ROLE OF NURSE IN ORGAN DONATION

PRESENTED BY:
DILIP SHARMA
1ST YEAR MSC NURSING
COLLEGE OF NURSING
AIIMS, BIBINAGAR
DON’T TAKE YOUR ORGANS TO HEAVEN

HEAVEN KNOWS WE NEED THEM HERE

Introduction:

• Organ donation is a voluntary process of giving one's organ/tissues after death or

while alive to save another life

• Need for Organ Donation: Every year, lakhs of people suffer from end-stage
organ failure. Organ donation rate in India: 0.5 per million population, vs. 36 in
Spain.
Why India needs more donors:

• 5 lakh people die due to lack of organs.

• Major shortage of hearts, livers, kidneys.

• Only ~10% of demand is met.

History of Transplantation in India

• 1965 – First successful kidney transplant

• 1994 – THOTA (Transplantation of Human Organs and Tissues Act) enacted

• 2012 – First hand transplant

• 2015 – Chennai: 23 organ transplants in 36 hours

• 2016 – First uterine transplant in Pune

• Organs That Can Be Donated:Heart, lungs, liver, kidneys, pancreas, intestine

• Tissues That Can Be Donated: Corneas, skin, bones, heart valves, tendons,
ligaments, blood vessels Bone marrow and stem cells
 Types of Transplants

• Autograft

Transplantation of tissue or organ within the same individual.

Example: Skin grafts from one part of the body to another in burn patients.

There is no risk of rejection since the donor and recipient are the same person.

• Allograft (Homograft)

Transplantation between two genetically non-identical individuals of the same species.

This is the most common type used in human organ transplants, such as kidney or liver.

It requires immunosuppressive therapy to prevent rejection.

• Xenograft (Heterograft)

Transplantation from a donor of a different species.

Example: Pig heart valves used in humans.

There is a high risk of rejection; usually used temporarily or as supportive therapy.

Special Types:

• Split Liver Transplant

A single donor liver is divided into two portions and transplanted into two recipients, typically one
adult and one child.
This method maximizes the use of a single donor organ and requires advanced surgical techniques
and precise matching.

• Domino Transplant
A chain of transplants in which a recipient of one transplant becomes a donor for another recipient.
Example: A patient with a metabolic liver disorder receives a healthy liver, and their own liver
(which is structurally normal but metabolically defective) is transplanted into another patient.
This method requires ethical approval and coordinated surgical planning.
Living Donor Requirements: Age 18–65

• Mentally sound

• medically fit

• Close relative or legal approval

Situations for Donation:

• Brain death

• Cardiac death
• Voluntary donation (pledged)
Organ donation shortage in india

• One of the major barriers to organ donation in India is the widespread presence of myths
and misconceptions. Many people believe in ideas related to rebirth, karma, and body
disfigurement after death, which leads to resistance against donating organs.

• Family refusal is another critical factor. Even when individuals pledge their organs,
families often refuse consent at the time of death due to emotional distress, or lack of
clarity about the donor’s wishes.

• There is a significant lack of awareness among the general population regarding the
concept, benefits, and process of organ donation.
• India also faces challenges related to inadequate infrastructure, especially in rural and
semi-urban hospitals, where the facilities for organ retrieval, storage, and transplantation
are either unavailable or underdeveloped.
Organ Donation Process:

• Donor Identification

Potential donors are identified, usually in ICU settings, based on medical criteria such as brain death
or impending circulatory death.

• Consent from Family or Donor Card

Consent is obtained either through a previously signed donor card or from the next of kin after
appropriate counseling.

• Medical Evaluation
A comprehensive medical assessment is conducted to evaluate the suitability of organs for
transplantation. This includes blood tests, infection screening, and organ function tests.
• Brain Death Certification
A formal diagnosis of brain death is made and certified by a panel of authorized medical
professionals, typically involving two separate examinations.

• Allocation through NOTTO/SOTTO

Organ allocation is done by authorized organizations such as NOTTO (National), SOTTO (State), or
ROTTO (Regional), ensuring fair and transparent distribution.

• Organ Retrieval
Organs are surgically retrieved by trained transplant surgeons in a sterile operating environment,
following standard protocols.

• Transport & Transplant

Organs are preserved using specialized solutions, packed in sterile containers, and transported—often
via Green Corridor—to the recipient hospital for transplantation.
Box Used

• Temperature-controlled sterile containers are used for the safe transportation of organs.

