ORGAN DONATION-  Story of Life After Death DR.ASHOKAN MANAGING TRUSTEE A.P.HITHENDRAN MEMORIAL TRUST THIRUKAZHUKUNDRAM KAN...
<ul><li>Organ and tissue donors leave a miraculous legacy </li></ul><ul><li>They are living proof that death can bring lif...
This  presentation has been made using  web site was created using 100% recycled electrons !!  Recycle yourself by becomin...
Death is not extinguishing the light but  putting out the lamp because the dawn has come - Rabindranath Tagore
Organ Donation – Concepts
Types of Organ Donors <ul><li>After Natural Death  </li></ul><ul><li>Living person – related to patient </li></ul><ul><li>...
Organ Donation by a Living person <ul><li>Blood </li></ul><ul><li>Eyes </li></ul><ul><li>Bone marrow </li></ul><ul><li>Kid...
Organ Donation after Natural Death <ul><li>Eyes </li></ul><ul><li>Skin and fascia </li></ul><ul><li>Heart Valves </li></ul...
Organ Donation After Brain Death <ul><li>Eyes ( 2 ) </li></ul><ul><li>Kidneys ( 2 )  </li></ul><ul><li>Liver ( 1 ) </li></...
<ul><ul><li>In a 15-hour operation that began on January 24 and concluded the next day, an 18-member surgical team transpl...
Transplant   Miracles !!!   <ul><ul><ul><li>Timothy Heidler, a  40-year-old man became the first successful recipient of a...
COMMMONEST TYPE OF ORGAN DONATION IN INDIA <ul><li>Blood  -  Living related or unrelated </li></ul><ul><li>Eyes -  After N...
EYE  DONATION
Eye Donation <ul><li>Keep the Eyes moist with water & eye-lids closed </li></ul><ul><li>Avoid  use of fans near or above t...
Brain Death Concepts <ul><li>First recognised in 1959 in Paris in Intensive care units ( coma de passe  )  </li></ul><ul><...
<ul><li>No wastage of organs if organ donation from brain dead donors  undertaken  </li></ul><ul><li>Almost 95% of organ d...
Potential Brain Dead Donor <ul><li>Patients are in Intensive care </li></ul><ul><li>Patients are on extensive life support...
Common Causes of Brain Death In India Road traffic Accidents the commonest cause of brain death
Brain dead Pool of Donors in India <ul><li>In any of the metropolitan city in India   </li></ul><ul><li>There are at least...
Cadaver Transplants in India 1995 -2001 <ul><li>KIDNEY   300 </li></ul><ul><li>HEART  25 </li></ul><ul><li>LIVER  10 </li>...
Organ Failure Incidence In India <ul><li>Kidneys - 150,000 patients require Transplants  </li></ul><ul><li>( 3000 - Transp...
DON’T TAKE YOUR ORGANS TO HEAVEN FOR  HEAVEN KNOWS THEY ARE NEEDED HERE !!
HISTORY OF HUMAN ORGAN TRANSPLANTATION 1954 Boston  - First Kidney Transplant  1967 Cape town - First Heart Transplant 196...
Transplant Organ Survival <ul><li>Longest living Kidney Transplant - 34 years </li></ul><ul><li>Longest surviving Heart Tr...
Age & Organ Donation Corneas 0 to 100 yrs Heart valves 0 to 60 yrs Trachea 15 to 60 yrs Skin 16 to 85 yrs Kidneys 0 to 70 ...
Time Factor & Safe Organ Preservation / Transplantation Kidneys - 48 hrs Pancreas - 24 hrs  Liver - 12 hrs Heart  & Lungs ...
Organ Donation  Ethical Aspects  <ul><ul><ul><ul><ul><li>Most of the social and Ethical problems in organ donation due to ...
Is Living Organ donation Ethical   ? <ul><li>Hippocratic oath – Do no Harm </li></ul><ul><li>Voluntarism – Decision to don...
Commercial Aspects of Organ Donation <ul><li>Human Rights Violation- in China (1990) – 1670 kidneys transplanted mostly fr...
ORGAN DONATION & RELIGION For that which is born death is certain  and for the dead, birth  certain.. Therefore grieve not...
Commercial Aspects of Organ Donation <ul><li>Human Rights Violation- in China (1990) – 1670 kidneys transplanted mostly fr...
