Now what?s life after death? Well, it?s not really as profound a question as it would seem. Later last month a 58-year-old woman died of brain haemorrhage and was declared brain-dead at MS Ramaiah Hospital in Bengaluru. Fortunately, her children decided to donate her organs and within 24 hours of her death, she had saved four lives. Her liver was sent to Vellore, both kidneys were donated to two other recipients and her cornea was donated to an eye bank. In the same month, 20-year-old Sumit Jain who lost his life in a train accident, helped six other people with his organs, with his declared wish to be a donor.
Fact of the day
In India such instances can be counted on finger tips, though things are different in Spain. Credited with one of the most successful organ donation and transplantation system of the world, Spain?s magic formula lies in the ?opt-out system?. Spanish Organizaci?n Nacional de Trasplantes understood that the problem of organ donor shortage was not the lack of suitable donors, but rather a problem of identifying potential donors and obtaining consent. Therefore, Spain implemented a standardised donation process in every hospital. The system automatically places citizens on a register of donors unless they or their family object. A reason why Dr Z S Meharwal, Director and Coordinator, Department of Cardiovascular Surgery, Escorts Heart Institute and Research Centre, Delhi urges India to ?draw inspiration from Spain where 95% of the organ donations are through cadaver donors.?
But how a mandatory system of organ donation would be received in India is a crucial matter indeed. However, few would deny that the issue needs to be urgently looked into, considering that the volunteer programmes in India have not exactly met with substantial success. Unlike the blood donation campaign, it has a long way to go.
A spokesperson in the Ministry of Health seeks to clarify on the Spanish model. ?In Spain ?presumed consent? only exists on paper. In reality what makes the practice succesful are trained co-ordinators who counsel and convince the family to donate the organs of the deceased,? he says. The Ministry of Health and Family Welfare is finalising the draft programme to promote organ donation. The provisions of the programme can be considered revolutionary in their own right, like asking in the driving license form if you?d like to opt for organ donation or not. Also there is a promotive provision for improving infrastructure whereby only hospitals with transplantation facilities are eligible for registration under the Transplantation of Human Organs Act 1994 right now. New provisions will relax this rule and that would mean more hospitals joining the network. ?Right now, around 20 hospitals in Delhi are registered under it,? says the Ministry of Health spokesperson. This is a large gap taking into account that Delhi has around 200 hospitals.
The roadblocks
Improving the law can help in checking illegal organ trade, putting an end to the likes of Amit Kumar and Manik Chowdhury who ran organ rackets in Gurgaon and Kolkata.
Cadaver donation is a viable solution by which deceased cadaveric donors who have been declared brain-dead and whose organs are kept workable by ventilators, drugs or other mechanical mechanisms until they can be excised for transplantation. However, the process is not as easy as it may seem. ?Cadaver donation is a relatively unknown concept in India. One, it is not easy to declare a person brain dead. Two, it is difficult for the family to accept brain death,? says Dr Aarti Vij, Organ Retrieval Banking Organisation (ORBO), AIIMS. ORBO has approximately 10,000 registered donors on its list and it is the only nodal agency in India that maintains a waiting list of terminally ill patients who require transplants. Most of the government and private hospitals in Delhi are on its network. But only one out of four families that ORBO approaches give their consent to donate the organs. ?The progress of the programme is slow but we do not want to hasten it at the stake of losing credibility and confidence amongst the masses,? says Vij. There are logistical issues to be taken care of ? right from obtaining consent from the family to co-ordinating between almost ten medical departments. Most of the time, the surgeons have to be pulled out from their routine rounds for the emergency and patients waiting for organ transplants also need to be informed, patients who may or may not be readily available at the time.
Writing on the wall
There is a urgent need to find an alternative strategy to promote organ donation. ?India has among the world?s highest number of deaths from road accidents. At any given time there are 8 to 10 brain dead patients in different ICUs in any major city of the country. However, the trend of organ donation is not catching on,? says Dr Meharwal. He affirms, ?heart and lung transplantations, either individually or in combination, are being performed in India since the first successful heart transplant in 1994, but their cumulative numbers are few. The reason for these organ transplants not taking off on a large scale is the absence of a viable cadaver donor programme.?
