THE CIRCLE OF LIFE
Transplants are one of the biggest achievements of modern medicine and can save or greatly enhance the lives of other people. However, it depends completely on donors and their families consenting to organ or tissue donation. One donor can save the lives of several people, restore the sight of two others, and improve the quality of life of many more.
Every year hundreds of people die while waiting for an organ transplant or before they even get on to the transplant list. There is a serious shortage of organs and the gap between the number of organs donated and the number of people waiting for a transplant has only increased.
Let us have a look at some of the key aspects of organ donation:
What is an organ?
An organ is a part of the body that performs a specific function: like your Heart, Lungs, Kidneys, Liver etc.
What are the organs that can be donated?
Liver, Kidneys, Pancreas, Heart, Lungs, Intestine.
What is a tissue?
A group of cells that performs a particular function in the human body, such as bone, skin, cornea of the eye, heart valve, blood vessels, nerves, tendons etc.
Tissues that can be donated
Cornea, bone, skin, heart valve, blood vessels, nerves, tendon etc.
What is Organ Donation?
Organ Donation is the gift of an organ to a person with end-stage organ disease and who needs a transplant.
Types of Organ Donation:
i) Living Donor Organ Donation: A person during his life can donate one kidney (the other kidney can maintain the body functions adequately for the donor), a portion of pancreas (half of the pancreas can sustain pancreatic functions) and a part of the liver (liver regenerates after a period of time in both recipient and donor).
ii) Deceased Donor Organ Donation: A person can donate multiple organs and tissues after (brain-stem/cardiac) death. Their organ will continue to live in another person’s body.
Age limit for Organ Donation:
It depends on whether it is living donation or cadaver donation. For example, in living donation, the person should be above 18 year of age. But the key factor is the person’s physical condition and not age. Specialists decide which organs are suitable case to case. Organs and tissue from people even in their 70s and 80s have been transplanted successfully all over the world. In the case of tissues and eyes, age usually does not matter. A deceased donor can donate organs and tissues as under:
· Kidneys, liver: up to 70 years
· Heart, lungs: up to 50 years
· Pancreas, intestine: up to 60-65 years
· Corneas, skin: up to 100 years
· Heart valves: up to 50 years
· Bone: up to 70 years
Living Donor: Any person not less than 18 years of age, who voluntarily authorises the removal of any of his organ and/or tissue, during his or her lifetime, as per prevalent medical practices for therapeutic purposes.
Deceased Donor: Anyone, regardless of age, race or gender can become an organ and tissue donor after death (Brainstem/Cardiac). Consent of near relative or a person in lawful possession of the dead body is required. If the deceased donor is under 18 years, then consent from one of the parents or any near relative authorised by the parents is essential. Medical suitability for donation is determined at the time of death.
How can I be a donor? What about a donor pledge?
You can be a donor by expressing your wish in the authorised organ and tissue donation form (Form-7 as per THOA or the Transplantation of Human Organs Act 1994). You may pledge to donate your organs by signing up with the National Organ and Tissue Transplant Organisation (www.notto.nic.in) or the Kerala Network for Organ Sharing (www.knos.org.in) and register yourself as a donor. For offline registration you may download Form 7 from NOTTO/KNOS websites. You will be required to fill Form 7 and send a signed copy to NOTTO at the address below:
National Organ & Tissue Transplant Organisation
4th Floor, NIOP Building, Safdarjung Hospital Campus,
New Delhi — 110029
You will get a donor card once you have registered.
What is an Organ Donor Register?
NOTTO/KNOS maintain an Organ Donor Register, a computerised database that records the wishes of people who have pledged organ and tissue donation and have decided that after their death they would like to leave a legacy of life for others.
Importance of a Donor Registry
A registry identifies who and where potential donors are. A registry gives a planner enough information to devise strategies to get more public cooperation and commitment towards organ donation. Having a registry in place allows doctors and transplant coordinators to check if a brain-dead person wished to donate following which approaching the family for consent becomes easier. It helps in saving crucial time in the process of organ donation.
Do I always need to carry my donor card?
Yes, it will be helpful for health professionals and your family.
Do I need to register my pledge with more than one organisation?
No, if you have already pledged with one organisation and received a Donor Card.
Can a person, without a family, register for pledge?
Yes, you can pledge, but you need to inform the person closest to you in life, a friend of long standing or a close colleague, about your decision of pledging. Healthcare professionals will then be able to speak to them at the time of your death for consent.
What is the benefit to my family or me after donation?
Donation of an organ or tissue provides an incomparable opportunity to give someone a second chance at life. Your donation not only affects one person or family but also society as a whole positively.