Religion & Organ Donation Jainism-  Jain religious leaders consider eye donation as a sublime form of charity and stress  ...
Catholicism -  Transplants are ethically and morally acceptable to the Vatican. Pope John Paul II. Religion & Organ Donati...
Religion & Organ Donation Jehovah’s Witnesses -  Jehovah’s Witnesses do not encourage organ donation but Believe it is a m...
Organ donation  Legal Aspects in India “  Its Provisions and Pitfalls”
Transplantation of Human Organs Act, 1994 <ul><li>Aims </li></ul><ul><li>Regulate removal, storage and transplantation of ...
Main Provisions of THO Act <ul><li>Concept of “Brain Stem death” accepted </li></ul><ul><li>Only “Living related  Donors” ...
Brain Stem Death <ul><li>Definition  - Stage at which all functions of the Brain Stem have permanently and irreversibly ce...
Organ Donor <ul><li>Person may authorize removal of any human organ before his death. </li></ul><ul><li>Person may express...
Offences and Penalties <ul><li>Commercial dealings in organs </li></ul><ul><ul><li>Imprisonment : 2 to 7 years </li></ul><...
<ul><li>Donors </li></ul><ul><li>Scrapping of Sub Clause (3) , Clause 9 of Chapter II </li></ul><ul><ul><li>If any donor a...
Organ Donation  Problems & Solutions
Problems with Cadaver Organ Donation Programme  in India <ul><li>Govt. Problem </li></ul><ul><li>  No Funding for programm...
Streamlining of  THO ACT <ul><li>Make it compulsory for doctors or medical social workers to ask for Organ Donation in a B...
Organ Donation Awareness Programmes <ul><li>Driving License with “Donor Card” clause </li></ul><ul><li>Education at School...
Carry the card in the wallet Serves also as an emergency card ORGAN DONAR CARD BY A.P.H.M.T.
Give Life a SECOND Chance… Carry a Donor Card Organ Donor Cards are issued by A.P.H.M.T.
…  When that happens don't call this my   “DEATHBED”,   call it my &quot; BED OF LIFE&quot;   and let my body be used by o...
Give my blood   to the teenager who has been pulled from the wreckage of his car,  so that he might  live to see his grand...
LIFE ......PASS IT ON !! Give my eyes   to a man who has never seen…. Sunrise A baby’s face or  Love in the eyes of a woman
Give my kidneys  to one who depends on a machine to exist from week to week Give my heart   to a person whose own heart ha...
a speechless boy will shout at the   crack of a bat   and a   deaf girl will hear the sound of rain against her window LIF...
If you must   bury something ,  let it be   my faults, my weaknesses   and all   my prejudice   against my fellowmen LIFE ...
Give my sins to the devil and give my soul to God, If you do what I have asked,  ……… I  WILL LIVE FOREVER    ( The above i...
THANKYOU ALL. In my end is my beginning                       - TS.Eliot Four Quartets For further information about organ...
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A P Hithendran Memorial Trust – Organ Donation –English Version

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A P Hithendran Memorial Trust – Organ Donation –English Version

  1. 27. ORGAN DONATION- Story of Life After Death DR.ASHOKAN MANAGING TRUSTEE A.P.HITHENDRAN MEMORIAL TRUST THIRUKAZHUKUNDRAM KANCHIPURAM DISTRICT. TAMILNADU 603109 INDIA
  2. 28. <ul><li>Organ and tissue donors leave a miraculous legacy </li></ul><ul><li>They are living proof that death can bring life, that sorrow can turn to hope, and that a terrible loss can become the greatest gift of all </li></ul><ul><li>Every day they lead us on a journey of hope, renewal, and transformation </li></ul>Organ Donation – A Gracious Act Death is not the last sleep. It is the final awakening                           - Walter Scott, Scottish novelist  
  3. 29. This presentation has been made using web site was created using 100% recycled electrons !! Recycle yourself by becoming an organ donor
  4. 30. Death is not extinguishing the light but putting out the lamp because the dawn has come - Rabindranath Tagore
  5. 31. Organ Donation – Concepts
  6. 32. Types of Organ Donors <ul><li>After Natural Death </li></ul><ul><li>Living person – related to patient </li></ul><ul><li>Living person – unrelated to patient </li></ul><ul><li>After Brain Death </li></ul>
