This document discusses organ donation and transplantation in India. It provides an introduction to organ donation and outlines the need for organ donation due to the large gap between available organs and people in need. It then discusses the history of successful transplants in India, types of transplants, living donor requirements, reasons for the shortage of organ donors, and situations under which organ donation occurs. The document also covers the legal aspects, forms, transplant rejection, immunosuppressive therapy, and the green corridor concept in India.

1. ORGAN DONATION AND ROLE OF
NURSE
PRESENTED BY:
MISS.SHWETA
SHARMA
M.SC. NURSING
1ST YEAR
AIIMS, JODHPUR

3. INTRODUCTION
Organ donation is the process of
removing tissues or organs from a live, or
recently dead, person called Donor to be
used in another live person called
Recipient.

5. NEED FOR ORGAN DONATION
In India, every year nearly 500,000 people die because of non-availability
of organs and this number is expected to grow due to scarcity of organ
donors.
The gap between the number of organs donated and the number of people
waiting for a transplant is getting larger.
One donor can save eight lives as he/she can donate up to 8 lifesaving
organs.
Around 5000 kidneys, 1000 livers, and around 50 hearts are transplanted
annually in India.
There is a need of roughly 2,00,000 kidneys, 50,000 hearts, and 50,000
livers for transplantation each year.

8. HISTORY OF SUCCESSFUL
TRANSPLANTS IN INDIA
In India-
1967 - First successful cadaver Kidney Transplant in India at KEM
Hospital, Bombay
1994 - First successful heart transplant done at AIIMS, 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, Ahmedabad

10. TYPES OF TRANSPLANTS

11. Split transplants

12. Domino transplants

14. LIVING DONOR REQUIREMENTS
 Good physical and mental health
 Must be at least 18 years old
 Must have a body mass index (BMI) that is less than 35
 Must be free from the following:
 Uncontrolled high blood pressure
 Diabetes
 Cancer
 Hepatitis
 Organ diseases
 Infectious diseases

15. KEY REASONS FOR SHORTAGE
OF ORGAN DONORS IN INDIA
Ignorance and lack of knowledge about
organ donation.
Lack of registering one’s wish to
donate.
Myths and beliefs.

16. SITUATIONS UNDER WHICH
ORGAN DONATION OCCURS
Live Donations –
Occurs when a living person wishes to donate organs to
some immediate family member in need.
Only first-degree relatives (Parents, siblings & children)
are allowed to be Live Donors.
They can donate one kidney, a portion of pancreas and
a part of the liver.

18. Cadaver/ Deceased Donations-
•Brain death
•Cardiac death/Natural
death

19. PROCESS OF ORGAN DONATION

21. BOX USED FOR ORGAN TRANSPORTATION
•Just prior to being removed from the donor, each organ is
flushed free of blood with a specially prepared ice-cold
preservation solution that contains electrolytes and
nutrients. The organs are then placed in sterile containers,
packaged in wet ice, and transported to the recipient's
transplant center.
•University of Wisconsin cold storage solution is the gold
standard for organ preservation.

25. ADVANTAGES
• A single donor can save more than one life.
• A donor can have normal life even after the transplant.
• People who are certified brain dead are capable of donating many
body parts.
• Organs can be donated after death and can be 'banked'.
• Potential donors are easy to find.

26. TRANSPLANT COORDINATORS

28. LEGAL ASPECTS OF ORGAN
DONATION
1.Transplantation of Human Organ and Tissue Act
(THOTA)
•Passed in 1994
•Amended in 2011, and new rules came into force
in 2014.
•It aims at regulation of removal, storage, and
transplantation of human organs for therapeutic
purposes and for prevention of commercial
dealings in human organs.

29. 2.National Organ and Tissue Transplant Organization
(NOTTO)
It is a National level organization set up under
Directorate General of Health Services, Ministry of
Health and Family Welfare, Government of India
located at 4th and 5th Floor of Institute of Pathology
(ICMR) Building in Safdarjung Hospital New Delhi. It has
following two divisions:
•"NATIONAL HUMAN ORGAN AND TISSUE REMOVAL
AND STORAGE NETWORK”
•"NATIONAL BIOMATERIAL CENTRE”

30. FUNCTIONS
At National Level:
•Lay down policy guidelines and protocols for various
functions.
•Network with similar regional and state level organizations.
•Compile and publish all registry data from States and
Regions.
•Creating awareness, promotion of organ donation and
transplantation activities.
•Co-ordination from procurement of organs and tissues to
transplantation when organ is allocated outside the region.

31. •Dissemination of information to all concerned
organizations, hospitals and individuals.
•Assist in data management for organ transplant
surveillance & registry of organ transplant and Organ
Donation.
•Consultancy support on the legal and non-legal
aspects of donation and transplantation.