Can I unpledge?
Yes, you can unpledge by calling the NOTTO office or writing to or visiting the NOTTO website www.notto.nic.in and avail of the un-pledge option by logging into your account. Let your family also know that you have changed your mind regarding your organ donation pledge.
Religious objections to donate organs and tissues?
No. None of our major religions objects to this noble cause. You could also discuss with your spiritual or religious leader or adviser.
Can people who have pledged become organ donors for sure?
No. Some people die in circumstances where they are not able to donate their organs. That is the reason we need people to take a pledge for organ donation and register themselves as potential donors.
Screening donors for transmissible diseases
Blood samples are taken from all potential donors and tested to rule out transmissible diseases and viruses such as HIV and Hepatitis.
Can I be a donor if I have an existing medical condition?
Yes. In most circumstances you can be a donor. A medical condition need not necessarily prevent a person from becoming an organ or tissue donor. The suitability of some or all organs or tissue is decided by a healthcare professional considering your medical history. In rare cases, the organs of donors with HIV or Hepatitis-C have been used to help others with the same condition. All donors undergo rigorous checks to guard against infection.
Can I be an organ donor, if I have been barred from donating blood?
Yes. The decision about whether some or all organs or tissue are suitable for transplant is always made by a specialist. There may be specific reasons why it has not been possible to donate blood, such as anaemia, blood transfusion, or hepatitis. It can even be a simple thing such as a cold or medication that you are taking that can prevent you from donating blood.
Whole body donation vs organ donation
Organ donation for therapeutic purposes is covered under the THOA Act. Whole-body donation is covered by Anatomy Act 1984. Organ and tissue donation is defined as the act of giving life to others after death by donating one’s organs to the needy suffering from end-stage organ failure. Body donation is defined as the act of giving one’s body after death for medical research and education. Those donated cadavers remain a principal teaching tool for anatomists and medical educators teaching gross anatomy.
After organ donation, can a dead body be handed over for medical education or research?
No. Bodies are not accepted for teaching or research if organs have been donated or if there has been a post-mortem. However, if only the corneas are to be donated, a body can be left for research.
How can I help in increasing organ donation?
· By becoming a donor and talking to your family about your decision of saving lives of others.
· Promoting donation by motivating people at workplace, in your community, at your place of worship, and in your civic organisations.
Can my organs be given to a foreigner?
As per the Transplantation of Human Organ Act, the sequence of allocation of organs shall be in the following order:
State List —> Regional list —> National List —> Person of Indian Origin —> Foreigner
Can I donate an organ while I am still alive?
Yes. But not all organs and tissues. The most common organ donated by a living person is a kidney as a healthy person can lead a completely normal life with one functional kidney. Kidneys transplanted from living donors have a better chance of long-term survival than those transplanted from a deceased donor. Nearly 90% of kidney transplants in India are from living donors. Besides the kidney, a part of the liver can be transplanted. It may also be possible to donate a segment of the lung and, in a very small number of cases, part of the small bowel. For all forms of living donor transplants the risk to the donor is key. Before a living donor transplant can go ahead there are strict regulations to meet.
Different types of living organ donation
Living Near-Related Donors: Only immediate blood relations are accepted as donors, such as parents, siblings, children, grandparents, and grandchildren (THOA Rules 2014). A spouse is also accepted as a living donor in the category of near relative and is permitted to be a donor.
Living Non-Near Relative Donors: They are other than near-relatives of recipient or patient. They can donate only for reasons of affection and attachment towards the recipient or for any other special reason.
SWAP Donors: In these cases where the living near-relative donor is incompatible with the recipient, there is provision for swapping of donors between two such pairs when the donor of the first pair matches with the second recipient and the donor of second pair matches with the first recipient. This is permissible only for near relatives as donors.
Age limit for living donor
Living donation should be done after 18 year of age.
What is Swap Donation?
Sometimes within a family, there is a potential related donor who, although willing, is unable to donate an organ to that particular recipient in the family due to blood group mismatch or some other medical reason. A similar situation could exist in another family. However, in these two families, the donor from one family could be medically fit for the recipient of the other family and vice versa. These two families then make a pair and make organ transplant possible for these two recipients of different families. This is called swap donation transplantation. Swap transplant is legally permitted in THOA (Amended) act 2012.
Will I become medically unfit after organ donation?
No. Living donors remain absolutely healthy for the rest of their life. Thus, the donor does not become medically unfit. However, in certain situations, a living organ donor is treated differently. Like in the Armed Forces, an organ donor could face issues related to promotions or further prospects in their job.