  7. 33. Organ Donation by a Living person <ul><li>Blood </li></ul><ul><li>Eyes </li></ul><ul><li>Bone marrow </li></ul><ul><li>Kidneys </li></ul><ul><li>Portion of Liver </li></ul><ul><li>Portion of Lung </li></ul><ul><li>Portion of Pancreas </li></ul>Iddham Shariram Paropkardum (This body is for the use of others) - Shankracharya
  8. 34. Organ Donation after Natural Death <ul><li>Eyes </li></ul><ul><li>Skin and fascia </li></ul><ul><li>Heart Valves </li></ul><ul><li>Bones and Tendons </li></ul><ul><li>Cartilage </li></ul><ul><li>Veins and Arteries </li></ul><ul><li>Middle Ear Bones </li></ul>The only thing you take with you when you're gone is what you leave behind  - John Allston
  9. 35. Organ Donation After Brain Death <ul><li>Eyes ( 2 ) </li></ul><ul><li>Kidneys ( 2 ) </li></ul><ul><li>Liver ( 1 ) </li></ul><ul><li>Lung ( 2 ) </li></ul><ul><li>Pancreas ( 1 ) </li></ul><ul><li>Small Intestine ( 1 ) </li></ul><ul><li>Voice Box or Larynx( 1 ) </li></ul><ul><li>Hand ( 2 ) </li></ul><ul><li>Penis ( 1 ) </li></ul><ul><li>Middle Ear Bones ( 2 ) </li></ul><ul><li>Skin and fascia - Numerous </li></ul><ul><li>Bone - Numerous </li></ul><ul><li>Cartilage - Numerous </li></ul><ul><li>Tendons - Numerous </li></ul><ul><li>Veins - Numerous </li></ul><ul><li>Arteries - Numerous </li></ul><ul><li>Nerves - Numerous </li></ul><ul><li>Fingers and Toes ( 20 ) </li></ul>
  10. 36. <ul><ul><li>In a 15-hour operation that began on January 24 and concluded the next day, an 18-member surgical team transplanted a left hand from a cadaver to 37-year-old Matthew David Scott and reported that Mr. Scott had wiggled a finger on his new hand, but controlled movement was not scheduled to begin for another few days. </li></ul></ul>Transplant Miracles !!! Medical miracles these days have a short life span of glory!!!
  11. 37. Transplant Miracles !!! <ul><ul><ul><li>Timothy Heidler, a 40-year-old man became the first successful recipient of a larynx (voice box) transplant and is reportedly doing well, about a month following surgery he used his new voice to state at a press conference that he was feeling &quot;the best I've felt in a long time“. </li></ul></ul></ul><ul><ul><ul><li>Previously Tim was using an electro-larynx for 19 years as his own larynx was injured in a motorcycle accident </li></ul></ul></ul>
  12. 38. COMMMONEST TYPE OF ORGAN DONATION IN INDIA <ul><li>Blood - Living related or unrelated </li></ul><ul><li>Eyes - After Natural Death </li></ul><ul><li>Kidney Donation - Mostly unrelated and sometimes related </li></ul>And he will wipe out every tear from their eyes and death will be no more. - Revelations 21:4 
  13. 39. EYE DONATION
  14. 40. Eye Donation <ul><li>Keep the Eyes moist with water & eye-lids closed </li></ul><ul><li>Avoid use of fans near or above the body </li></ul><ul><li>Contact the nearest Eye Bank </li></ul><ul><li>Takes 5 to 10 minutes for the doctor or technician to perform the procedure </li></ul>Cornea removed Eyeball Cornea Eyeball 35 million people are BLIND or going blind in the developing world and most of them can be cured
  15. 41. Brain Death Concepts <ul><li>First recognised in 1959 in Paris in Intensive care units ( coma de passe ) </li></ul><ul><li>Formally accepted as a form of death in 1968 by the ad hoc committee at Harvard </li></ul><ul><li>Accepted by Govt. of India in 1994 as a form of death </li></ul>In Babies under one year brain death concept not applicable
  16. 42. <ul><li>No wastage of organs if organ donation from brain dead donors undertaken </li></ul><ul><li>Almost 95% of organ donors in western world originate from Brain Dead Donors </li></ul><ul><li>Largest pool of organ Donors in the world </li></ul>Brain dead Pool of Donors
  17. 43. Potential Brain Dead Donor <ul><li>Patients are in Intensive care </li></ul><ul><li>Patients are on extensive life support medication and machines </li></ul><ul><li>Patient are on artificial breathing machines </li></ul><ul><li>They usually have a brain injury or bleeding within the brain or a brain tumour </li></ul>Once brain death diagnosed term “Cadaver” used for patients
  18. 44. Common Causes of Brain Death In India Road traffic Accidents the commonest cause of brain death
  19. 45. Brain dead Pool of Donors in India <ul><li>In any of the metropolitan city in India </li></ul><ul><li>There are at least on an average between 10 to 20 patients admitted in different ICUs who are brain Dead </li></ul>Even Doctors often fail to diagnose or recognise this condition!!
