2. Organ donation is the process of Retrieving or Procuring
an organ from a live or deceased person known as a
DONOR. The process of recovering organs is called
HARVESTING. This organ is transplanted into the
RECEPIENT who is in need of that organ.
There are two types of organ donation – Live Donation &
Deceased or Cadaver Donation.
Live Donation is from a healthy and living person. This
can only be done in the case of a liver or a kidney (because
the liver can grow back to its normal size, and a donor can
survive on one kidney).
WHO declares OD as a theme for World Health Day (7th
April) to generate global interest, awareness, and
preparedness.
3. Organ donation and
transplantation (ODT) has roots
in ancient Indian mythology with
vivid examples, such as guru
Dadeech and Lord Ganesha,
considered epitomes of our rich
culture, tradition, religion,
spirituality, charity, salvation, and
science
4. The donation rate is critical where the needs are
greatest, such as in India (1 donor per million
population) and in China (0.5 donor per million
population).
In China, about 300,000 patients would benefit from
organ transplants annually, but only about 10,000
transplants are currently carried out
the ratio of supply to demand for organ transplants
1:304.
World Health Organization show that the mean ratio
of organ supply to demand worldwide is 1:25
5. Worldwide, kidneys are the most commonly transplanted
solid organs followed by liver and then heart. Cornea and
musculoskeletal grafts are the most commonly
transplanted tissues; these outnumber organ transplants
by more than tenfold.
Nobody knows the actual need of people requiring an
organ transplant. Since the untreated patients die and are
not to be found in the hospital statistics or registries. The
patients who die untreated may not be seen by specialist
physicians or may never be admitted to a hospital; they
may, in fact, never be diagnosed or ever be seen by a
doctor in many countries.
6. In advanced Western economies, however,
death certificate records are one way of
assessing the causes of death of the
population, and while they have their
weaknesses, these records can provide
reasonable estimates of need.
No country in the world till date collects
sufficient organs to meet the needs of their
citizens. Spain, Austria, Croatia, USA,
Norway, Portugal, Belgium, and France
stand out as countries with high rates of
deceased organ donors.
OD is popularly reflected as per million
population (pmp) and OD across the world
Spain has consistently recorded the
highest deceased OD rate of 35.1
7. At any given time, every major city would
have 8–10 brain dead patients in
various ICUs with 4–6% of all hospital
deaths being brain death.
In India, road accidents account for
around 1.4 lakh deaths annually and of
these almost 65% sustain severe head
injuries as per a study carried out by
AIIMS, Delhi, meaning that there are
almost 90,000 patients who may be brain
dead.
Young deaths occurring either due to
road traffic accidents or cardiovascular
phenomenon provide the best option of
yielding high quality organs but also
requires air and road linkage
8. States level
Tamil Nadu is the model state for ODT in India with OD of 1.3 pmp
(India: 0.05–0.08) because of mandatory executive actions, public-
private partnership, good coordination and added facilities, the
number of cadaveric transplant increased drastically in the last
decade.
Other leading states in ODT activities are Delhi, Andhra Pradesh,
Kerala, Karnataka, Gujarat, Maharashtra, and Uttar Pradesh.
large number of Nongovernment Organizations (NGOs) such as Multi
Organ Harvesting Aid Network, Chennai; Foundation for Organ
Transplantation and Education, Bangalore; Delhi
Organ Procurement Network and Transplant Education, Delhi;
Organ Retrieval Banking Organization, New Delhi; and
Deceased Organ Retrieval Sharing Organization, Delhi in contributing
immensely on community and health staff awareness, training of
transplant coordinator, monitoring, evaluation, and coordination.
9. Registry
Since health is a state subject, there is no central collation of data with
regard to solid ODT
Indian transplant registry started in the year 2005 by the efforts of the
Indian Society of Organ Transplantation and provides a fair collation
and reflection of data of participating center on trend, state, and
gender related information of kidney and liver transplant.
NPCB provides funds to states/NGOs for corneal disease
management, training, development of eye-banks/eye donation
center, and salary component of grief (eye) counselor, hence there is
central collation of data related to corneal donation.
There were 400 eye banks in India at one point of time; however,
due to non-donation of corneas/eyes after death, significant
proportion have become nonfunctional with only 250 at present.
