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Organ Donors

Organ Donors  

Organ Donation is the entire practice of retrieving a human organ from a living or deceased person, who is referred to as a Donor, and transplanting it into a recipient. The recipient will be a patient who is suffering from organ failure and who will not survive unless she/he receives an organ replacement. The process of recovering organs is called Retrieval.
Let’s take a close look at the different organs that can be donated by a person after death and while the person is still alive. There are eight organs that can be donated and transplanted. Kidneys: Both kidneys can be donated by a deceased donor. On average the lifespan of a transplanted kidney is around nine years, but it varies from individual to individual. Of all organs in the human body, the demand of kidneys is the highest, and kidneys are most frequently donated organs. A kidney disease most likely affects both kidneys at the same time. A living donor can easily donate one kidney to someone and function well for the rest of their lives. Liver: The liver is an important organ with primary functions of bile production & excretion: excretion of bilirubin, cholesterol, hormones, and drugs; metabolism of fats, proteins and carbohydrates; enzyme activation; storage of glycogen, vitamins and minerals; synthesis of plasma proteins; blood detoxification and purification. The liver is the only organ in the human body that can grow calls and regenerate. A donated liver from someone who has died (a deceased donor) can further be split into two pieces and transplanted into two different people to save their lives. A living donor can heave a portion of her/his liver removed to donate to someone, and the remaining portion will regenerate to almost its full previous size. Heart: A heart is a muscular organ which pumps blood through the human body. In a Peron’s life, the heart will beat around 2.5 billion times on average and keep the blood running in the body. After being retrieved from the donor, a heart can survive for 4-6 hours only. Lungs: Single or double lung transplants can be performed from deceased donors. Additionally, living donors can donate a single lobe from the lungs, though it will not regenerate. Pancreas: A deceased donor pancreas can be transplanted into an ailing patient. A living donor can also donate a portion of the pancreas and still retain pancreas functionality. Intestine: after death, a donor can donate their intestine. Although quite rare, a living donor can donate a portion of the intestine. In addition to organs, you can also donate tissues such as corneas, skin, bones, ligaments, heart valves etc.
Tissue donation is the process of Retrieving or Procuring tissues from a living or deceased persons, called a Donor, and transplanted into the recipient who needs it. Medical Science has made tremendous progress in recent times in the field of organ donation and transplantation, with organ donation from one person capable of saving up to 9 lives and improving lives of many others. However, due to the prevalence of myths about organ donation, and the lack of awareness about the topic in India, a majority of people do not take up this noble cause for the benefit of others.
Layers of cells that function together to serve a specific purpose are called tissues. Most tissues should be donated within 6 hours of the donor’s death. Cornea: cornea donation or eye donation is the most common tissue donation. The Cornea is a transparent covering over the eye. It is also the eye;;s primary focusing element. Recipients who suffer from corneal blindness can gain their sight again after a corneal transplant. These patients are those who may have been blinded by an accident, infection or disease. Either the entire Cornea can be transplanted or it can be transplanted in parts. A Corneal Transplant is does not need any anti-rejection drugs in the recipient. Corneas from all ages of recipients are effective as long as the Doctors as they are healthy. Bones: Bones from deceased donors are used to replace bones of recipients whose bones are cancerous. A Bone transplant can be done instead of amputating the cancerous arm. Skin: Skin can be used as grafting for burn victims, acid attack victims or for post mastectomy breast reconstruction , amongst other things. Veins: Donated veins are commonly used in surgeries for cardiac bypass. Apart from these, other tissues that can be donated are muscles, tendons, ligaments, cartilage and heart valves.
When the body is infected with a microbe (virus, bacterium, parasite or fungus), it stimulates the production of important immune cells. After recovery from a disease, some of the immune cells will "remember" these microbes. This is called immunological memory. Next time the body is exposed to the same type of microbe, the immune system will recognise it. The body's defence against the disease becomes faster and more powerful and can prevent the person from becoming ill. This is naturally acquired active immunity.
There are two types of organ donations – Living Organ Donations & Deceased Organ Donations. Living Organ Donation: This is when you retrieve an organ from a healthy living person and transplant it into the body of someone who is suffering from end-stage organ failure. This is commonly done in the case of a liver or a kidney failure (because the liver can grow back to its normal size and a donor can survive on one Kidney) Living donors are classified as either a near relative or a distant relative/Friends etc. A near – relative is spouse, son/daughter, brother/sister, parents, grandparents and grandchildren. Those other than near-relative can be distant relatives and friends who will need the permission of the State Authorization Committee to donate organs, if the hospital refuses to entertain such cases, the patent may send a legal notice to the hospital for not following the Transplant Act. Deceased Organ Donation: When we talk about pledging our organs for donation or about organ donation after death, we are talking about Deceased Organ Donation. This is an organ donation from a person who has been declared brain stem dead by a team of authorized doctors at a hospital. A person is said to be brain stem dead when there is an irreversible loss of consciousness, absence of brain stem reflexes and irreversible loss of the capacity to breathe. A lot of people think that whenever and however they die, their organs can be donated. That is not true. In India, organ donation after death is only possible in the case of Brain stem death. Donation after cardiac death is common in the west, but in India it is rare for donations to take place after cardiac death. Although it is possible for organs such as the liver and the kidney to be easily donated from a living donor to a recipient, we should work towards an environment where everyone donated their organs after their deaths (if they can), so no living person should have to donate an organ to another.
All organs and tissues that are viable can be donated after a person dies.