  20. 46. Cadaver Transplants in India 1995 -2001 <ul><li>KIDNEY 300 </li></ul><ul><li>HEART 25 </li></ul><ul><li>LIVER 10 </li></ul><ul><li>PANCREAS 01 </li></ul><ul><li>LUNGS 01 </li></ul><ul><li>TOTAL 336 </li></ul>Averages just over 50 cadaver organ transplants a year
  21. 47. Organ Failure Incidence In India <ul><li>Kidneys - 150,000 patients require Transplants </li></ul><ul><li>( 3000 - Transplants done ) </li></ul><ul><li>Heart - 50,000 patients require Transplants </li></ul><ul><li>( 26 Transplants done) </li></ul><ul><li>Liver –100,000 patients require Transplants </li></ul><ul><li>(12 Transplants done) </li></ul>Above organs also called Solid organs besides including lungs and Pancreas
  22. 48. DON’T TAKE YOUR ORGANS TO HEAVEN FOR HEAVEN KNOWS THEY ARE NEEDED HERE !!
  23. 49. HISTORY OF HUMAN ORGAN TRANSPLANTATION 1954 Boston - First Kidney Transplant 1967 Cape town - First Heart Transplant 1966 Minneapolis- First Pancreas Transplant 1967 Pittsburg - First Liver Transplant 1983 Toronto - First Lung Transplant First Transplant attempted in 1902 in Russia on dogs
  24. 50. Transplant Organ Survival <ul><li>Longest living Kidney Transplant - 34 years </li></ul><ul><li>Longest surviving Heart Transplant Patient - 22 years </li></ul><ul><li>Longest living Liver Transplant - 27 years </li></ul><ul><li>Longest living Lung Transplant - 12 years </li></ul>Longest living Indian Transplant patient has lived for 30 years
  25. 51. Age & Organ Donation Corneas 0 to 100 yrs Heart valves 0 to 60 yrs Trachea 15 to 60 yrs Skin 16 to 85 yrs Kidneys 0 to 70 yrs Heart 0 to 60 yrs Lungs 0 to 60 yrs Liver 0 to 70 yrs Almost 23 different tissues and organs of the body can be donated
  26. 52. Time Factor & Safe Organ Preservation / Transplantation Kidneys - 48 hrs Pancreas - 24 hrs Liver - 12 hrs Heart & Lungs - 6 hrs Research on Cryo-preservatives may help to preserve organs for a much longer period
  27. 53. Organ Donation Ethical Aspects <ul><ul><ul><ul><ul><li>Most of the social and Ethical problems in organ donation due to kidney donation </li></ul></ul></ul></ul></ul>
  28. 54. Is Living Organ donation Ethical ? <ul><li>Hippocratic oath – Do no Harm </li></ul><ul><li>Voluntarism – Decision to donate in a family may not be voluntary </li></ul><ul><li>Usually more woman donate than men - mother or wife are the commonest donors </li></ul><ul><li>Usually trafficking of organs from the poor to the rich </li></ul>One in 1000 living donor is likely to die even in best of surgical hands !!
  29. 55. Commercial Aspects of Organ Donation <ul><li>Human Rights Violation- in China (1990) – 1670 kidneys transplanted mostly from executed criminals </li></ul><ul><li>Bizarre instances of kidneys being removed by surgeons from an innocent donor is reported from all over the world regularly </li></ul>On e-bay the famous Internet Auction websites a Kidney was being auctioned for almost One million dollars!!!
