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.