The Living Donation Process

  • The living donor needs to undergo some medical tests and evaluations to check and confirm her/his her medical compatibility with the recipient.
  • The living donor’s medical compatibility is confirmed by a doctor. Only after all the tests have positively confirmed that the donor is compatible with the recipient, can the transplant take place.
  • The living donor’s organs are retrieved surgically by doctors. They will be stored in special chemical solutions briefly until they are transplanted into the recipient.
  • The living donor will need to remain under medical care for a few days or weeks after organ retrieval until she/he is fit to go home.

The Deceased Donation Process

  • A deceased donor is often someone who has suffered a fatal injury to the head or had Brain Haemorrhage. She/He is declared brain stem dead by a group of medical experts in a hospital.
  • The donor’s family has to give consent for the donation before the process of organ retrieval can be carried out. Meanwhile the donor is kept on life-support with Doctors looking after all her/his needs until the retrieval of the organs is allowed to move forward.
  • Suitable recipients for all the organs are identified from a waiting list. They are notified and asked to reach their respective hospitals.
  • After retrieval the body of the donor is respectfully handed over to the family.
The primary legislation related to organ donation and transplantation in India. Transplantation of Human Organs & Tissues Act, was passed in 1994 and is aimed at regulation of removal, storage and transplantation of human organs for therapeutic purposes and for prevention of commercial dealings in human organs.

Some of the main Provisions of the Act are as follows:
• Bain stem death identified as a form of death. Process and criteria for brain stem death certification defined
• Allows transplantation of human organs and tissues from living donors and cadavers (after cardiac or brain stem death).
• Regulatory and advisory bodies for monitoring transplantation activity and their constitution defined. For more information on the Transplant Law in India read our Organ Transplant Laws Made Easy section.
What is Brain Death and how is it related to organ donation? A brain stem death or brain death results from a severe irreversible injury to the brain or haemorrhage which causes all the brain activity to stop. All areas of the brain are damaged and no longer may functions be maintained by an artificial support system. This maintains circulation to vital organs long enough to facilitate organ donation. Patients classified as brain stem dead can have their organs surgically removed for organ donation.

A Brain Dead person has absolutely no chance of recovering. Brain death is a form of death and is irreversible.

