Organ donation and orbo seminar

Organ Donation and ORBO
Dr.Neha Singh
Dr.Geet Bhuyan
VMMC AND SAFDARJUNG HOSPITAL ,NEW DELHI

Outline
 Definition
 History
 Indian statistic
 Myths
 Types and mode of donation
 Indications and contraindications
 THOTA
 Offences and penalties
 ORBO
 Briefing of Organ transplantation

“The Soul is invisible,knowing this you should not grieve for body”
- Bhagvad Geetha 2:25
“The dead sustain their bond with the living through virtuous deeds”
-Guru Granth Sahib,p143
“Whosoever saves the life of a person would be as if he saved the life of all the
mankind”
-Holy Quran chapter 5:32.
“Freely you have received,freely give”.
-Mathew,chapter 10:8

DEFINITION
Organ Donation means that a person pledges that during his
lifetime/after death, organs from his/her body can be used for
transplantation to help terminally ill patients and giving them a
new lease of life.

HISTORY
 The first living organ donor in a successful transplant
was Ronald lee herrick(1931–2010), who donated a kidney to
his identical twin brother in 1954.
 The lead surgeon, Dr.Joseph Edward Murray, won the nobel
prize in physiology or medicine in 1990 for advances in organ
transplantation.

 1905 - 1st Successful cornea transplant
 1917 - Skin transplant
 1954 – Kidney transplant
 1967 – Liver Transplant
 1968 – Heart , pancrease transplant
 1983 – Lung transplant
 1987 – Intestine transplant
 1998 – Hand transplant
 2011 – Uterus transplant

Transplant milestones in India
 1965 – First successful kidney transplant (deceased donor)
KEM hospital,Mumbai
 1994 – First successful heart transplant
Dr.P.Venugopal,aiims,New delhi
 1998 – First successful liver transplant
Apollo hospitals,New delhi
 1999 - First successful lung-heart transplant
Dr.K.M cherian,Madras medical college

SHOCKING STATISTICS !
In India around 6,000 people die waiting for organ transplant.
Every 16 minutes someone is added in the waiting list.
10 dies daily from the list without the organ.

DONOR CRISIS
Donor crisis:Huge gap between demand and supply of the organs.

SITUATION IN INDIA
 Annually 1.6 lakh people die due to Road Traffic Accidents.
 67% death occurs usually due to Brain stem Death.
 IT means that there are 93,000 potential organ donors every year.
 But in reality,only 0.13 people donate their organs per lakh
population.
 In India,Tamilnadu ranks first among all states.

TYPES OF DONORS
Living near relative Donors
 Living Donors Living non-near relative Donors
Swap donors
 Deceased Donors (Cadeveric donors)

VOLUNTARY DONATION
 Everywhere organ donation is voluntary
 Two voluntary systems :
1. Opt In - Where Donor gives Consent
2. Opt Out – Where anyone who has not refused is considered as a donor
 In India , we have The Opt In system
 In span,Iraq,Iran and many western countries practice the Opt Out system.

Organs/tissues that can be donated
 Living donor-
 one kidney
 A part of liver
 A portion of pancreas
 Deceased donor -
Heart
Lungs
Kidneys
Liver
Pancreas
Intestine
 Tissues that can be donated-cornea/eye ball , skin, bones, heart valves, blood vessels etc.

Common Indications
Organs/Tissues Indication
Cornea • Corneal scarring due to Trauma
• Hereditary or congenital corneal clouding
Lung • Chronic obstructive pulmonary Fibrosis
• Cystic fibrosis
• Idiopathic Pulmonary Fibrosis
• Bilateral Bronchiectasis
• Idiopathic Pulmonary Hypertension
Heart • Dilated Cardiomyopathy
• Coronary Artery Disease
• Congenital heart Defect
• Amyloidosis
• Valvular Heart Disease
• Failure of a previous heart Transplant
Kidney End Stage Renal Disease
Pancreas Type 1 Diabetes not controlled by standard treatment
Liver • Chronic Liver Failure
• Biliary Atresia

Who can be a donor?
All of us can be organ donor , irrespective of age, community.
Children can also be an organ donor after taking consent from
their parents.

Exclusion criteria
 All malignancies except the following:
Localized squamous cell carcinoma
Localized basal cell carcinoma
Primary CNS tumor without Metastatic potential
History of malignancy with >5 years of disease free interval.
 Uncontrolled Sepsis
 Seropositive
 Note:
HBV/HCV positive person can still donate but only to HBV/HCV positive recipient.

Is there a “right age” for organ donation ?
ORGAN AGE
Cornea 0-100 yrs
Kidney 0-70 yrs
Liver 0-70 yrs
Lung 0-60 yrs
Heart 0-60 yrs
Heart valves 0-50 yrs
Bone 0-70 yrs
Pancreas 0-60 yrs
Intestine 0-60 yrs

Organ Donation – At hospital or home ?
 Only possible when the patient dies in the I.C.U. and is declared brain stem
dead.
 No vital organs can be retrieved if the death occurs at home.
 Tissues like cornea and skin can be retrieved within a specific time,even if the
indivisual dies at home.

Brain Death Certificate
 In India,According to The Transplantation of Human Organs and Tissue Act (THOTA)
1994,brain death is certified by a “Board Of Medical Experts” consisting of:
 The Medical Superintendent (MS) in charge of the hospital in which
“Brainstem death” has occurred.
 A specialist,nominated by the MS in charge of the hospital ,from a panel of
names approaved by the Appropriate Authority.
 A neurologist or a neurosurgeon, nominated by the MS in charge of the
hospital ,from a panel of names approaved by the Appropriate Authority.
 The Doctor under whose care the “brain-stem “death has occurred.

