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'Brain death identification and certification is a big challenge in organ donation'
As the number of people donating their organs after death are not high in India, less number of people can be saved. The country needs a nation-wide and a powerful awareness drive - like the way it was done to eradicate Polio - to encourage more people to donate their organs after their death. In this context, a NGO is doing its best to persuade people to donate organs of family members after their death.

DONATED ORGANS can save lives. Out of about 140,000 brain dead cases due to road accidents, 80,000 people can be potential donors of organs. Latest research suggests that if 20 per cent of families who have a case of brain death, and offer to donate his or her organs, all demands for organ transplantation in India will be met.

In India only 0.8 people per million donate their organs. While in Britain it is 17 per million, and 35 per million in Spain. A person who is announced as brain dead can save lives of about eight people as lungs, kidneys, eyes, blood vessels, cartilage and tissues can be donated to patients who require them. Given this urgent need for more organ donation the Chennai-based NGO Multi Organ Harvesting Aid Network Foundation (MOHAN) is playing an important role in making people aware about organ donation by traveling to various places withing the country to organise seminars and address people about brain death, and clarify myths related to organ donation. CJ Ashim Sunam interviewed the Executive Director of MOHAN foundation, (Delhi office) Pallavi Kumar to know about organ donation in the country.

CJ: MOHAN (Multi Organ Harvesting Aid Network Foundation) plays an important role in making the public aware about organ donation. How do you convince people about the importance of organ donation?

Pallavi Kumar: The Foundation holds regular talks for the general public, either through presentations at corporates, colleges, hospitals, etc., or by setting up awareness kiosks at health melas, etc. The presentation includes various issues around organ donation, statistics of people waiting for transplants and the number of people who die waiting, clarity on medical and legal aspects, on organ sharing, on the various myths and misconceptions that people harbour, etc. It focuses on what a single YES can do and how it can save so many lives.

There is also sharing of stories of other organ donor families who took this bold and altruistic step. Getting the media to do positive stories around organ donation is a constant effort on part of the Foundation as it motivates the general public. Screening of films/spots on organ donation at hospitals on the LCD screens is another way that the Foundation sends the message across.

CJ: What is the legal procedure you follow when someone is willing to donate his/her body organs?

PK: Organ donation can only take place in specific hospitals that have been authorised to certify brain death. In case, death takes place in a centre that has not been approved, the Foundation facilitates the shifting of the body in an ambulance on a ventilator to an authorised centre.

Brain death has to be certified by a team of 4 doctors (the treating physician, the medical superintendent, a neurologist/neurosurgeon and an intensivist). The Foundation ensures that all 4 are present at the time of certification and all the tests specified by the Transplantation of Human Organs Act are conducted and recorded in Form 8 as specified by the act. The tests have to be conducted twice at an interval of 6 hours.

The family consent is recorded in Form 6 after the second set of tests. If the deceased is a minor, Form 9 is also filled out. In case of an accident, it is treated as a medico legal case, the police has to conduct an inquest and coordinate with the forensic department to give a ‘no objection’ to organ retreival

CJ: Do people readily come forward and donate their organs?

PK: In our experience, we see a very positive attitude amongst the general public towards organ donation once they have been adequately educated on the subject. I personally see lack of awareness and the absence of a well-defined program run by the government as the main obstacles.

CJ: As per Indian laws, if a person pledges to donate his/her organ after death, it is the kin of the family who takes the final decision – to donate or not? How do you cope with this challenge?

PK: Our effort is to convince the individual, as all said and done it is a person’s individual decision as it concerns his/her body. We then encourage the individual to convince his/her family. It would be a rare situation that the individual had consented for organ donation during his/her lifetime and the family does not respect the wishes. It would only happen in the case where there was no talk of organ donation before death and the family is approached for the same after death – in such cases family members are unsure and could either agree or refuse organ donation.

In our experience in the south, if a person had signed up the donor card (in Delhi the signing of donor card has still not become very common as less work has been done on awareness), the family almost always agreed. Of course, effective counselling done by trained personnel do convince families of potential donors even in the absence of any earlier conversation around organ donation.

CJ: The Transplantation of Human Organs Act (THOA), 1994, has made the concept of brain death legal, but still families are not willing to donate after a person has been certified as brain dead. Why? What do you do when a person or his family is willing to donate but the donor is or is not brain dead?

PK: In the current scenario, not enough brain death identification and certification is taking place. That is a big challenge.

Even if brain death is certified, families are not aware of the concept and very often confuse it as coma. They continue to hope that some miracle will happen and the person will come back to life. The concept of brain death has to be clearly explained by the treating physician for families to be able to take informed decisions. They need to understand that brain death is death – legally and medically – and the person will never return to life.

Very often, families want to donate organs even though it is not brain death. In such cases, they are explained how solid organ donation cannot take place in the case of cardiac death, and they help to make an eye donation.

CJ: Which organs are most donated by donors? For which organs is there the most demand among patients?

PK: Organs most commonly retrieved are kidneys, liver and the heart. In some cases, pancreas, intestines and lungs are also retrieved though there are fewer centres doing these transplants. Demand for kidneys is the highest, followed by liver.

Most commonly retrieved tissues are the corneas and the heart valves. Skin and bone tissues are also retrieved in select cities (very few facilities).

CJ: Selling organs is a trade in India with poor people selling their kidneys for a meager amount. Can donation with the help of say sponsorship enable the needy or voluntary donors to not only donate but also earn from it?

PK: Selling or buying kidneys is illegal in our country, India, and the law does not allow it. Donation with compensation is an ethical debate that has no straight answers.

CJ: Do patients have to pay for using the donated organ?

PK: No, patients do not have to pay for the donated organ. Each hospital has its own fixed transplant package that they charge but not for the organ.

CJ: Does India have the required infrastructure to deal with organ donation in small towns as well as big cities?

PK: Definitely not. India has a very poor and inadequate infrastructure to make organ donation happen. Even in metros, it is a challenge, leave alone two and three tier cities. There are a handful of transplant centres, only in bigger cities and most of them do not have a defined program in place for facilitating organ donation. Health is a state subject and save a few state governments such as Tamil Nadu, Andhra Pradesh, and Maharashtra - most states have not invested in this program, and there has been no impetus. As a result there is no central registry either for registration of donors or recipients and for a equitable and fair sharing of organs.

There are no trained transplant coordinators employed by these centres who will counsel the families in time of grief and offer them the option of organ donation.

CJ: Which hospitals in India are proactive in ensuring availability of donated organs?

PK: Most transplant centres in Chennai, Hyderabad and Mumbai. A few in Ahmedabad. In Delhi-NCR – Medanta, Gangaram, Fortis, AIIMS, Apollo, BLK are some of the centres who have made a few donations happen. Army RR has been running a fairly successful program.

CJ: Can people donate their organs while being alive?

PK: One Kidney can be donated while a person is alive, as all of us have 2 kidneys and can do with one. A portion of the liver can be donated as liver as an organ has the ability to regenerate.

Please note that liver donation can only take place among blood relations – such as parents, siblings, children grand-parents and grand-children and the spouse (even though it is not a blood relative).

Donations outside these are considered illegal and have to approved by an authorisation committee, which checks to see that the motive of donation is altruistic, that there was no commercial transaction or coercion.

CJ: Are there any restrictions in the number of organs that a person can donate after death?

PK: No. Other than the solid organs, there are innumerable tissues that can be donated. Depends on the family wishes and the capacity of the retrieving hospital.

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