Organ donation and role of nurse

Organ donation and role of nurse

1. ORGAN DONATION AND ROLE OF NURSE PRESENTED BY: MISS.SHWETA SHARMA M.SC. NURSING 1ST YEAR AIIMS, JODHPUR

2. INTRODUCTION Organ donation is the process of removing tissues or organs from a live, or recently dead, person called Donor to be used in another live person called Recipient.

3. NEED FOR ORGAN DONATION In India, every year nearly 500,000 people die because of non-availability of organs and this number is expected to grow due to scarcity of organ donors. The gap between the number of organs donated and the number of people waiting for a transplant is getting larger. One donor can save eight lives as he/she can donate up to 8 lifesaving organs. Around 5000 kidneys, 1000 livers, and around 50 hearts are transplanted annually in India. There is a need of roughly 2,00,000 kidneys, 50,000 hearts, and 50,000 livers for transplantation each year.

4. HISTORY OF SUCCESSFUL TRANSPLANTS IN INDIA In India- 1967 - First successful cadaver Kidney Transplant in India at KEM Hospital, Bombay 1994 - First successful heart transplant done at AIIMS, Delhi 1995 - First successful multi-organ transplant done at Apollo Hospital, Chennai 1998 – First Successful Lung transplant, Madras Medical Mission Hospital, Chennai 1999 – First Pancreas Transplant, Ahmedabad

5. TYPES OF TRANSPLANTS

6. Split transplants

7. Domino transplants

8. LIVING DONOR REQUIREMENTS Good physical and mental health Must be at least 18 years old Must have a body mass index (BMI) that is less than 35 Must be free from the following: Uncontrolled high blood pressure Diabetes Cancer Hepatitis Organ diseases Infectious diseases

9. KEY REASONS FOR SHORTAGE OF ORGAN DONORS IN INDIA Ignorance and lack of knowledge about organ donation. Lack of registering one’s wish to donate. Myths and beliefs.

10. SITUATIONS UNDER WHICH ORGAN DONATION OCCURS Live Donations – Occurs when a living person wishes to donate organs to some immediate family member in need. Only first-degree relatives (Parents, siblings & children) are allowed to be Live Donors. They can donate one kidney, a portion of pancreas and a part of the liver.

11. Cadaver/ Deceased Donations- Brain death Cardiac death/Natural death

12. PROCESS OF ORGAN DONATION

13. BOX USED FOR ORGAN TRANSPORTATION Just prior to being removed from the donor, each organ is flushed free of blood with a specially prepared ice-cold preservation solution that contains electrolytes and nutrients. The organs are then placed in sterile containers, packaged in wet ice, and transported to the recipient's transplant center. University of Wisconsin cold storage solution is the gold standard for organ preservation.

14. ADVANTAGES A single donor can save more than one life. A donor can have normal life even after the transplant. People who are certified brain dead are capable of donating many body parts. Organs can be donated after death and can be 'banked'. Potential donors are easy to find.  

15. TRANSPLANT COORDINATORS

16. LEGAL ASPECTS OF ORGAN DONATION 1.Transplantation of Human Organ and Tissue Act (THOTA) Passed in 1994 Amended in 2011, and new rules came into force in 2014. It aims at regulation of removal, storage, and transplantation of human organs for therapeutic purposes and for prevention of commercial dealings in human organs.

17. 2.National Organ and Tissue Transplant Organization (NOTTO) It is a National level organization set up under Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India located at 4th and 5th Floor of Institute of Pathology (ICMR) Building in Safdarjung Hospital New Delhi. It has following two divisions: "NATIONAL HUMAN ORGAN AND TISSUE REMOVAL AND STORAGE NETWORK” "NATIONAL BIOMATERIAL CENTRE”

18. FUNCTIONS At National Level: Lay down policy guidelines and protocols for various functions. Network with similar regional and state level organizations. Compile and publish all registry data from States and Regions. Creating awareness, promotion of organ donation and transplantation activities. Co-ordination from procurement of organs and tissues to transplantation when organ is allocated outside the region.

