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Dr . Rajiv Kumar Jain - Organ Banking Programme

ORGAN DONATION• There are two ways of Organ donation:• Living related donors:- only immediate blood relations(brother, sister, parents & children) can donate as per theTransplantation of Human Organ Act 1994. Living donorcan donate only few organs, one kidney (as one kidney iscapable of maintaining the body functions), a portion ofpancreas (as half of the pancreas is adequate for sustainingpancreatic functions) and part of the liver (as the fewsegments that are donated will regenerate after a period oftime) can be donated.• Cadaver Organ donor:- can donate all organs after braindeath.

Organs and Tissues TO Be Donated• The major donor organs and tissues are heart, lungs,liver, pancreas, kidneys, eyes, heart valves, skin, bones,bone marrow, connective tissues, middle ear, bloodvessels. Therefore one donor can possibly give gift oflife to many terminally ill patients who would notsurvive otherwise.

DIAGNOSIS OF BRAIN DEATH• It is done by independent advice of a team of doctorswhose qualification and experience is accepted by thehospital for such purposes. Doctors carry out a set oftests to confirm brain death.• The two sets of tests are carried out at the interval of atleast 6-12 hrs. Legal time of death is the time at whichthe second set of test is carried out. Once declaredbrain dead, further artificial support is futile andactually is emotional and financial trauma. At thistime a decision for organ donation should be taken atthe earliest.

DONOR PROFILE• Anyone, regardless of age, race or gender can becomean organ and tissue donor. If he/she is under the age of18 years, then the consent of parent or legal guardian isessential. Medical suitability for donation isdetermined at the time of death.

CONSENT FOR ORGAN DONATIONFOR BRAIN DEAD PERSON• Donors who have during their lifetime consented fororgan donation in writing in the presence of twowitnesses (at least one of whom is a near relative,)should carry their donor cards with them and alsoexpress their wishes to their near and dear ones.• In case of no such consent or donor pledge form wasfilled before death, then the authority to give consentfor organ donation lies with the person lawfully inpossession of the dead body.

TERMINAL DISEAES THAT CAN BECURED BY TRANSPLANT• Heart: Heart failure• Lungs: Terminal lung illnesses• Kidneys: Kidney failure• Liver :Liver failure• Pancreas: Diabetes• Eyes :Blindness• Heart valve: Valvular disease• Skin : Severe burns

PRIORITIZATION FOR RECEIVINGTRANSPLANT• Organs are matched to recipients on the basis ofmedical suitability, urgency of transplant, duration onthe waiting list and geographical location.

NATIONAL ORGAN TRANSPLANTPROGRAMME• Emphasis on Cadaver Donation• Aims: 1.To enhance the facilities for Organtransplantation throughout the country; 2. Toestablish a network for equitable distribution ofretrieved deceased organs and 3. To increase theavailability of organs through facilitation and attitudechange• Involves building up human resources• Creation of a body for procurement, distribution oforgans at national, regional and zonal level coveringthe entire country.

THE REPORT OF TRANSPLANT OF HUMAN ORGANS ACT - REVIEWCOMMITTEEORGAN PROCUREMENT PROGRAM• 20.The committee took note of the fact that at present there exists anorganization by the name of Organ Retrieval and Banking Organisation(ORBO) at All India Institute of Medical Sciences (AIIMS). It is a nationallevel facility set up by the Government of India to facilitate transplantprogram in the country with a view to encourage organ donations, fair andequitable distribution of organs available in the organ bank and optimumutilization of human organs. It is accordingly recommended that theinfrastructure, scope and ambit of ORBO activities should be enlarged andthe Central Government should create 5 Regional Centres/Units of ORBO tocover Northern, Southern, Eastern, Western and Central Regions of thecountry. All persons desirous of availing cadaver organs through ORBO mustget themselves registered for priority by paying such reasonable registrationfees as may be fixed by the Central Government or ORBO. Such RegionalUnits may in turn have one State Unit covering each State following withinthe jurisdiction of the Regional Unit. The policy decision and thefunctioning guidelines of all Regional Units and State Units should begoverned by the Central Agency of ORBO in order to keep uniformity ofprocedures, guidelines, infrastructure and functional norms in all Units inrelation to human organ transplant.

ORGAN PROCUREMENT PROGRAM• 21. All Units of ORBO should have provision forpreserving all types of preservable human organs so as tokeep them transplantable within the period of their shelflife.The storage/preservations units should be built,equipmentalised and installed as per the contemporaryinternational standards and on adequate mechanism andinfrastructure should be made available to each such unit,to facilitate storage/ preservation of donated humanorgans, which may be received from different sources andunder different programs. Technically qualified staff mustbe employed to regulate the storage/ preservation programfunction and persons of adequate seniority and highintegrity should be employed to control and supervise suchactivities keeping in view the sensitivity and significance ofthis entire exercise and also to monitor effective check toprevent any commercial factors creeping into.