• These boxes maintain the organ at 4°C to slow down metabolic activity and preserve
viability.

• Often used during Green Corridor transfers for quick and secure organ delivery.
 Transplant Rejection Reactions

• Hyperacute – Hyperacute Rejection Occurs within minutes to hours after

transplantation.Caused by pre-existing antibodies in the recipient’s body against donor
antigens. Results in immediate graft failure.

• Acute Rejection_ Occurs within days to weeks after the transplant. Mediated by T-
lymphocytes attacking the donor organ. Can often be managed with immunosuppressive
therapy.

• Chronic Rejection_ Occurs months to years after transplantation. Characterized by gradual

loss of graft function due to progressive fibrosis and vascular damage. Often irreversible
and leads to the need for re-transplantation.
 Immunosuppressive therapy.
• It helps suppress the recipient’s immune response and ensures long-term graft survival. The
therapy usually involves a combination of drugs, tailored to the type of transplant and patient’s
condition.

 Corticosteroids

o Example: Prednisolone, Methylprednisolone

o Used for induction, maintenance, and treatment of acute rejection

o Broad immunosuppressive and anti-inflammatory effects

o Side effects: Weight gain, hyperglycemia, osteoporosis, mood changes

 Calcineurin Inhibitors (CNIs)

o Examples: Tacrolimus, Cyclosporine

o Inhibit T-cell activation by blocking calcineurin pathway

o Side effects: Nephrotoxicity, hypertension, neurotoxicity, gum hyperplasia (Cyclosporine)

 Monoclonal Antibodies

o Examples: Basiliximab, Alemtuzumab

o Target specific immune cells (e.g., IL-2 receptor on T-cells)

o Mostly used during induction therapy or for steroid-resistant rejection

o Side effects: Risk of infections, infusion reactions

 Green Corridor system

• A Green Corridor is a special traffic route created by traffic police and civic authorities for
the rapid and unobstructed transportation of harvested organs from the donor hospital to
the recipient hospital.

• The purpose is to minimize transportation time, as organ viability is time-sensitive

(especially for heart, lungs, and liver).

• Traffic signals along the route are manually controlled or synchronized to ensure a non-stop
journey for the ambulance carrying the organ.
• Typically, police escorts are deployed to clear the path and monitor real-time movement
using GPS.

• It has been successfully implemented in several Indian cities including Chennai,

Mumbai, Delhi, Hyderabad, and Bengaluru.

• The concept significantly increases the chances of a successful transplant by ensuring

the organ remains viable upon arrival.
 Role of Nurse

• Identification of Potential Donors

Nurses working in ICUs or emergency departments play a key role in early recognition of brain-
dead or dying patients who may be eligible for organ donation. They notify the transplant
coordinator and initiate evaluation.

Emotional Support and Counselling

Nurses are often the first point of contact with grieving families. They offer emotional support,
answer questions, address concerns, and facilitate compassionate communication, helping families
make an informed decision about donation.
 Coordinating Between Units and Teams
Nurses serve as key coordinators between different departments—ICU, operation theatre, transplant
team, and hospital administration. They ensure smooth communication and minimize delays in the
donation process.

 Monitoring Organ Function and Maintaining Donor Stability

Nurses in critical care continuously monitor vital signs, organ perfusion, fluid balance, and
laboratory parameters of the donor to maintain organ viability until retrieval. This includes
ventilator management and administration of medications.

• Ethical Advocacy
Nurses ensure that informed consent is taken without coercion. They uphold ethical standards,
respect patient autonomy, and ensure the dignity of the donor is maintained throughout the process.
• Educating Patients and Families
Nurses educate families about the process, legalities, myths, and benefits of organ
donation. They help clarify misconceptions such as religious objections, body
disfigurement, and concerns about organ misuse.

• Community Awareness and Health Promotion

Nurses contribute to increasing public awareness about organ donation by organizing or
participating in health camps, rallies, school programs, and awareness campaigns
during events like Organ Donation Day.
 Assisting in Documentation and Legal Forms
Nurses assist in preparing and verifying essential documents such as:
o Form 1 – Consent from a living donor

o Form 7 – Consent for organ retrieval from brain-dead donor

o Form 10 – Recipient’s consent for transplant

They also ensure that brain death certification is properly documented as per legal
requirements.