Few facts about Skin donation
• Can be done at Home.
• Whole procedure takes about 35-40 mins.
• Skin is harvested from both the legs,both thighs and the back.
• Only uppermost layer of skin is harvested.
• No bleeding from the site.
• No disfigurement of the body
• No blood matching,HLA matching for skin donation
• To be harvested within 6 hours

LAWS AND RULES GOVERNING ORGAN
TRANSPLANTATION IN INDIA
 TRANSPLANTATION OF HUMAN ORGANS AND TISSUES ACT
(THOTA),1994
Initiated by State government of Goa,Himanchal Pradesh and
Maharashtra.
 AIMS:
• To regulate removal,storage and Transplantation of Human
Organs for Therapeutic purposes.
• To prevent commercial dealings in organs .
• To recognize Brain Death

Removal of human organs not to be
authorised in certain cases
1. If the person empowered to give authority, has reason to believe that an
inquest may be required in pursuance of the provisions of any law for
the time being in force.
2. No authority shall be given to the person to whom such body has been
entrusted solely for the purpose of interment,cremation or other
disposal

Authority for removal of human organs in case
of unclaimed bodies in hospital or prison
 If body is not claimed by any near relatives of the deceased person within
48 hours from the time of death , authority may be given,in the
prescribed form,by the person in charge of control of hospital/prison.
 No authority shall be given if the person empowered to give such
authority has reason to believe that any near relative is likely to claim the
body in future.

Commercial Dealings of Organs
In an interesting field study published in he Journal Of
American Medical Association on Economic and Health
Consequences of Selling A Kidney In India – it was found that
 96% of participants (over 300) sold their kidneys to pay off
debts.
 Average amount received was Rs 75,000 ,which they sent on
debts,food and clothes.

OFFENCES AND PENALTIES
OFFENCES PUNISHMENTS
1.Removal of human organs without authority
• Any person who renders his services to
any hospital conducts,associates with, or
helps in any manner
Imprisonment for a term which may extend
to 5 years
And fine may extend to Rs10,000
• A registered medical practitioner 1st time offence – removal of name from
register of council for a period of 2 years
Subsequent offence – Permanent removal
2.Commercial dealings Imprisonment for a term which shall not be
<2years and may extend to 7 years
And fine shall not be less than Rs 10,000
may extend to Rs 20,000
3.Contravention of any other provision of
the THOTA
Imprisonment for a term which may extend
to 3 years
or fine which may extend to Rs 5,000

Location - AIIMS,New Delhi.
Faculty In charge – Dr.Arti Vij
Professor Hospital Administration
Cardio Thoracic & Neuro Sciences Centre

Objectives
 To encourage organ donations.
 fair and equitable distribution.
 optimum utilization of human organs.
 To maintain donor registration.
 co-ordination from procurement of organs to transplantation.
 To keep records of waiting list of all concerned hospitals, organizations
and individuals,
 Create awareness.

 ORBO is establishing a network with all the hospitals of delhi, including private and
government hospitals, which later on will be expanded at national and international level.
 Participating hospitals / agencies have the infrastructure, and an officer from each
organisation nominated as nodal officer to coordinate with the ORBO.

Organ Transplantation
Transplantation is the act of surgical removal of an organ from
the potential donor and placing it into the recipient.
It is needed when the recipient’s organ has failed or has been
damaged due to illness or injury.

Types of Transplant
 Autograft – A transplant of tissue from a person to oneself (Skin grafts,vein
extraction for coronary artery bypass surgery).
 Allograft – A transplanted organ or tissue from a genetically non-identical
member of the same species.
 Isograft – Organs or tissues are transplanted from one to genetically identical
other person (identical twin).
 Xenotransplant : When transplantation is performed between different species.

Maximum Time Span Between Recovering
Organs/Tissues and Transplantation
 Healthy organs should be transplanted as soon as possible.
Organ/Tissue Time
Heart 4-6 hours
Lungs 4-6 hours
Intestine 6-10 hours
Liver 12-15 hours
Pancreas 12-24 hours
Kidneys 24-48 hours
Skin 5 years
Cornea 14 days
Heart Valves 10 years
Bone 5 years

Pathophysiology of organ damage during transplant
 The injury an organ sustains during recovery,preservation and transplant occurs
primarily as a result of ischemia and hypothermia.
 Damage to organs during transplantation occurs in 2 phases:
1st ,the warm ischemic phase –includes time from the interruption of
circulation to the donor organ to the time the organ is flushed with
hypothemic preservation solution.In multiorgan recovery,the organs are
cooled before they are removed.
2nd ,the cold ischemic phase occurs when the organ is preserved in a
hypothermic state prior to transplantation into the recipient.

Preservative solutions
 Hyperkalemic,Crystalloid cardioplegia Solution – Heart
 University of Wisconsil ,UW solution – Liver ,Lungs
 Euro – Collins solution – Kidneys and Pancreas
 85% glycerol – Skin

Cost Of Transplants In India
 KIDNEY : In government sector – Rs 50,000 – Rs 1 lakh (depends on
sophisticated investigations)
In private sector – Rs 3.5 lakh- Rs 15 lakh
 Cornea : In government sector - Rs 8000
In Private Sector – Rs 35,000 – Rs 65,000
 Liver : In AIIMS,New Delhi – Free of cost
PGI Chandigarh – Rs 7 lakh – Rs 8 lakh
ILBS New Delhi : Rs 12lakh – Rs 14lakh
In private sector – Rs 18 lakh –Rs 30 lakh
 Heart : In private Sector 10 lakh – Rs 20 lakh

Organ donation and orbo seminar

Organ donation and orbo seminar

More Related Content

What's hot

Similar to Organ donation and orbo seminar

Recently uploaded

Organ donation and orbo seminar