ORGAN DONATION- Story of Life After Death

DR.ASHOKANMANAGING TRUSTEE

A.P.HITHENDRAN MEMORIAL TRUSTTHIRUKAZHUKUNDRAM KANCHIPURAM

DISTRICT. TAMILNADU 603109INDIA

Organ and tissue donors leave a miraculous

legacy 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 Every day they lead us on a journey of hope,

renewal, and transformation

Organ Donation – A Gracious Act

Death is not the last sleep. It is the final awakening                          - Walter Scott, Scottish novelist 

This presentation has been made using web site was created using 100% recycled

electrons!! Recycle yourself by becoming an organ

donor

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

• After Natural Death

• Living person – related to patient

• Living person – unrelated to patient

• After Brain Death

Organ Donation by a Living person

Blood

Eyes

Bone marrow

Kidneys

Portion of Liver

Portion of Lung

Portion of PancreasIddham Shariram Paropkardum

(This body is for the use of others) - Shankracharya

Organ Donation after Natural Death

• Eyes• Skin and fascia• Heart Valves• Bones and Tendons• Cartilage• Veins and Arteries• Middle Ear Bones

The only thing you take with you when you're gone is what you leave behind  - John Allston

Organ Donation After Brain Death

• Eyes ( 2 )• Kidneys ( 2 ) • Liver ( 1 )• Lung ( 2 )• Pancreas ( 1 )• Small Intestine ( 1 )• Voice Box or

Larynx( 1 )• Hand ( 2 )• Penis ( 1 )

• Middle Ear Bones ( 2 )

• Skin and fascia - Numerous

• Bone - Numerous• Cartilage - Numerous• Tendons - Numerous• Veins - Numerous• Arteries - Numerous • Nerves - Numerous• Fingers and Toes

( 20 )

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.

Transplant Miracles !!!

Medical miracles these days have a short life span of glory!!!

Transplant Miracles !!!

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 "the best I've felt in a

long time“.

Previously Tim was using an electro-larynx for 19

years as his own larynx was injured in a motorcycle

accident

COMMMONEST TYPE OF ORGAN DONATION IN INDIA

• Blood - Living related or unrelated

• Eyes - After Natural Death

• Kidney Donation - Mostly unrelated and sometimes related

And he will wipe out every tear from their eyes and death will be no more.

- Revelations 21:4 

EYE DONATION

Aishwarya Rai, Amitabh Bachhan, Jaya Bhachhan,

Rajnikanth, and many other film personalities have

pledged their Eyes at different times on media

Eye Donation

• Keep the Eyes moist with water & eye-lids closed

• Avoid use of fans near or above the body • Contact the nearest Eye Bank • Takes 5 to 10 minutes for the doctor or

technician to perform the procedure

Cornea removed EyeballCornea Eyeball

35 million people are BLIND or going blind in the developing world and most of them can be cured

0 5,000 10,000 15,000 20,000

1998-991997-981996-97

Eye Donation

Corneas Retrieved in India 1996- 99

1998-99

1997-98

1996-97

3 million corneally blind people in India. 60% are children below the age of 12. Target retrieval of corneas by Eye bank of India is 150,000 corneas

per year.

Brain Death Concepts

• First recognised in 1959 in Paris in Intensive care units (coma de passe )

• Formally accepted as a form of death in 1968 by the ad hoc committee at Harvard

• Accepted by Govt. of India in 1994 as a form of death

In Babies under one year brain death concept not applicable

No wastage of organs if organ donation from

brain dead donors undertaken Almost 95% of organ donors in western world

originate from Brain Dead Donors Largest pool of organ Donors in the world

Brain dead Pool of Donors

Potential Brain Dead Donor

• Patients are in Intensive care• Patients are on extensive life support

medication and machines• Patient are on artificial breathing machines• They usually have a brain injury or

bleeding within the brain or a brain tumour

Once brain death diagnosed term “Cadaver” used for patients

Common Causes of Brain Death

In India Road traffic Accidents the commonest cause of brain death

Brain dead Pool of Donors in India

In any of the metropolitan city in India

There are at least on an average between 10 to 20 patients admitted in different

ICUs who are brain Dead

Even Doctors often fail to diagnose or recognise this condition!!

Transplant Statistics

• Number of transplants done throughout the world - 5,50000

• Number of patients on transplant waiting list - 1,50000

• Number of Transplants worldwide 1997 - 37,072

Annual transplant figures are not rising. Though Waiting lists though are perpetually going up.