  30. 56. ORGAN DONATION & RELIGION For that which is born death is certain and for the dead, birth certain.. Therefore grieve not over that which is inevitable . - Bhagavad Gita
  31. 57. Commercial Aspects of Organ Donation <ul><li>Human Rights Violation- in China (1990) – 1670 kidneys transplanted mostly from executed criminals </li></ul><ul><li>Bizarre instances of kidneys being removed by surgeons from an innocent donor is reported from all over the world regularly </li></ul>On e-bay the famous Internet Auction websites a Kidney was being auctioned for almost One million dollars!!!
  32. 58. Religion & Organ Donation Jainism- Jain religious leaders consider eye donation as a sublime form of charity and stress  a powerful link between ‘daan’ (charity) and ‘moksha’ (salvation).  Highest eye donation rate in India among Jains of Gujarat . Hinduism - No prohibition to donating organs. This act is an individual decision . Protestantism - Protestants encourage and endorse organ donation. Death is just a beginning of another life                          - Upanishads
  33. 59. Catholicism - Transplants are ethically and morally acceptable to the Vatican. Pope John Paul II. Religion & Organ Donation Judaism - Judaism teaches that saving a human life takes precedence over maintaining the sanctity of the human body . Buddhism - &quot;We honor those people who donate their bodies and organs to the advancement of medical science and to saving lives.” – Buddhist Priest at meeting in Chicago God created man to be immortal and made him to be an image of his own eternity - Bible, The Wisdom of Solomon
  34. 60. Religion & Organ Donation Jehovah’s Witnesses - Jehovah’s Witnesses do not encourage organ donation but Believe it is a matter best left to the individual’s conscience Islam - In 1983 the Muslim Religious Council initially rejected organ donation by followers of Islam, but it has reversed its position, provided donors consent in writing prior to their death. The organs of Muslim donors must be transplanted immediately and should not be stored in organ banks &quot;If one is in the position to donate an organ to save another’s life it’s obligatory to do so, even if the donor never knows who the beneficiary will be,” - Rabbi Moses Tendler
  35. 61. Organ donation Legal Aspects in India “ Its Provisions and Pitfalls”
  36. 62. Transplantation of Human Organs Act, 1994 <ul><li>Aims </li></ul><ul><li>Regulate removal, storage and transplantation of human organs for therapeutic purposes </li></ul><ul><li>To prevent commercial dealings in organs </li></ul>Tamil Nadu Assembly passed the Act in May 1995
  37. 63. Main Provisions of THO Act <ul><li>Concept of “Brain Stem death” accepted </li></ul><ul><li>Only “Living related Donors” are allowed to donate organs without legal problems </li></ul><ul><li>For unrelated Donors - Permission from “Authority” required prior to surgery </li></ul><ul><li>Requires - “Regulation and Registration of hospitals” undertaking transplantation </li></ul><ul><li>“ Punishment for any commercial dealings in organs” </li></ul>1 st Relative – Father / Mother / Brother / Sister / Wife / Son/ Daughter
  38. 64. Brain Stem Death <ul><li>Definition - Stage at which all functions of the Brain Stem have permanently and irreversibly ceased </li></ul><ul><li>Certification </li></ul><ul><ul><li>Panel of four doctors </li></ul></ul><ul><ul><li>Two sets of tests to be carried out - minimum of six hours in between the tests </li></ul></ul><ul><ul><li>Form No. 8 to be used for certification </li></ul></ul>Death is usually a gradual event. Nail and hair can continue to Grow even after death !!