The majority of solid organ transplants done in India are living related
or unrelated transplants with approximately 200 transplant centers
in the country mostly led by private players and NGOs.
10. Legislation
Some of the broad areas included in recent amendments are:
Provision of registration and renewal of retrieval and transplant centers
Definition of term “near relatives” to include grandparents and grandchildren
Removal of eyes/corneas permitted by a trained technician
Brain death certification board has been simplified so as to enable a
surgeon/physician and an anesthetist/intensivist to be included in the medical
board in the event of non-availability of a neurosurgeon/neurologist for certification of
brain death
Authorization committee to be hospital based if number of transplants
undertaken is 25 or more in a year at the respective transplantation centers, and if
the number are <25 in a year, then the state or district level authorization committee
would grant approval(s)
Medical practitioner involved in transplantation team will not be a member of
authorization committee
It is mandatory for the intensive care unit (ICU)/treating medical staff to request
relatives of brain dead patients for OD
Swap donations of organs between near relatives allowed
Procedures for foreign nationals notified if they happen to be donor or recipient
11. Detail procedures notified to prevent commercial activities and exploitation of
minors
Establishment of a National Organ Retrieval, Banking, and Transplantation
Network
Maintenance of registry of donors and recipients waiting for organ transplants
Mandatory position of a “transplant coordinator” in all hospitals registered for ODT
Every authorized transplantation center must have its own website. The identity of the
people in the database shall not be in public domain
The authorization committee is required to take a final decision within 24 hr of holding
the meeting for grant of permission or rejection for transplant. The website of
transplantation center shall be linked to state/regional/national networks through
online system for organ procurement, sharing, and transplantation
The cost for maintenance of the cadaver (brain-stem dead declared person),
retrieval of organs or tissues, their transportation and preservation, shall not be
borne by the donor family and may be borne by the recipient or institution or
government or NGO or society as decided by the respective state government or union
territory administration
Detailed procedures regarding quality assurance, donor screening, qualification and
experience of doctor/transplant coordinator, laboratory investigations, equipment,
documentation, other requirements, etc., should be notified.
12. ACT AND RULES UNDER TRANSPLANT OF HUMAN ORGANS ACT (THOA)
Transplantation of Human Organs and Tissues Rules, 2014
THOA amendment 2011
Transplantation Of Human Organs(Amendment)Rules,2008
THO Rules, 1995 (Original Rules)
THOA 1994
13. National Organ and Tissue Transplant Organization
(NOTTO) 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”.
"National Human Organ and Tissue Removal and
Storage Network”
nodal networking agency for Delhi and shall network
for Procurement Allocation and Distribution of
Organs and Tissues in Delhi.
14. At National Level :
Lay down policy guidelines and protocols for various functions.
Network with similar regional and state level organizations.
All registry data from States and Regions would be compiled and
published.
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.
Dissemination of information to all concerned organizations,
hospitals and individuals.
Monitoring of transplantation activities in the Regions and
States and maintaining data-bank in this regard.
To assist in data management for organ transplant surveillance
& organ transplant and Organ Donor registry.
Consultancy support on the legal and non-legal aspects of
donation and transplantation.
Coordinate and Organize trainings for various cadre of workers.
FUNCTION/ACTIVITIES
15.
FOR DELHI AND NCR
Maintaining the waiting list of terminally ill patients requiring
transplants.
Networking with transplant centres, retrieval centres and tissue banks.
Co-ordination for all activities required for procurement of organs and
tissues including medico legal aspects.
Matching of recipients with donors.
Allocation, Transportation, Storage and Distribution of Organs and
Tissues within Delhi and National Capital Territory region.
Post-transplant patients & living donor follow-up for assessment of
graft rejection, survival rates etc.
Awareness, Advocacy and Training workshops and other activities for
promotion of organ donation.
16. National Biomaterial Centre (National Tissue
Bank)
to fulfill the demands of tissue transplantation
including activities for procurement, storage and
fulfil distribution of biomaterials.
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.
