the awareness about organ donation to
general public and health care professionals, the Central
Government of India made - NOTTO: National
Organ and Tissue Transplant Organization, ROTTO:
Regional Organ and Tissue Transplant Organization and
National Organ Transplant Programmes along with
various public health programs incorporating the role of
public health professionals all across the country.
6
NAVEEN GOKUL R, BDS IV, PDCH
7. Master Title
AMENDMENTS FOR ORGAN TRANSPLANTATION
IN INDIA
THE TRANSPLANTATION
OF HUMAN ORGANS
ACT - 1994
THE TRANSPLANTATION
OF HUMAN ORGANS
ACT - 1995
THE TRANSPLANTATION
OF HUMAN ORGANS
RULES, 2008
SOURCE : THE MOHAN FOUNDATION
7
NAVEEN GOKUL R, BDS IV, PDCH
8. Master Title
ORGAN TRANSPLANTATION IN INDIA
THE
TRANSPLANTATION
OF HUMAN
ORGANS BILL, 2011
THE
TRANSPLANTATION
OF HUMAN
ORGANS
TISSUES RULES,
2014
SOURCE : THE MOHAN FOUNDATION
8
NAVEEN GOKUL R, BDS IV, PDCH
10. Master Title
WHY IS ORGAN,
TISSUES AND EYE
DONATION SO
IMPORTANT?
10
NAVEEN GOKUL R, BDS IV, PDCH
11. Master Title
THE IMPORTANCE OF ORGAN DONATION
• POWER TO SAVE LIVES
• CHARIABLE ACT WITH NO COST
• PROMOTING FELLOW HUMAN TO GROW
REGISTERED
DONORS
• RECEIVES 2nd CHANCE IN LIFE TO LIVE
• ABILITY TO HEAL, FREEDOM FROM PAIN, OR THE ABILITY
TO SEE AGAIN
RECIPIENTS
• FAMILY RECEIVES SOME COMFORT WHEN A LOVED ONE IS
ABLE TO BE A DONOR
• FAMILIES HAVE SOME CONSOLATION THAT THEIR LOSS
HELPED SAVE OR IMPROVE THE LIVES OF OTHERS
DONORS AND
FAMILIES
11
NAVEEN GOKUL R, BDS IV, PDCH
13. Master Title
WHY IS IT IMPORTANT TO REGISTER AS A
DONOR?
DONATION POTENTIAL -
LESS THAN 4% OF PEOPLE DIE IN A HOSPITAL ON A VENTILATOR
- ALLOWS FOR THE POTENTIAL OF ORGAN DONATION
LACK OF KNOWLEDGE AND AWARENESS –
LEGAL AUTHORIZATION FOR ORGAN, TISSUE AND EYE
DONATION FOR TRANSPLANT, RESEARCH AND EDUCATION
DISPROPORTIONATELY HIGH RACIAL AND
ETHNIC NEEDS -
BASED ON DISEASES AND CONDITIONS OCCURING IN
POPULATIONS
13
NAVEEN GOKUL R, BDS IV, PDCH
14. Master Title
ETHNICITY MATTERS – HELP DIVERSIFY THE DONOR
REGISTRY
SOME ETHNIC GROUPS HAVE AN UNUSUALLY HIGH NEED FOR ORGAN
TRANSPLANTS
• African Americans, Latinos, Asians, Native Americans, and Pacific Islanders are 3 times
more likely to suffer from kidney disease +liver disease
DONORS AND WAITING RECIPIENTS WHO SHARE THE SAME ANCESTRY ARE
MORE LIKELY TO MATCH.