32. • Allocation, Transportation,
Storage and Distribution of
Organs and Tissues.
• Follow-up of post-transplant
patients & living donor for
assessment of graft rejection,
survival rates etc.
• Awareness, Advocacy and
Training workshops and other
activities for promotion of organ
donation.

33. •National Biomaterial
Centre (National Tissue
Bank)-
The main thrust &
objective of establishing
the centre is to fill up the
gap between ‘Demand’
and ‘Supply’ as well as
‘Quality Assurance’ in the
availability of various
tissues.

34. • The centre will take care of the following Tissue allografts: -
 Bone and bone products e.g. deep-frozen bone allograft, freeze dried bone
allograft
 Duramater
 Fresh frozen human amniotic membrane
 High temperature treated board cadaveric joints like knees, hips and shoulders,
cadaveric cranium bone graft, loose bone fragment, different types of bovine
allograft, used in orthodontics
 Skin graft
 Cornea
 Heart valves and vessels

35. •Activities
 Coordination for tissue procurement and distribution
 Donor tissue screening
 Removal of tissues and storage
 Preservations of tissue
 Laboratory screening of tissues
 Tissue tracking

36.  Sterilization
 Records maintenance, Data Protection and Confidentiality
 Quality Management in tissues
 Patient Information on tissues
 Development of Guidelines, Protocols and Standard
Operating Procedures
 Trainings
 Assisting as per requirement in registration of other Tissue
Banks

37. FORMS FOR ORGAN DONATION AND
TRANSPLANTATION
• FORM 1-
FOR ORGAN OR TISSUE DONATION FROM IDENTIFIED LIVING NEAR RELATED DONOR
• FORM 2-
FOR ORGAN OR TISSUE DONATION BY LIVING SPOUSAL DONOR
• FORM 3-
FOR ORGAN OR TISSUE DONATION BY OTHER THAN NEAR RELATIVE LIVING DONOR
• FORM 4-
FOR CERTIFICATION OF MEDICAL FITNESS OF LIVING DONOR
• FORM 5-
FOR CERTIFICATION OF GENETIC RELATIONSHIP OF LIVING DONOR WITH RECIPIENT

38. • FORM 6-
FOR SPOUSAL LIVING DONOR
• FORM 7-
FOR ORGAN OR TISSUE PLEDGING
• FORM 8-
FOR DECLARATION CUM CONSENT
• FORM 9-
FOR UNCLAIMED BODY IN A HOSPITAL OR PRISON
• FORM 10-
FOR CERTIFICATION OF BRAIN STEM DEATH
• FORM 11-
APPLICATION FOR APPROVAL OF TRANSPLANTATION FROM LIVING DONOR

39. • FORM 12-
APPLICATION FOR REGISTRATION OF HOSPITAL TO CARRY OUT ORGAN OR
TISSUE TRANSPLANTATION OTHER THAN CORNEA
• FORM 13-
APPLICATION FOR REGISTRATION OF HOSPITAL TO CARRY OUT ORGAN/TISSUE
RETRIEVAL OTHER THAN EYE/CORNEA RETRIEVAL
• FORM 14-
APPLICATION FOR REGISTRATION OF TISSUE BANKS OTHER THAN EYE BANKS
• FORM 15-
APPLICATION FOR REGISTRATION OF EYE BANK, CORNEAL
TRANSPLANTATION CENTRE, EYE RETRIEVAL CENTRE UNDER
TRANSPLANTATION OF HUMAN ORGANS ACT
• FORM 16-
CERTIFICATE OF REGISTRATION FOR PERFORMING ORGAN/TISSUE
TRANSPLANTATION/RETRIEVAL AND/OR TISSUE BANKING

40. • FORM 17-
CERTIFICATE OF RENEWAL OF REGISTRATION
• FORM 18-
CERTIFICATE BY THE AUTHORIZATION COMMITTEE OF HOSPITAL
• FORM 19-
CERTIFICATE BY COMPETENT AUTHORITY
• FORM 20-
VERIFICATION CERTIFICATE IN RESPECT OF DOMICILE STATUS OF
RECIPIENT OR DONOR
• FORM 21-
CERTIFICATE OF RELATIONSHIP BETWEEN DONOR AND RECIPIENT
IN CASE OF FOREIGNERS

41. FORM 10-FOR CERTIFICATION OF BRAIN
STEM DEATH
-To be filled by the board of medical experts certifying brain-stem
death
-4 members sign the certificate of brain stem death:
1.Medical administrator incharge of the hospital
2.Authorized specialist.
3.Neurologist/Neurosurgeon
4.Medical officer treating the patient

42. -The certificate includes patient details, and
preconditions such as diagnosis, date and time of
accident/onset of illness, date and onset of non-
reversible coma and 2 medical examinations.
-The minimum time interval between the first and
second testing will be 6 hours in adults. In case of
children 6 to 12 years of age, 1 to 5 years of age and
infants, the time interval shall increase depending on the
opinion of experts.