Transplant Activity of Western World (1985 to 1992)

1985 1986 1987 1988 1990 1991 19920

5000

10000

15000

20000

25000

Kidneys - Cadaverkidneys - LivingLiver Heart

1989

TOTAL TRANSPLANT ACTIVITY IN INDIA (1998 – 1999)

0

500

1000

1500

2000

2500

3000

3500

1998 1999

Kidney - LivingKidneys - cadaverLiverHeart

Golden IT triangle of India Chennai, Bangalore and Hyderabad, are also famous as “Kidney Bazaars” in the western world

Cadaver Transplants in India 1995 -2001

KIDNEY 300HEART 25LIVER 10PANCREAS 01LUNGS 01

TOTAL 336

Averages just over 50 cadaver organ transplants a year

Organ Failure Incidence In India

• Kidneys - 150,000 patients require Transplants

( 3000 - Transplants done )• Heart - 50,000 patients require Transplants

( 26 Transplants done)• Liver –100,000 patients require Transplants

(12 Transplants done)

Above organs also called Solid organs besides including lungs and Pancreas

DON’T TAKE YOUR ORGANS TO HEAVEN FOR

HEAVEN KNOWS THEY ARE NEEDED HERE !!

SOLID ORGAN DONATION

Anil Kumble, Sunil Shetty, Yukta Mukhi, Revathi Menon

and Madhavan have endorsed their views on multi-organ donation

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

Transplant Organ Survival

Longest living Kidney Transplant - 34 years

Longest surviving Heart Transplant Patient

- 22 years

Longest living Liver Transplant - 27 years

Longest living Lung Transplant - 12 years

Longest living Indian Transplant patient has lived for 30 years

Age & Organ Donation

Corneas 0 to 100 yrsHeart valves 0 to 60 yrsTrachea 15 to 60 yrsSkin 16 to 85 yrsKidneys 0 to 70 yrsHeart 0 to 60 yrsLungs 0 to 60 yrsLiver 0 to 70 yrs

Almost 23 different tissues and organs of the body can be donated

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

Organ Donation Ethical Aspects

Most of the social and Ethical problems in organ donation due to

kidney donation

Is Living Organ donation Ethical ?

• Hippocratic oath – Do no Harm• Voluntarism – Decision to donate in a

family may not be voluntary• Usually more woman donate than men -

mother or wife are the commonest donors• Usually trafficking of organs from the poor

to the rich

One in 1000 living donor is likely to die even in best of surgical hands!!

Commercial Aspects of Organ Donation

• Human Rights Violation- in China (1990) – 1670 kidneys transplanted mostly from executed criminals

• Bizarre instances of kidneys being removed by surgeons from an innocent donor is reported from all over the world regularly

On e-bay the famous Internet Auction websites a Kidney was being auctioned for almost One million dollars!!!

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

Commercial Aspects of Organ Donation

• Human Rights Violation- in China (1990) – 1670 kidneys transplanted mostly from executed criminals

• Bizarre instances of kidneys being removed by surgeons from an innocent donor is reported from all over the world regularly

On e-bay the famous Internet Auction websites a Kidney was being auctioned for almost One million dollars!!!

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

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 - "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

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

"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

Organ donation Legal Aspects in India

“ Its Provisions and Pitfalls”

Transplantation of Human Organs Act, 1994

Aims Regulate removal, storage and

transplantation of human organs for therapeutic purposes

To prevent commercial dealings in organs

Tamil Nadu Assembly passed the Act in May 1995

Main Provisions of THO Act

Concept of “Brain Stem death” accepted Only “Living related Donors” are allowed to donate

organs without legal problems For unrelated Donors - Permission from “Authority”

required prior to surgery Requires - “Regulation and Registration of hospitals”

undertaking transplantation “Punishment for any commercial dealings in organs”

1st Relative – Father / Mother / Brother / Sister / Wife / Son/ Daughter

Brain Stem Death

Definition - Stage at which all functions of the Brain Stem have permanently and irreversibly ceased

Certification – Panel of four doctors

– Two sets of tests to be carried out - minimum of six hours in between the tests

– Form No. 8 to be used for certification

Death is usually a gradual event. Nail and hair can continue to Grow even after death !!

Organ Donor

Person may authorize removal of any human organ before his death.

Person may express his wish to donate his organs in the event of his death, through a ( Form No. 5 )

“Informed Consent” of Family is crucial to cadaver organ donation.