19. Dissemination of information to all concerned organizations, hospitals and individuals. Assist in data management for organ transplant surveillance & registry of organ transplant and Organ Donation. Consultancy support on the legal and non-legal aspects of donation and transplantation.

20. Allocation, Transportation, Storage and Distribution of Organs and Tissues. Follow-up of post-transplant patients & living donor for assessment of graft rejection, survival rates etc. Awareness, Advocacy and Training workshops and other activities for promotion of organ donation.

21. National Biomaterial Centre (National Tissue Bank)- The main thrust & objective of establishing the centre is to fill up the gap between ‘Demand ’ and ‘ Supply’ as well as ‘ Quality Assurance ’ in the availability of various tissues.

22. The centre will take care of the following Tissue allografts: - Bone and bone products e.g. deep-frozen bone allograft, freeze dried bone allograft Duramater Fresh frozen human amniotic membrane High temperature treated board cadaveric joints like knees, hips and shoulders, cadaveric cranium bone graft, loose bone fragment, different types of bovine allograft, used in orthodontics Skin graft Cornea Heart valves and vessels

23. Activities Coordination for tissue procurement and distribution Donor tissue screening Removal of tissues and storage Preservations of tissue Laboratory screening of tissues Tissue tracking

24. Sterilization Records maintenance, Data Protection and Confidentiality Quality Management in tissues Patient Information on tissues Development of Guidelines, Protocols and Standard Operating Procedures Trainings Assisting as per requirement in registration of other Tissue Banks

25. FORMS FOR ORGAN DONATION AND TRANSPLANTATION FORM 1- FOR ORGAN OR TISSUE DONATION FROM IDENTIFIED LIVING NEAR RELATED DONOR FORM 2- FOR ORGAN OR TISSUE DONATION BY LIVING SPOUSAL DONOR FORM 3- FOR ORGAN OR TISSUE DONATION BY OTHER THAN NEAR RELATIVE LIVING DONOR FORM 4- FOR CERTIFICATION OF MEDICAL FITNESS OF LIVING DONOR FORM 5- FOR CERTIFICATION OF GENETIC RELATIONSHIP OF LIVING DONOR WITH RECIPIENT

26. FORM 6- FOR SPOUSAL LIVING DONOR FORM 7- FOR ORGAN OR TISSUE PLEDGING FORM 8- FOR DECLARATION CUM CONSENT FORM 9- FOR UNCLAIMED BODY IN A HOSPITAL OR PRISON FORM 10- FOR CERTIFICATION OF BRAIN STEM DEATH FORM 11- APPLICATION FOR APPROVAL OF TRANSPLANTATION FROM LIVING DONOR

27. FORM 12- APPLICATION FOR REGISTRATION OF HOSPITAL TO CARRY OUT ORGAN OR TISSUE TRANSPLANTATION OTHER THAN CORNEA FORM 13- APPLICATION FOR REGISTRATION OF HOSPITAL TO CARRY OUT ORGAN/TISSUE RETRIEVAL OTHER THAN EYE/CORNEA RETRIEVAL FORM 14- APPLICATION FOR REGISTRATION OF TISSUE BANKS OTHER THAN EYE BANKS FORM 15- APPLICATION FOR REGISTRATION OF EYE BANK, CORNEAL TRANSPLANTATION CENTRE, EYE RETRIEVAL CENTRE UNDER TRANSPLANTATION OF HUMAN ORGANS ACT FORM 16- CERTIFICATE OF REGISTRATION FOR PERFORMING ORGAN/TISSUE TRANSPLANTATION/RETRIEVAL AND/OR TISSUE BANKING

28. FORM 17- CERTIFICATE OF RENEWAL OF REGISTRATION FORM 18- CERTIFICATE BY THE AUTHORIZATION COMMITTEE OF HOSPITAL FORM 19- CERTIFICATE BY COMPETENT AUTHORITY FORM 20- VERIFICATION CERTIFICATE IN RESPECT OF DOMICILE STATUS OF RECIPIENT OR DONOR FORM 21- CERTIFICATE OF RELATIONSHIP BETWEEN DONOR AND RECIPIENT IN CASE OF FOREIGNERS