17. The centre will take care of the following Tissue allografts:-
Bone and bone products
e.g. Deep frozen bone allograft,
Freeze dried bone allograft
Dowel allograft
AAA bone,
Duramater,
Facialata,
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
Other tissues shall be gradually included
18. Activities
Coordination for tissue procurement and distribution
Donor Tissue Screening
Removal of Tissues and Storage
Preservations of Tissue
Laboratory screening of Tissues
Tissue Tracking
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
19.
20. DONATE ORGANS……………………..SAVE LIVES
DONATE LIFE
PLEASE BE AN ORGAN DONOR……AND LET THE LIFE CONTINUE
PLEDGE TO DONATE YOUR ORGANS AND TISSUES TODAY
ALL MAJOR RELIGIONS SUPPORT ORGAN AND TISSUE DONATION
GIVE THE GIFT OF LIFE …………….ENJOY THE ART OF GIVING
YOU MAY HAVE NOT DONATED ANYTHING THROUGHOUT YOUR LIFE BUT CAN DONATE YOUR TISSUES AND
ORGANS AFTER YOUR DEATH
MAKE SURE YOUR WISH TO DONATE ORGANS IS KNOWN TO YOUR FAMILY AND FRIENDS
ANYONE CAN……AND EVERY ONE SHOULD DONATE ORGANS
ONE ORGAN DONOR CAN SAVE UP TO 8 LIVES AND ENHANCE THE LIVES OF MANY OTHERS THROUGH TISSUE
DONATION.
ORGAN DONATION……..HOPE OF LIFE
WE BURN OR BURY….WHY NOT DONATE?
WHY DESTROY GIFT OF LIFE…DONATE IT
AFTER BRAIN DEATH ANYONE CAN GIVE ORGANS/TISSUES TO ANYONE
ORGAN DONATION IS THE WAY TO CONTINUE TO LIVE FOREVER
SALE AND PURCHASE OF ORGANS IS ILLEGAL AND ONE CAN BE JAILED FOR THIS
DISCUSS ORGAN DONATION WITH YOUR FAMILY…….IT IS YOUR WISH
IS THERE LIFE AFTER DEATH…….YES
GIFT OF LIFE…..PASS IT ON
DON'T TAKE YOUR ORGANS TO HEAVEN WITH YOU. HEAVEN KNOWS WE NEED THEM HERE
LIVE….AND THEN GIVE
BE AN ORGAN DONOR…..ALL IT COSTS IS A LITTLE LOVE
DO NOT LIVE ONLY FOR YOURSELF……..
CHIRAG KE BUJHNE SE PEHLE …….JYOT SE JYOT JALATE CHALO
BESHAK MERI JINDAGI KISI KE KAAM NA AAYI……PAR MERI MAUT NE KAYEE BUJHTE HUYEN DEEPAK JALA DIYE
HELP A GENERATION………WITH ORGAN DONATION
GIVE YOUR ORGANS WHEN YOU'RE DONE. SAVE LIVES, THAT'S WHY WE RUN.
PLEDGE TO DONATE……GIVE THEM A HOPE
FAMOUS SLOGANS
21. Obstacles to Organ Donation in
India
When Indian science minister Vilasrao
Deshmukh passed away , the head of the
Chennai hospital where he was treated said
he may have survived, had he had a liver
transplant.
That a government minister failed to secure
a liver transplant on time underscores the
flaws in India’s organ-donation system.
In a country where 200,000 people need a
new kidney every year and 100,000 need a
new liver, only 2% to 3% of the demand for
new organs is met
Finding a donor match is difficult to begin
with. In India, this challenge is compounded
by bureaucratic hurdles and lack of
awareness.
22. “There is a lot of red-tapism and paperwork involved
in getting a transplant,”
23. Under Indian law, for instance, it’s relatively easy for
close relatives to donate an organ, or part of it, to a
family member in need
if the potential donor is not related to the person who
needs the organ, the transplant needs to be approved
by a state-level committee or by a hospital committee
that includes government officials. This, explains can
cause unnecessary delays.
Other organs used in transplants are donated from people
who are brain dead. Known as “deceased” organ
donation, this requires the approval of the donor’s
next of kin.
24. Here, the main problem is awareness, say doctors.
The first challenge is that it is often difficult for family
members to accept their loved one is brain dead. “On
a life support system, the person looks like he/she is
sleeping. The body is warm to touch and the heart is
beating,” . This makes it difficult for doctors to convince
the family members to donate the organs of their relative.