• Compatible blood and tissue types are more likely to be found within the same
ethnicity
14
NAVEEN GOKUL R, BDS IV, PDCH
15. Master Title
THE POWER OF ORGAN DONATION
. . . AND CAN SAVE AND HEAL 75 LIVES THROUGH
LIFESAVING AND HEALING GIFTS OF TISSUE AND CORNEA
DONATION 15
NAVEEN GOKUL R, BDS IV, PDCH
17. Master Title
LIFE SAVING ORGAN TRANSPLANTS :
HEART - CAD, CHD, Cardiomyopathy, Valvular Heart Diseases
LUNG - COPD, Emphysema, Pulmonary Fibrosis,
Hypertension, Congenital Defects
LIVER - Hepatitis, Biliary Disease, Tumors, Liver Cancer,
Cirrhosis
KIDNEY - Diabetes, High Blood Pressure, End Stage Renal
Disease, Polycystic Kidney Disease
PANCREAS - Type 1 Diabetes without Renal Disease,
Hypoglycemic Unawareness
17
NAVEEN GOKUL R, BDS IV, PDCH
18. Master Title
LIFE SAVING OR HEALING TISSUE
TRANSPLANTS :
CORNEAS - restore loss of vision, cornea infection or injury
TENDONS & LIGAMENTS - sports injuries - cruciate
ligament, joint restoration
HEART VALVES - replace damaged heart valves
VEINS - CA bypass surgery, repair damaged, hemodialysis
fistula
SKIN - burn victims, diabetic wound repair, mastectomy, and
abdominal wall reinforcement
BONES - bones destroyed by cancer, trauma or infection; in
dental, spine and neck surgeries
18
NAVEEN GOKUL R, BDS IV, PDCH
19. Master Title
THE DIFFERENCES BETWEEN ORGAN DONATION
AND TISSUE AND EYE DONATION
• POSSIBLE ONLY IF A PATIENT DIES ON A
MECHANICAL VENTILATOR ( <5% OF ALL DEATHS)
• ORGANS MUST BE PROPERLY PRESERVED AND
QUICKLY TRANSPLANTED
• ORGAN TRANSPLANTATION BYPASSING SYSTEMIC
DISEASES
• LIFE SAVING PROCEDURE
ORGAN
DONATION
• TISSUES CAN BE PRESERVED FOR LATER USE
• IMMEDIATE TRANSPLANTATION IS NOT NECESSARY
• TISSUE DONATION IS EITHER A LIFE-SAVING OR LIFE-
ENHANCING PROCEDURE
TISSUES
AND
CORNEA
DONATION
19
NAVEEN GOKUL R, BDS IV, PDCH
20. Master Title
ORGAN DONATION IN TAMIL NADU
• Organ transplantation in the Indian state of Tamil
Nadu is regulated by India's Transplantation of
Human Organs Act (THOA) 1994 and is facilitated by
the Transplant Authority of Tamil Nadu
(TRANSTAN) of the Government of Tamil Nadu and
several NGOs.
• Tamil Nadu ranks FIRST in India in deceased organ
donation rate at 1.8 per million population, which is
seven times higher than the national average (~ 0.5
per million population)
20
NAVEEN GOKUL R, BDS IV, PDCH
21. Master Title
ORGAN DONATION IN TAMIL NADU
• Tamil Nadu made BRAIN DEATH CERTIICATION
MANDATORY in 2008, becoming the first Indian state to
do so – “ HITHENDRAN CASE ”
• It was also the first state to create “GREEN
CORRIDORS" to quickly transport donated organs to its
destined hospital.
• Between 2008 and 2019, about 7,783 organ
transplants were done successfully.
•Non-profit organisations - MOHAN Foundation played
a major part in the domain of organ transplantation
21
NAVEEN GOKUL R, BDS IV, PDCH
26. Master Title
WHY ORGAN DONATION IS NOT
POPULAR IN INDIA ?
26
NAVEEN GOKUL R, BDS IV, PDCH
27. Master Title
1. 46.4% of population question organ donation
- POOR AWARNESS ACCEPTANCE
2. 11.9% of population refuse organ donation -
RELIGIOUS ISSUES
3. 41.5% of population refuse organ donation -
LAWS & ETHICAL CONSIDERATIONS
KEY FACTORS FOR ORGAN DONATION
REFUSAL
Out of total 100 individuals
SOURCE : International Journal of Public Health Research 2018 Vol 5 No 2
27
NAVEEN GOKUL R, BDS IV, PDCH
28. Master Title
1. LACK OF FAMILY CONSENT
• When a person is declared brain dead it is difficult for the
family to initially accept the death, heart continues to beat.
• Brain death is often confused with coma and the family
harbors hope of the patient reviving.
•But the fact is that brain death is irreversible even if the
organs continue to function.