29. FORM 10-FOR CERTIFICATION OF BRAIN STEM DEATH -To be filled by the board of medical experts certifying brain-stem death -4 members sign the certificate of brain stem death: Medical administrator incharge of the hospital Authorized specialist. Neurologist/Neurosurgeon Medical officer treating the patient

30. -The certificate includes patient details, and preconditions such as diagnosis, date and time of accident/onset of illness, date and onset of non-reversible coma and 2 medical examinations. -The minimum time interval between the first and second testing will be 6 hours in adults. In case of children 6 to 12 years of age, 1 to 5 years of age and infants, the time interval shall increase depending on the opinion of experts.

31. TRANSPLANT REJECTION REACTION Hyperacute Occurs minutes to hours after transplantation No treatment (organ must be removed) Acute Occurs days (one week) to months after transplantation T- cytotoxic lymphocytes attack the transplanted organ Chronic Occurs over months to years

32. Most common signs & symptoms- Pain at the site of the transplant Feeling ill Flu-like symptoms Fever Weight change Swelling Decreased urine output

33. IMMUNOSUPPRESSIVE THERAPY Triple therapy (all PO/IV) Cyclosporine-Prevent a cell-mediated attack (helper T-cells) against the organ Corticosteroid: prednisone-methylprednisolone ( Solu -Medrol)-Suppress inflammatory response Cytotoxic drug: mycophenolate mefetil ( CellCept ) or cyclophosphamide (Cytoxan) -Suppress immune response by inhibiting proliferation of T and B cells Monoclonal Antibodies: muromonab-CD3- Used for preventing and treating acute rejection episodes Polyclonal Antibodies: Atgam - Used as induction therapy or to treat acute rejection.

34. Immunosuppressive Therapy: Side Effects Nephrotoxicity Increased risk of infection Lymphoma Hepatotoxicity Neutropenia Thrombocytopenia Diarrhoea/nausea/vomiting

35. GREEN CORRIDOR Green corridor is a demarcated, cleared out special road route created for an ambulance that enables harvested organ(s) meant for transplant to reach the destined hospital . It is a special corridor created without any stoppages.

36. The prime objective of creation of these green corridors has arisen from the fact that organs have a short preservation time; henceforth, within few hours, the entire process, right from harvesting, interinstitutional transportation, and final transplantation surgery must be completed. In the past few years, this concept of green corridors has taken up across the nation and has successfully managed to save a number of lives through timely delivery of organs.

37. ROLE OF NURSE •Registered professional nurse are often the primary care givers for patients approaching the final stage of life. •It is the nurse who facilitates the coping of patients and their families. In general, the work of transplant nurse is anchored on counselling and facilitating the process for organ or tissue donation by educating and guiding to the donor families without doubt, a difficult, heart wrenching process.

38. •The nurses stay with the patients and help the family to understand the organ donation process, which includes keeping the brain-dead patient’s body functioning until the organ been collected. •There are guidelines for nurses who work in areas where organ donation and transplant occur. She should be the “whistle blower” if any unethical things happen. 1. The nurses first obligation is the well-being of the patient entrusted to our care. 2. The act of procuring organs should never be the explicit causes of a person’s death. 3. Nurses understand the good of organ donation itself.

39. RESEARCH ARTICLES 1.Knowledge, attitude, and practice regarding organ donation among adult population of urban Puducherry, South India Gokul Sarveswaran et al (2018) conducted a community-based cross-sectional study during April to May 2017 among 257 randomly selected participants in selected wards of urban Puducherry. Data regarding knowledge, attitude, and practice were collected through pretested semi-structured questionnaire. Almost 90% of the study participants have heard about organ donation. However, only 28% had adequate knowledge regarding organ donation. 58% had positive attitude toward organ donation. Practice regarding registration for organ donation was only 2.3%. Knowledge regarding organ donation was more among joint family and middle socioeconomic status . The study concluded that less than one-third of the study population had adequate knowledge regarding organ donation. Even though more than half of them had positive attitude toward organ donation only six individuals registered for organ donation .