43. TRANSPLANT REJECTION
REACTION
• Hyperacute
 Occurs minutes to hours after transplantation
 No treatment (organ must be removed)
• Acute
 Occurs days (one week) to months after
transplantation
 T- cytotoxic lymphocytes attack the transplanted organ
• Chronic
 Occurs over months to years

44. •Most common signs & symptoms-
Pain at the site of the transplant
Feeling ill
Flu-like symptoms
Fever
Weight change
Swelling
Decreased urine output

45. IMMUNOSUPPRESSIVE THERAPY
1. Triple therapy (all PO/IV)
• Cyclosporine-Prevent a cell-mediated attack (helper T-cells) against the organ
• Corticosteroid: prednisone-methylprednisolone (Solu-Medrol)-Suppress
inflammatory response
• Cytotoxic drug: mycophenolate mefetil (CellCept) or cyclophosphamide
(Cytoxan) -Suppress immune response by inhibiting proliferation of T and B
cells
1. Monoclonal Antibodies: muromonab-CD3- Used for preventing and treating
acute rejection episodes
2. Polyclonal Antibodies: Atgam - Used as induction therapy or to treat acute
rejection.

46. • Immunosuppressive Therapy: Side Effects
Nephrotoxicity
Increased risk of infection
Lymphoma
Hepatotoxicity
Neutropenia
Thrombocytopenia
Diarrhoea/nausea/vomiting

47. GREEN CORRIDOR
 Green corridor is a
demarcated, cleared out
special road route created for
an ambulance that enables
harvested organ(s) meant for
transplant to reach the
destined hospital.
 It is a special corridor created
without any stoppages.

48. •The prime objective of creation of these green
corridors has arisen from the fact that organs have a
short preservation time; henceforth, within few
hours, the entire process, right from harvesting,
interinstitutional transportation, and final
transplantation surgery must be completed.
•In the past few years, this concept of green corridors
has taken up across the nation and has successfully
managed to save a number of lives through timely
delivery of organs.

50. ROLE OF NURSE
•Registered professional nurse are often the primary
care givers for patients approaching the final stage of
life.
•It is the nurse who facilitates the coping of patients
and their families. In general, the work of transplant
nurse is anchored on counselling and facilitating the
process for organ or tissue donation by educating and
guiding to the donor families without doubt, a difficult,
heart wrenching process.

51. •The nurses stay with the patients and help the family to
understand the organ donation process, which includes
keeping the brain-dead patient’s body functioning until the
organ been collected.
•There are guidelines for nurses who work in areas where
organ donation and transplant occur. She should be the
“whistle blower” if any unethical things happen.
1. The nurses first obligation is the well-being of the patient
entrusted to our care.
2. The act of procuring organs should never be the explicit
causes of a person’s death.
3. Nurses understand the good of organ donation itself.

52. RESEARCH ARTICLES
1.Knowledge, attitude, and practice regarding organ donation among adult
population of urban Puducherry, South India
Gokul Sarveswaran et al (2018) conducted a community-based cross-sectional
study during April to May 2017 among 257 randomly selected participants in
selected wards of urban Puducherry. Data regarding knowledge, attitude, and
practice were collected through pretested semi-structured questionnaire.
Almost 90% of the study participants have heard about organ donation.
However, only 28% had adequate knowledge regarding organ donation. 58%
had positive attitude toward organ donation. Practice regarding registration for
organ donation was only 2.3%. Knowledge regarding organ donation was more
among joint family and middle socioeconomic status. The study concluded
that less than one-third of the study population had adequate knowledge
regarding organ donation. Even though more than half of them had positive
attitude toward organ donation only six individuals registered for organ
donation.

53. 2.A study on knowledge and attitude about organ donation among
medical students in Kerala
GS Adithyan et al (2017) conducted a cross-sectional study to assess the
knowledge and attitude of medical students regarding organ donation at
Government Medical College, Trivandrum, Kerala, India. Data were
collected by self-administered questionnaire from 194 final-year MBBS
students during 2016, who were selected by convenient sampling. The
questionnaire had three sections to gather information of
sociodemographic details of the students, knowledge on organ donation,
and the attitude toward organ donation. The findings showed that a
majority of the students had adequate knowledge regarding organ
donation, but it is not translated into their willingness for donation – both
cadaveric and live. The study concluded the need for educational
interventions for medical students to make them understand the
importance of organ donation.

54. SUMMARY AND CONCLUSION
 As discussed throughout the presentation, learning about
organ donation will help nurses to care for patients who
want to donate organ and who require organ transplant.
 Nurses can facilitates the coping of patients and their
families.
 Nurses can also counsel the patients and their family for
various options available in organ donation.

55. REFERENCES
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57. 11.Gokul Sarveswaran, Manikanda Nesan Sakthivel, Yuvaraj
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