KEY FACTORS FOR ORGAN DONATION
REFUSAL
28
NAVEEN GOKUL R, BDS IV, PDCH
29. Master Title
2. SUPERSTITIONS AND MISCONCEPTIONS
• Most of the myths associated with organ donation are
false.
• People who are ready to donate organs often register their
wish by thinking that they will have to bear the cost till the
organ is harvested in other person’s body.
• Instead of taking an expert advice, people make
assumptions and decide to not donate organs
KEY FACTORS FOR ORGAN DONATION
REFUSAL
29
NAVEEN GOKUL R, BDS IV, PDCH
30. Master Title
3. LACK OF EDUCATION AND AWARNESS
• Lack of proper education to the attendants, lack of
awareness among general public about organ donation,
process of organ donation add to the superstitions and
misconceptions make organ donation a tedious task.
•Many times doctors are also not fully aware about the
process of organ donation and things related to it which
makes it difficult for the family of deceased or brain dead
person to take a vital decision
KEY FACTORS FOR ORGAN DONATION
REFUSAL
30
NAVEEN GOKUL R, BDS IV, PDCH
31. Master Title
4. LACK OF BRAIN DEATH DECLARATION
• In some hospitals doctors also lack knowledge about brain
death and keep the patient on ventilator for as long as it is
possible.
•Many of brain death cases occur in government hospitals
where in brain death declaration is low rather negligible.
• Also, less government hospitals are involved in the
process of organ transplantation and retrieval.
KEY FACTORS FOR ORGAN DONATION
REFUSAL
31
NAVEEN GOKUL R, BDS IV, PDCH
32. Master Title
5. LACK OF ORGAN TRANSPLANT AND RETRIEVAL CENTRES
• Not all hospitals are equipped to carry out the process of
organ transplantation and retrieval.
• Out of 301 hospitals equipped to handle the process, only
250 have registered with National Organ and Tissue
Transplant Organisation (NOTTO).
• Currently, in India, there are only 5 (ROTTO) Regional
Organ and Tissue Transplant Organisation and 6 (SOTTO)
State Organ and Tissue Transplant Organisation are in the
proposal state.
KEY FACTORS FOR ORGAN DONATION
REFUSAL
32
NAVEEN GOKUL R, BDS IV, PDCH
33. Master Title
IMPLEMENTING APPROACHES FOR
ORGAN DONATION ACCEPTANCE
33
Challenges Solutions
Awareness
Prime Minister highlighted DDOT in “Mann Ki Baat”
radio program
“Mobile caller tune, festival celebration, walkathon” on
organ donation theme
Religious, NGOs support to overcome religious, socio-
cultural barriers
Social media, TV, and digital reforms
Implementing organ pledge while applying for a driving
license in all states
Include organ donation in the education system
syllabus, developing IEC materials as per regional need
Facility for pledging for donation of organ
NAVEEN GOKUL R, BDS IV, PDCH
34. Master Title
IMPLEMENTING APPROACHES FOR
ORGAN DONATION ACCEPTANCE
34
Registry, allocation, transplant
team
Uniform data collection and data
management system
Government priority and support
Commitment of authorities, institutions,
and individuals for pledge, waiting list,
and transplant outcome registry
Government guidelines for donation after
circulatory death donors
“One Nation One Policy” for digital organ
allocation
NAVEEN GOKUL R, BDS IV, PDCH
35. Master Title
IMPLEMENTING APPROACHES FOR
ORGAN DONATION ACCEPTANCE
35
Training, capacity building
Organ transplant fellowships
Local multiorgan retrieval team to
avoid delay in multiorgan retrieval
by multiple teams
Abundancy of general surgeons
and paid on case by case basis
NAVEEN GOKUL R, BDS IV, PDCH
37. Master Title
I. FIXED DISTANCE FROM DONOR HOSPITAL
Advantages:
• Easy to explain
• Extends distribution area,
particularly for medically urgent
patients
Disadvantages:
• Fixed boundaries
• Differences in population density
may affect patients with similar
matching characteristics
SOURCE : NHS
37
NAVEEN GOKUL R, BDS IV, PDCH
38. Master Title
II. MATHEMATICALLY OPTIMIZED
BOUNDARIES
Limited
number of
large districts
Large number of localized
neighborhoods
Advantages
• Provides consistent results
• Can be monitored and scaled
Disadvantages
• Boundaries may be
complex and not uniform
• Fixed boundaries
SOURCE : NHS
38
NAVEEN GOKUL R, BDS IV, PDCH
39. Master Title
III. CONTINUOUS DISTRIBUTION
Advantages:
• Two patients who are similar in
suitability would be treated much the
same way
• Priority would consider specific
clinical characteristics about the
candidate
• More likely that organ offers would
be matched efficiently with highest
medical need
Disadvantages:
• Less easy to understand and explain
SOURCE : NHS 39
NAVEEN GOKUL R, BDS IV, PDCH
41. Master Title
CONCLUSION
India has performed 12,666 transplants in 2019, the
second-largest volume by country worldwide. Main
goals in the future will be a close collaboration by all
key players and the necessity to increase the
support of healthcare in the public sector. Cultural
and religious barriers to organ donation need to be
addressed, and educational efforts need to target
both medical professionals as well as the general
population. An expert infrastructure in hospitals
needs to assure the identification of donors and an
optimized management.