Once brain stem death or brain death has been declared, the person is dead but their organs are still alive because they have been kept alive through artificial means. This means that if a person dies at home or anywhere else, and their heart stops beating they cannot donate their vital organs, because the organs of a person who has died a cardiac death will die within minutes of the heart stopping. Therefore the only time you can donate your vital organs is if you are in hospital and have been declared brain dead.
In case a cardiac death it is possible to donate your corneas and tissues such as bones, skin, veins, blood stem cells, blood and platelets, tendons, ligaments, heart valves, cartilage and even your body.

While the incidence of brain death is obviously less common than cardiac death, it is important to remember that organ donations will take place only if everyone is aware about when and how they can donate organs.
Organ donation after Brain Death is strictly regulated. According to the provisions of the Transplantation of Human Organs & Tissues Act. THOTA 1994 the protocols for declaration of brain stem death or brain death has been defined. Any organ donation process must involve the following steps before the actual transplant can occur.
  • A Registered Medical Practitioner in charge of the Hospital where the brain stem death patient is admitted.
  • A Registered Medical Practitioner nominated from the panel of Doctors who have bee approved by the Appropriate Authority.
  • A Neurologist/Neuro-Surgeon. (If a Neurologist/Neurosurgeon is not available to carry out the tests then any Surgeon or Physician and Anesthetist or Intensive who is nominated by Medical Administrator In-charge from the panel of names who have been approved by the appropriate Authority can included in the panel).
  • The registered medical practitioner treating the deceased. Results of the tests are recorded on Form 10 of the THOT Act 2014. The family’s consent is obtained on Form 8.
This Organ Donation Procedure is strictly followed. The certifying clinicians must have no interest or benefit in any way from transplantation of cadaver donor organs. The legal time of death in these circumstances is taken as the second set of brain stem death tests. The certification should be done on laid out forms as per the act. The medical director or medical superintendent of the hospital should finally countercheck and sign the form. It is only after these formalities have been completed, should organs be retrieved.
Organ donations require prior consent from the donor’s family in India. According to the Transplantation of Human Organs & Tissues Act 1994. The next of kin of the patient will decide whether to donate their organs and tissues. Once a person is declared brain stem dead, the transplant coordinator of the hospital will counsel the family and give them the option of donating organs and tissues. The family may or may not agree and can till the last minute before retrieval change their mind about donating. It has been noted that a lot of families even in the face of devastating loss agree to organ donation to save the lives of others. For them it is the only good thing that could come out of the death of a loved one and for this reason alone it is everyone’s absolute right to be asked if they want to donate.
Usually the organ donation request is made in the time interval between the diagnosis of brain stem death and cardiac death. According to law doctors are required to take the family members consent before retrieving organs even if the brain stem dead patient has pledged his or her organs. The doctor on duty is required by law to ask for the organs from the relative in case of brain stem death. Brain stem death is relatively a new concept and making request for organ donation in these circumstances can be an extremely difficult task for a doctor or a nurse to undertake. If the deceased carries a Donor Card (A card the size of a credit card expressing their desire about organ donation) the task of asking for organ donation becomes easier. If the relatives are agreeable the process of organ donation is under taken and vital organs like heart, lungs, liver, pancreas and kidneys are removed for transplantation. The process of organ donation and transplantation requires co-ordination between different teams operating almost simultaneously and sometimes in different locations. It may require getting surgeons from different specialties together for both donor and recipient surgery.
In medico legal cases to proceed with organ donation police NOC is required and the same must be intimated to the designated forensic expert responsible for conducting the post – mortem. The forensic expert can be present during the retrieving doctor makes notes of the retrieved organs and conduct the post – mortem simultaneously or the retrieving doctor makes notes of the retrieved organs which will form a part of the post-mortem report and the body is sent to the forensic expert for completion of post-mortem formalities.
In medico legal cases to proceed with organ donation police NOC is required and the same must be intimated to the designated forensic expert responsible for conducting the post – mortem. The forensic expert can be present during the retrieving doctor makes notes of the retrieved organs and conduct the post – mortem simultaneously or the retrieving doctor makes notes of the retrieved organs which will form a part of the post-mortem report and the body is sent to the forensic expert for completion of post-mortem formalities.