• The Committee is of the considered view that it is extremely importantto educate and sensitize public; generate general awareness and removedoubts and misgivings by undertaking nationwide massive publicitycampaign using all types of mass-media to promote cadaver organdonation. To be specific, the Committee makes the followingrecommendations:-• I.CADAVER DONORS• A. (1) A national organ transplant program with special emphasisto promote cadaver donations, is recommended. The program shouldfocus on the following:-• a) Develop a focused information, education and Communication(IEC) strategy to create awareness about organ transplantation andcadaver donations.• b) Involve Religious leaders and NGOs to sensitize the communityabout cadaver donations.• c) School curriculum may include certain information about organdonation to bring awareness amongst youth.• d) Get short films made to be frequently shown in electronic visualmedia highlighting the desirability and virtuosity of the cadaverdonations. Some larger duration, inspiring and enlighteningdocumentary films should also be got made to achieve above objective.

• (2) Every hospital should make it mandatoryfor the ICU/Treating Medical staff requestrelatives of brain dead patients for organdonation. A record of all brain dead patients andthat the next of kin who are approached shouldbe kept.• (3) More Hospitals with adequate ICUfacilities and availability of specialists to diagnosebrain death be recognized as cadaver donor organharvesting centers.• (4) Retrieval of organs from non heartbeating patients should be permissible afterconsent of the next of kin is taken. This mayserve as a valuable source of organs.

• (5) Adequate facilities/Professional Fee todoctors who certify brain death.• (6) The Hospitals/centers in transplantationactivity be advised to have a post of a Co-coordinatorin the ICU (who may be a doctor or a senior nursingstaff member) independent of the Transplant Team,who is trained in the communication skills and whocan liaison between the treating physician and therelatives of the potential brain-death donor and theORBO. Such coordinator should possess skills tocommunicate with the relatives and friends of thepatient with a view to explain to them the merits ofcadaver organ donation and who possesses adequateknowledge to remove their doubts and answer theirqueries with regard to the procedure involved intransplantation activity.

• (7) It should be mandatory to report all braindead potential donors to a central agency (likeORBO).• (8) Organs should be considered a nationalresource and established guidelines &mechanism be used to allot cadaver organsequitably & fairly and ordinarily on the basis ofpriority of registration.

• B. Incentives for the family of Cadaver Organ Donor•• (1) Preferred status in organ transplantation waiting list ifthe next of kin of the brain dead donor requires organtransplantation in future.• (2) Appreciation letter/award by the State/localGovernment. Certificate of appreciation by State/localGovernment with an identity card endorsing his eligibility toobtain and avail various benefits recommended here. The cardmay prominently display a motivating slogan such as “Thank youfor saving a life”.• (3) Life long cost incentives such as discounts and partiallyfree treatment in certain specified types of ailments, to beoffered by the concerned hospital at their discretion, which canbe availed in other branches if any as well of the concernedhospital.• (4) Comprehensive health care scheme for the spouse orone child or the parents of the deceased to be evolved by theCentral Government/ State Government as the case may be.• (5) 100% concession in 2nd Class by Indian Railways for thespouse or one child or parents of the cadaver donor.

• II.LIVE DONORS• A: Promote Swap Operations: Swap operations that isto say that two different willing but incompatible ‘nearrelative’ donors (vis-à-vis their intended relatedrecipient) are permitted to donate their organs inexchange without any commercial interest and onlydue to the reason that despite willingness, their organwas not found medically compatible for their intendedrecipients. This would greatly help patients who have‘near relatives’ willing to donate but incompatible fortheir recipient. Swap operations may be considered byauthorization committee on case to case basis and asper the existing THOA Act and rules.

• B: Benefits for Live Donors• (1) Comprehensive health care scheme may be evolved by theGovernment.• (2) Life long free renal/liver checkup, follow-up and care in hospital,(including its other branches, if any), where organ donation has takenplace.• (3) To secure the donor against mortality risk due to organ donationrelated reasons, a customized Life Insurance policy of Rs. 2 Lakhs for 3years with one time premium to be paid by Recipient.• (4) Certificate of appreciation to all live donors by State/localGovernment with an identity card endorsing his eligibility to obtain andavail various benefits recommended here. The card should prominentlydisplay a slogan such as “Thank you for saving a life”.• (5) Compensation for any expenses / loss of income incurred asspecified in Section 2 (k) of the THOA Act.• (6) 50% concession in 2nd Class by Indian Railways.• Those donors who do not wish to avail of any or all of above incentivesmay waive their entitlement in writing before the AuthorisationCommittee.

• In order to create public awareness and educatecommon-man about organ transplant and organdonation, intensive use of print and electronicmedia should be undertaken under thesupervision of ORBO. Additionally the altruisticvirtues of organ donation must also behighlighted in the promotion campaigns withprovision for registration with ORBO for altruisticcadaver donations.

FUND TO PROMOTE CADAVER ORGANDONATIONS• 24. The resources for such activity should be contributed fromthe Government Fund for which a separate budget should beallocated. Individual, corporate and WHOdonations/contributions to this fund must also be encouragedthrough publicity campaigns and requests. A surcharge of 2 to4% of the total hospital bill may also be considered to belevied on the recipients, who have taxable income of Rs. 5 lacsper annum and above to augment the corpus of such funds.• 25. To make the fund stable and growing, steps to be taken tointensify and popularize the information and educationcampaign of the above nature. Public personalities andcelebrities must be approached to come forward and lend theircontribution in raising money for this fund, the utilization ofwhich must be entrusted with ORBO.

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