Even if the family is ready to donate organs, religious
superstitions become impediments.
In one case a family refused to donate a kidney from a
brain dead relative on a particular day because it was
new moon day (“Amavasya”),
25. To increase the number of organs available for transplant,
there is another option: incentivize donations by
paying donors. Indian law does not allow this.
paying a willing donor for their organ should not be
confused with the illegal trade of organs. This
practice is alarmingly common in India, as the book
“THE RED MARKET” recently revealed.
Singapore is an example of a country that has
made paying donors for their organs legal, where the
government set up a national registry for the long-term
follow-up of living donors and providing them with some
health insurance.
26. Another problem is that there are too few surgeons
and hospitals equipped for transplants.
Ventilators for preserving the organs of a brain
dead person and intensive-care unit personnel trained
to manage such situations are prerequisites for a
transplant, doctors.
“The private hospitals are still well equipped,” but
“government hospitals are not well geared.”
27. Cost and Survival Outcome
The cost of organ transplant varies across the globe,
but most common kidney transplant can range from
as low as $5,000 (India), $70,000 (China) to $100,000
(USA).
Another recent report is referring to estimated billed
cost per member per month in the USA depicts that
transplantation is indeed a costly affair cornea
($28,000), kidney ($300,000) and liver ($700,000).[50]
28. Even in the government sector in India, the renal
transplant may incur personal expenditure ranging from
Rs. 50,000/- to Rs. 100,000/- depending on the availability
of sophisticated investigations; cornea (Rs. 8000/-), liver
transplant (AIIMS, New Delhi: Free of cost; PGI
Chandigarh: Rs. 7/-–Rs. 8/-lakhs, ILBS New Delhi: Rs. 12/-–
Rs. 14/-lakhs) while in private sector renal transplant may
range from Rs. 3.5 lakh to 15 lakh depending on
compatible or non-compatible blood group transplant;
cornea (Rs. 35,000/-–Rs, 65,000/-), liver (Rs. 18–30
lakh), and heart transplant may cost ranging from Rs.
10 lakh to Rs. 20-lakhs (Times of India).
Contrary to general perception, the long-term cost of
renal transplantation is lower compared to hemodialysis
or peritoneal dialysis.[
Even the quality of life and survival
are reportedly better among renal transplant recipients.
29. SUMMARY
Organ donation is the process of Retrieving or Procuring an organ from a live
or deceased person
8–10 brain dead patients in various ICUs with 4–6% of all hospital
deaths being brain death.
Indian transplant registry started in the year 2005 by the efforts of the Indian
Society of Organ Transplantation
200 transplant centers in the country mostly led by private players and
NGOs.
OBSTACLES-
Fear of death and surgical mutilation
Lack of awareness of brain death concept among medical professionals and
public
A misapprehension about brain death
Fear to declare patient dead even before they are actually dead
Religious fallacies
Out-of-pocket expenses
Lack of system regarding identification and maintenance of brain dead donors
Socio-cultural beliefs including desire to be buried/burnt completely and re-
birth without a missing organ
30. Mental non-acceptance of idea living with another person's organ say kidney
Lack of government support
Public and professionals attitude to brain death and OD
Lack of system transparency and perception of misuse of organs
Dynamics of decision making for actual donation
Poor funding and budget due to competing need/demand
Inadequate health insurance
Adverse media reporting and negative publicity
Legal, administrative/bureaucratic, and equity issues
Non-availability of trained transplant coordinators/counselors
Hospital infrastructure, logistics, manpower, functional linkage, and support
system.
kidney transplant can range from as low as $5,000 (India), $70,000 (China)
to $100,000 (USA).
31. CONCLUSION
To conclude,
It is not that people do not want to donate, but that there
are no mechanisms in hospitals to identify and certify
brain deaths. It may also be pertinent to mention that no
one empowers the relatives of a brain dead person to save
lives of other people by donating their relative organs.
in an environment of flexible bureaucratic procedures,
system readiness, technical know-how, and abundance of
organs linked with high motivation, positive attitude of
health staff, transparent communication, counseling and
functional coordination of different institutions/units will
lead the graph reversal from low to high ODT activities in
India and may offer another functional model to the
world.