  39. 65. Organ Donor <ul><li>Person may authorize removal of any human organ before his death. </li></ul><ul><li>Person may express his wish to donate his organs in the event of his death, through a ( Form No. 5 ) </li></ul><ul><li>“ Informed Consent” of Family is crucial to cadaver organ donation. </li></ul>“ Presumed Consent” – In some countries the law demands organ donation from its citizens, unless they express otherwise in writing
  40. 66. Offences and Penalties <ul><li>Commercial dealings in organs </li></ul><ul><ul><li>Imprisonment : 2 to 7 years </li></ul></ul><ul><ul><li>Fines : Rs.10,000/- to Rs.20,000/- </li></ul></ul><ul><li>Penalties for Doctors </li></ul><ul><ul><li>First Offence : Name struck off State Medical Register for 2 years </li></ul></ul><ul><ul><li>Subsequent Offence : Name struck off permanently </li></ul></ul>Since the Act was passed there has been only one criminal prosecution against a doctor in Delhi
  41. 67. <ul><li>Donors </li></ul><ul><li>Scrapping of Sub Clause (3) , Clause 9 of Chapter II </li></ul><ul><ul><li>If any donor authorizes the removal of any of his human organs before his death under sub-section (1) of section 3 for transplantation into the body of such recipient, not being a near relative as is specified by the donor, by reason of affection or attachment towards the recipient or for any other special reasons, such human organ shall not be removed and transplanted without the prior approval of the Authorization Committee. </li></ul></ul>Pitfalls - THO ACT Majority of kidney transplants in the country use this clause resulting in “ legal commercial racket of kidneys”
  42. 68. Organ Donation Problems & Solutions
  43. 69. Problems with Cadaver Organ Donation Programme in India <ul><li>Govt. Problem </li></ul><ul><li> No Funding for programme </li></ul><ul><li>Hospital problem </li></ul><ul><li>No efforts to identify & maintain “Brain Dead” donors </li></ul><ul><li>Community Problem </li></ul><ul><li> No Awareness of “Brain-Death” Concept </li></ul>Spain has the highest number of brain death patients going on to organ donation – 32 per million population
  44. 70. Streamlining of THO ACT <ul><li>Make it compulsory for doctors or medical social workers to ask for Organ Donation in a Brain Dead Situation </li></ul><ul><li>Identify doctors or senior nurses to work as Transplant Coordinators in each ICU </li></ul><ul><li>In Medico-legal cases it should be possible to perform Post-Mortem at same time as organ retrieval in presence of a Forensic Expert </li></ul>No financial costs involved in the above recommendations
  45. 71. Organ Donation Awareness Programmes <ul><li>Driving License with “Donor Card” clause </li></ul><ul><li>Education at School and College Level </li></ul><ul><li>Free Air time on Doordarshan and Private Channels for films on Organ Donation </li></ul><ul><li>Tax Exemption for documentaries on Organ Donation </li></ul><ul><li>Indirect incentives to donor families </li></ul><ul><li>Honoring cadaver donor families </li></ul>In states of Maharastra & Gujarat slogans about “Eye donation” displayed on National Highways
  46. 72. Carry the card in the wallet Serves also as an emergency card ORGAN DONAR CARD BY A.P.H.M.T.
  47. 73. Give Life a SECOND Chance… Carry a Donor Card Organ Donor Cards are issued by A.P.H.M.T.
  48. 74. …  When that happens don't call this my “DEATHBED”, call it my &quot; BED OF LIFE&quot; and let my body be used by others to lead fuller lives   LIFE ......PASS IT ON !! At a certain moment a doctor will determine that my brain has ceased to function and that, for all intents and purposes, my life has stopped…
  49. 75. Give my blood to the teenager who has been pulled from the wreckage of his car, so that he might live to see his grandchildren play LIFE ......PASS IT ON !!
  50. 76. LIFE ......PASS IT ON !! Give my eyes to a man who has never seen…. Sunrise A baby’s face or Love in the eyes of a woman
  51. 77. Give my kidneys to one who depends on a machine to exist from week to week Give my heart to a person whose own heart has caused nothing but endless days of pain LIFE ......PASS IT ON !!
  52. 78. a speechless boy will shout at the crack of a bat and a deaf girl will hear the sound of rain against her window LIFE ......PASS IT ON !! Explore every corner of my brain, take my cells and let them grow so that someday….
  53. 79. If you must bury something , let it be my faults, my weaknesses and all my prejudice against my fellowmen LIFE ......PASS IT ON !! Burn what is left of me and scatter the ashes to the winds to help the flowers grow
  54. 80. Give my sins to the devil and give my soul to God, If you do what I have asked, ……… I WILL LIVE FOREVER   ( The above is a Legacy of Robert N.West written in 1976 ) LIFE ......PASS IT ON !!
  55. 81. THANKYOU ALL. In my end is my beginning                     - TS.Eliot Four Quartets For further information about organ donation contact us at: A.P.HITHENDRAN MEMORIAL TRUST. NO.2, 5 TH STREET TEACHERS NAGAR THIRUKAZHUKUNDRAM KANCHIPURAM DISTRICT TAMILNADU INDIA.

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