Receiving organs from a friend or other than near relative
As per THOA, any living person other than a near relative can also donate an organ because of affection towards the recipient or for any other special reason. Such cases need to be approved by the regional (zonal) authorisation committee other than the Authorisation Committee of the Hospital, where the transplant will take place. The approval of the hospital’s authorisation committee is mandatory in all cases involving relatives.
What is Cadaver/Deceased?
The Oxford Dictionary defines ‘cadaver’ as ‘a dead human body’. Medically, a cadaver is a corpse used for dissection and study. In the area of organ transplantation, a cadaver refers to a brain-dead body with a beating heart, on life-support systems.
What is Brain-Stem Death?
Brain-stem death is the cessation of stem function due to irreversible damage. It is irreversible and the person is dead. It is also called Brain Death in India. A brain stem-dead person cannot breathe on his own; however, the heart has an inbuilt mechanism for pumping as long as it is supplied with oxygen and blood. As a ventilator blows air into the lungs of brain stem-dead person, his heart continues to receive oxygenated blood while drugs can help maintain blood pressure. The heart will continue to beat for a time after brain stem death; this does not mean that the person is alive or that there is any chance for recovery.
The declaration of brain-stem death is made via accepted medical standards. The parameters emphasise the three clinical findings necessary to confirm irreversible cessation of all functions of the brain, including the brain stem: coma (loss of consciousness) with a known cause, absence of brainstem reflexes, and apnoea (absence of spontaneous breathing). These tests are carried out twice at the interval of at least 6-12 hours by a team of medical experts. Brain-stem death is accepted under the Transplant Human Organ Act since 1994.
Is brain-stem death legally accepted as death?
Yes, as per the Transplantation of Human Organs Act 1994.
Who certifies brain-stem death?
As per THOA, a board of medical experts consisting of the following will certify such death:
· Doctor in charge of the hospital (medical superintendent)
· Doctor nominated from a panel of doctors appointed by Appropriate Authority
· Neurologist/neurosurgeon/intensivist nominated from a panel appointed by Appropriate Authority
· Doctor treating the patient
A panel of four doctors carries out the tests together to certify brain death.
Who explains to the family about brain-stem death?
The doctor (intensivist/neurologist/neurosurgeon) treating the patient.
If the family is willing to donate organs of the potential brain-stem dead donor, what should they do?
The family can approach the counsellor of the hospital, the transplant coordinator, or the doctors themselves.
Who will receive my organ?
Your vital organs will be transplanted into those individuals who need them most urgently. Organs are matched with recipients on the basis of medical suitability, urgency of transplant, duration on the waiting list, and geographical location. NOTTO and its state units (Regional Organ and Tissue Transplant Organisation and State Organ and Tissue Transplant Organisation) besides KNOS work round the clock, every day of the year, and cover the whole of the country. Tissue is occasionally matched for size and tissue type, but otherwise is freely available to any patient in need of a transplant.
If my family refused cadaver organ donation, will my treatment be affected?
No. Even though your family refuses organ donation, the treatment will be carried out as per clinical condition. Organ donation is never linked to treatment. These two are separate entities. A completely different team work for donation. Also, doctors involved in transplant operation are never involved in the donation process from the family of potential donor.
If I carry a donor card, will my organ be taken out without my family being asked?
No. Even if you carry a donor card, your immediate family members and close relatives will be asked for consent for donation of organs and tissues. Consent is mandatory from the person lawfully in possession of the dead body. Organ donation cannot take place without consent.
Can I express a wish to donate organs to some people and not to others?
No. Organs and tissue cannot be accepted unless they are freely donated. You may, however, express your wish to donate any particular organ and/or tissue.
Does organ/tissue removal affect cremation/burial arrangements or disfigure the body?
No. The removal of organs or tissues will not interfere with customary funeral or burial arrangements. The appearance of the body is not altered. A highly skilled surgical transplant team removes the organs and tissues to be transplanted. Surgeons stitch up the body carefully, hence no disfigurement occurs.
What if I had pledged to donate my organs, but my family refuses?
In most situations, families agree. If, however, the family or those closest to the person who has died object to the donation even when the person who has died has given explicit permission, healthcare professionals will discuss the matter sensitively with them. They will be encouraged to accept the dead person’s wishes. However, if the family still objects, then the donation process will be terminated.
Is there a difference in organs between heart-beating donor or donor after cardiac death?
Yes. Heart-beating donor means the patient has been declared brain-stem dead and that his/her organs can be retrieved when heart is still beating with assistive devices. A beating heart keeps up blood supply to organs, thus preventing any potential damage to them. Donation after cardiac death, however, needs to be done immediately, as without blood supply, the organs become viable after a certain period of time.