Organ donation and orbo seminar

Seminar on Organ Donation

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

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

3. “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

4. 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.

5. 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.

6. 1905 - 1 st 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

7. 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

8. 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.

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

10. 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.

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

12. VOLUNTARY DONATION Everywhere organ donation is voluntary Two voluntary systems : Opt In - Where Donor gives Consent 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.

13. 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.

14. 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

15. 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.

16. 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.

17. SCREENING

18. 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

19. 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.

20. Brain death

21. 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.

22. 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

23. 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

24. Removal of human organs not to be authorised in certain cases 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. 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

25. 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.

26. 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.

27. 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 1 st 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 but 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

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

29. 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.

30. 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.

31. 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.

32. 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.

33. 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

34. 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: 1 st ,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. 2 nd ,the cold ischemic phase occurs when the organ is preserved in a hypothermic state prior to transplantation into the recipient.

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

36. 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

37. 13 th August