40. 2.A study on knowledge and attitude about organ donation among medical students in Kerala GS Adithyan et al (2017) conducted a cross-sectional study to assess the knowledge and attitude of medical students regarding organ donation at Government Medical College, Trivandrum, Kerala, India. Data were collected by self-administered questionnaire from 194 final-year MBBS students during 2016, who were selected by convenient sampling. The questionnaire had three sections to gather information of sociodemographic details of the students, knowledge on organ donation, and the attitude toward organ donation. The findings showed that a majority of the students had adequate knowledge regarding organ donation, but it is not translated into their willingness for donation – both cadaveric and live. The study concluded the need for educational interventions for medical students to make them understand the importance of organ donation.

41. SUMMARY AND CONCLUSION As discussed throughout the presentation, learning about organ donation will help nurses to care for patients who want to donate organ and who require organ transplant. Nurses can facilitates the coping of patients and their families. Nurses can also counsel the patients and their family for various options available in organ donation.

42. REFERENCES 1.Cleveland clinic. Organ Donation and Transplantation. Available from https://my.clevelandclinic.org/health/articles/11750-organ-donation-and-transplantation [cited 10 jan 2020] 2.The Times of India. ORGAN DONATION DAY. Available from https://timesofindia.indiatimes.com/topic/organ-donation-day [cited 10 jan 2020] 3.Organ donation – Current Indian scenario. Journal of the Practice of Cardiovascular Sciences. Available from http://www.j-pcs.org/article.asp?issn=2395-5414;year=2018;volume=4;issue=3;spage=177;epage=179;aulast=Nallusamy [cited 9 jan 2020] 4.Frequently Asked Questions. Finger Lakes Donor Recovery Network. Available from http://www.donorrecovery.org/learn/frequently-asked-questions/#q1 [cited 9 jan 2020] 5.Organ donation. Available from https://www.slideshare.net/sandipandhar/organ-donation-9534178?next_slideshow=1 [cited 9 jan 2020]

43. 6.Transplantation of human organs and tissues Act. Indian Journal of Transplantation. Available from http://www.ijtonline.in/article.asp?issn=2212-0017;year=2018;volume=12;issue=2;spage=84;epage=89;aulast=Sahay [cited 9 jan 2020] 7.Organ transplantation. Available from https://www.slideshare.net/sarangidipu/organ-transplantation-ppt-56263976 [cited 10 jan 2010] 8.Role of nurse in organ donation. Available from https://www.slideshare.net/jagdishsamabd/role-of-nurse-in-organ-donation-86525051 [ cited 10 jan 2020] 9.Organ Donation Step by Step. OneLegacy . Available from https://www.onelegacy.org/newsroom/presskit/organ_stepbystep.html [cited 10 jan 2020] 10.Living Donor Requirements. JOHNS HOPKINS MEDICINE. Available from https://www.hopkinsmedicine.org/transplant/programs/kidney/living_donors/requirements.html [cited 10 jan 2020]

44. 11.Gokul Sarveswaran , Manikanda Nesan Sakthivel, Yuvaraj Krishnamoorthy, Yashodha Arivarasan , and Jayalakshmy Ramakrishnan. Knowledge, attitude, and practice regarding organ donation among adult population of urban Puducherry, South India. J Educ Health Promot . 2018; 7: 117. doi : 10.4103/jehp.jehp_44_18. PMID: 30271802. 12.Adithyan G S, Mariappan M, Nayana K B. A study on knowledge and attitude about organ donation among medical students in Kerala. Indian J Transplant 2017;11:133-7 13. Koushal V, Sharma R, Kumar A. Impact of green corridors in organ donation: A single-center experience.Indian J Transplant 2018;12:110-2