41
NAVEEN GOKUL R, BDS IV, PDCH
43. Master Title
REFERENCES
43
1. Kute, Vivek B. DM, FRCP1; Ramesh, Vasanthi MS2,3; Rela, Mohamed MS, FRCS, DSc4
On the Way to Self-sufficiency: Improving Deceased Organ Donation in India,
Transplantation: August 2021 - Volume 105 - Issue 8 - p 1625-1630 doi:
10.1097/TP.0000000000003677
2. Arvinder S. Soin, Rohan J. Chaudhary, Prashant Bhangui, Ankur Gupta, Kamal S.
Yadav, Amit Rastogi, Comment – Bold policy changes are needed to meet the need
for organ transplantation in India, American Journal of Transplantation,
10.1111/ajt.16755, 22, 1, (324-325), (2021).
3. Knowledge, attitude and practice of organ donation in urban areas of
Puducherry – A Community based study Devi K.1*, Leondra L.2, Poovitha R.3
DOI: https://doi.org/10.17511/ijphr.2018.i2.06
4. Beliefs and barriers for organ donation and influence of educational intervention on
dental students: A questionnaire study Patthi Basavaraj, Jain Swati, Singla Ashish,
Singh Shilpi, Kundu Hansa, Singh Khushboo
NAVEEN GOKUL R, BDS IV, PDCH
44. Master Title
REFERENCES
44
5. Sam N, Ganesh R, Indrapriyadarshini V, Jeyamarthan S, Nandhini C K. Awareness,
knowledge, and attitude regarding organ donation among final year students of
medical, Dental, Engineering, and Arts and Science Colleges in Thiruvallur and
Chennai City, India. Indian J Transplant 2018;12:25-9
6. National Organ Transplant Programme - DGHS
https://dghs.gov.in/content/1353_3_NationalOrganTransplantProgramme.aspx
7. Tamuli, R. P., Sarmah, S., & Saikia, B. (2019). Organ donation - "attitude and
awareness among undergraduates and postgraduates of North-East India". Journal
of family medicine and primary care, 8(1), 130–136.
https://doi.org/10.4103/jfmpc.jfmpc_206_18
8. NHS - https://www.organdonation.nhs.uk/
NAVEEN GOKUL R, BDS IV, PDCH
45. Master Title
REFERENCES
45
9. NDTV FORTIS - https://sites.ndtv.com/moretogive/lack-organ-donation-india-
half-million-people-die-annually-india-due-unavailability-organs-2107/
10. NDTV Organ Donation Day: Tamil Nadu Is Again The ‘Best Performing State’ In
Organ Donation - https://sites.ndtv.com/moretogive/organ-donation-day-tamil-
nadu-best-performing-state-organ-donation-2842/
11. MOHAN FOUNDATIONS - https://www.mohanfoundation.org/deceased-organ-
donation-in-india.asp
12. ORGAN INDIA - https://www.organindia.org/
13. STATISTA - https://www.statista.com/topics/2389/organ-donations-and-
transplants/
NAVEEN GOKUL R, BDS IV, PDCH