Consider this: ?two lakh people die of liver failure in India each year. In atleast 4,500 cases transplantations can be done but only 300 transplantations eventually take place,? says Dr A S Soin, Senior Consultant Surgeon, Department of liver transplantion and surgical gastroentolgy, Sir Ganga Ram Hospital, Delhi. He emphasises on the need for strengthening the infrastructure and orgainsing the structure. Plans of opening regional organ donation centres in India still remains in the pipeline. Streamlining the process also promises to open avenues for transplantation tourism in India. Currently, 20% of liver transplants in Ganga Ram hospital are of medical tourists. Figures from the developed world would vouch for that. ?The increase in donor numbers has been encouraging but still not enough to meet the great demand for transplantable organs. By far the largest gap between demand availability is for kidney transplants. It is both the most commonly needed and transplanted organ. More than 78,000 people need kidney transplants, and the demand continues to increase,? says Joel Newman, Assistant Director, Communications, United Network for Organ Sharing (UNOS). From both deceased and living donors, roughly 16,000 to 17,000 kidney transplants are performed each year in the US according to UNOS.
Thanks to other medical and surgical advancements, the waiting list for the heart has dramatically declined. ?The waiting list for heart transplant is about 2,700 people, one-third less than what it was 10 years ago. The need for liver transplants is still high but has also declined from its peak. That waiting list is now about 15,700,? adds Newman. The scope of transplant tourism, therefore, is huge. If only things could move faster here in India.
Things are changing, albeit slowly. Consider Gujarat which is emerging as a model state in the context of cadaver donation. According to Institute of Kidney Disease and Research Centre (IKDRC), Ahmedabad, 15% of Gujarat?s transplants are from cadaver donated organs as compared to 5 to 10 % all over the country. ?We performed 273 transplants last year and 278 in 2007,? says Dr H L Trivedi, Director, IKDRC. ?The challenge is to incite faith in people. Most people do not trust doctors and refrain from donating their organs.? he adds. IKDRC has established an inter-city network to help people in other cities in Gujarat to donate their organs.
Changing the momentum of the movement depends on one little thing ? reading the writing on the wall and drawing inspiration from the likes of Sumit Jain. That?s all it takes.
In the know
Myth Only hearts, livers, and kidneys can be transplanted.
Fact Needed organs include the heart, kidneys, pancreas, lungs, liver and intestines. Tissue that can be donated include the eyes, skin, bone, heart valves and tendons.
Myth My history of medical illness means my organs or tissues are unfit for donation.
Fact At the time of death, the appropriate medical professionals will review your medical and social histories to determine whether or not you can be a donor. With recent advances in transplantation, many more people than ever before can be donors. It’s best to tell your family your wishes and sign up to be an organ and tissue donor on your driver’s license or an official donor document.
Myth I am too old to be a donor.
Fact People of all ages and medical histories should consider themselves potential donors. Your medical condition at the time of death will determine what organs and tissue can be donated.
Myth If I agree to donate my organs, my family will be charged for the costs.
Fact There is no cost to the donor?s family or estate for organ and tissue donation. Funeral costs remain the responsibility of the family.
Myth Organ donation disfigures the body and changes the way it looks
Fact Donated organs are removed surgically, in a routine operation similar to gallbladder or appendix removal. Donation does not change the appearance of the body for the funeral service.
Myth My religion prohibits organ donation.
Fact All major organised religions approve of organ and tissue donation and consider it an act of charity.
Source: United Network for Organ Sharing
life beautiful
Organ donor Julie De Rossi (above) poses in this undated portrait. Julie De Rossi didn?t become a meaningless traffic statistic in the early hours of March 17, 2004 after being struck by a drunk driver.
An organ donor, she has since helped mend more than 50 people, including Cincinnati Bengals quarterback Carson Palmer (right), the top-paid player in the National Football League. The knee that Palmer heard snapping apart after a crushing hit during a January playoff game is now held together by Julie De Rossi’s Achilles tendon.
How to be a donor
?We make a living by what we get, but we make a life by what we give,? says Norman MacEwan. Some food for thought there…Well, even Renuka Chowdhury, Minster of Women and Child Development and Delhi?s mayor Aarti Mehra have pledged their organs.
•You can download the donor form from ORBO website. Alternatively you can call their special 24-hour. helpline at 1060.
• Fill the organ donor form (also available at most hospitals and clinics) in the presence of two witnesses.
• Preserve the organ donor card with you all the times (better keep it in your wallet).
• You would need to discuss your decision with your family members and loved ones. Even if you sign a donor card, it is essential that your family knows your wishes. Your family is asked to sign a consent form in order for your donation to occur.
Law of the land
Retail tycoon Tang Wee Sung, founder of CK Tang Ltd, was sentenced to one day in jail and fined S$17,000 ($11,813) by a Singapore court for trying to buy a kidney and lying about it in a case that?s forced lawmakers to rethink a ban on organ trading. Singapore has the fifth-highest incidence of kidney failure in the world, according to the National Kidney Foundation. In most cases, the blood-filtering organ was disabled by a form of diabetes often linked to obesity, and which is projected to afflict one-in-seven adults living on the island by 2030.