• Infection Control and Patient Safety

During and after organ retrieval procedures, nurses ensure aseptic techniques, proper personal
protective equipment (PPE) use, and maintain strict infection control protocols to protect both
donor and healthcare team.
Legal Aspects of Organ Donation in India

 THOTA (Transplantation of Human Organs and Tissues Act), 1994

o Enacted to regulate the removal, storage, and transplantation of human organs

and tissues for therapeutic purposes.
o Prevents commercial dealings in human organs.

o Applicable throughout India and amended in 2011 and 2014 to strengthen

enforcement.
 Brain Death Certification

o Mandatory for deceased organ donation.

o Requires a panel of four independent doctors to certify brain death on two separate
occasions, with a gap of 6 hours (for adults).
o Doctors must be registered medical practitioners and include:
 The treating physician

 A neurologist/neurosurgeon or intensivist

 A medical administrator

 A government-authorized independent doctor

 Consent Rules

o For living donation: requires written informed consent from the donor.

o For deceased donation: consent from next of kin or via pledged donor card.

o Special scrutiny is required if the donor is unrelated to the recipient.

 Penalties for Organ Trafficking

o Engaging in or facilitating commercial trade of organs can lead to imprisonment (5–10

years) and fines up to ₹20 lakhs.
o Hospitals must be registered and compliant under THOTA; violations can lead to license
cancellation.
Important Legal Forms in Organ Donation (India)

 Form 1 – Consent for organ donation by a living donor (related or unrelated, with
appropriate approvals).

 Form 5 – Brain Death Certificate, issued by the authorized medical panel following all
guidelines.

 Form 7 – Application for approval of organ retrieval from a brain-dead donor.

 Form 10 – Consent of the recipient for undergoing an organ transplant procedure.

 Conclusion

• Organ donation is a noble and life-saving act that has the potential to give a second chance
at life to multiple individuals. It not only benefits the recipients but also provides meaning
and legacy to the donor and their family.

• Nurses play a crucial role in this process—not just in clinical care, but also in advocacy,
education, coordination, and emotional support. They are often the bridge between the
grieving family and the healthcare team, ensuring that the process is handled with
sensitivity, ethics, and professionalism.
• By raising awareness, dispelling myths, and promoting informed decision-making,
nurses can help overcome the challenges that contribute to the shortage of organ donors in
India.

• Organ donation is a noble and life-saving act that has the potential to give a second
chance at life to multiple individuals. It not only benefits the recipients but also provides
meaning and legacy to the donor and their family.
YOU DON’T HAVE TO BE A DOCTOR TO SAVE LIVES

YOU CAN BE AN ORGAN DONOR.

 References
1. Brunner LS, Suddarth DS, Smeltzer SC, Bare BG, Hinkle JL, Cheever KH. Brunner & Suddarth's Textbook of Medical-Surgical
Nursing. 14th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2018.

2. Potter PA, Perry AG, Stockert PA, Hall AM. Fundamentals of Nursing. 9th ed. St. Louis: Elsevier Mosby; 2016.

3. Park K. Park's Textbook of Preventive and Social Medicine. 26th ed. Jabalpur: Bhanot Publishers; 2021.

4. Ministry of Health and Family Welfare, Government of India. The Transplantation of Human Organs and Tissues Act (THOTA), 1994,
with Amendments. New Delhi: MoHFW; [Internet]. Available from: https://main.mohfw.gov.in

5. National Organ and Tissue Transplant Organisation (NOTTO). Guidelines and Protocols for Organ Donation and Transplantation.
[Internet]. New Delhi: NOTTO; [cited 2025 Jul 7]. Available from: https://notto.abdm.gov.in

6. Shroff S. Legal and ethical aspects of organ donation and transplantation. Indian J Urol. 2009 Jan;25(3):348–55. doi:10.4103/0970-
1591.56208.

7. Subramanian T, Baby J. Role of nurses in promoting organ donation: A review. Int J Nurs Educ Res. 2020;8(4):511–4.
doi:10.5958/2454-2660.2020.00109.3.

8. Sethi N, Tiwari SC. Transplant immunology and immunosuppressive therapy. Indian J Nephrol. 2012 Jan;22(1):5–11.
doi:10.4103/0971-4065.83726.