“Presumed Consent” – In some countries the law demands organ donation from its citizens, unless they express otherwise in writing

Offences and Penalties

Commercial dealings in organs Imprisonment : 2 to 7 years Fines : Rs.10,000/- to Rs.20,000/-

Penalties for Doctors First Offence : Name struck off State Medical

Register for 2 years Subsequent Offence : Name struck off

permanently

Since the Act was passed there has been only one criminal prosecution against a doctor in Delhi

Donors• Scrapping of Sub Clause (3) , Clause 9 of

Chapter II– 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.

Pitfalls - THO ACT

Majority of kidney transplants in the country use this clause resulting in “ legal commercial racket of kidneys”

Organ Donation Problems & Solutions

Problems with Cadaver Organ Donation Programme in India

Govt. Problem

No Funding for programme

Hospital problem

No efforts to identify & maintain “Brain Dead”

donors

Community Problem

No Awareness of “Brain-Death” Concept

Spain has the highest number of brain death patients going on to organ donation – 32 per million population

Streamlining of THO ACT

Make it compulsory for doctors or medical social workers to ask for Organ Donation in a Brain Dead Situation

Identify doctors or senior nurses to work as Transplant Coordinators in each ICU

In Medico-legal cases it should be possible to perform Post-Mortem at same time as organ retrieval in presence of a Forensic Expert

No financial costs involved in the above recommendations

MOHAN Foundation - Objectives( Multi Organ Harvesting Aid Network )

Formed in 1997

Spread Message of Organ Donation

Works as a support group for Patients, Public & Physicians

Foundation subgroups –

Organ Sharing Group – INOS

Counselling unit – Manashanthi

Patient Support Group

Publishes “Indian Transplant Newsletter”

Organ Donation Awareness Programmes

Driving License with “Donor Card” clause Education at School and College Level Free Air time on Doordarshan and Private

Channels for films on Organ Donation Tax Exemption for documentaries on

Organ Donation Indirect incentives to donor families Honoring cadaver donor families

In states of Maharastra & Gujarat slogans about “Eye donation” displayed on National Highways

Carry the card in the walletServes also as an emergency card

ORGAN DONAR CARD BY A.P.H.M.T.

Give Life a SECOND Give Life a SECOND Chance…Chance…Carry a Donor CardCarry a Donor Card

Organ Donor Cards by MOHAN Foundation

HONOUR OF CADAVER ORGAN DONORS ORGANISED BY MOHAN FOUNDATION

MEMORIAL SERVICE 31ST OCT 1999 Loyola College, Chennai

Saplings Planted in Memory of cadaver Organ Donors by their family members in the Campus of Loyola College on 30th Oct 1999 - organised by MOHAN Foundation

Painting Completion on Organ Donation theme organized for schools by MOHAN Foundation in March 2001

Movie in English, Hindi and Tamil for Television ChannelsMade by MOHAN Foundation

Formed in Nov’1999 by MOHAN Foundation Essence of INOS – “Not to Waste Any Organ” Hospital in group includes – Apollo, CMC Vellore,

Sri Ramachandra Hospital and Sundaram Medical

Foundation About 30 different organs shared between hospitals

INOS - Initiative for organ sharing Group

UNOS in USA is the largest organization such organization and is partly funded by the government

Counselling Unit- Manashanthi

• Formed in April 2001

• As a support group for emotional failure

• Located at Annanagar

• Counselling available between 10AM and 1PM

• Organises counselling lectures and workshops

… When that happens don't call this my “DEATHBED”, call it my

"BED OF LIFE" and let my body be used by others to lead fuller lives 

… When that happens don't call this my “DEATHBED”, call it my

"BED OF LIFE" and let my body be used by others to lead fuller lives 

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…

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

Give my eyes to a man who has never seen….

Sunrise

A baby’s face

or Love in the eyesof 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 has caused nothing but endless days of pain

a speechless boy will shout at the crack of a bat and a deaf girl will hear the sound of rain against her window

Explore every corner of my brain, take my cells and let them grow so that someday….

If you must bury something, let it be my faults, my weaknesses and all my prejudice against my fellowmen

Burn what is left of me and scatter the ashes to the winds to help the flowers grow

If you must bury something, let it be my faults, my weaknesses and all my prejudice against my fellowmen

Burn what is left of me and scatter the ashes to the winds to help the flowers grow

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 )

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.