Organ Donation, are we doing enough to spread enough awareness?

The emotional upheaval of death is the most difficult to overcome and accepting the notion of organ donation by the relatives can be very difficult. However if the body is to be buried or cremated some of the organs can be donated to give a critically ill organ failure patients a second chance in life.

"Shankracharya firmly believed in the concept of organ donation and said - Iddham Shariram Paropkardum (This body is for the use of others)". Most people donate the belongings of their loved ones after their death, organ donation also should be considered in the same spirit. It is the noblest of all donations. The act is as holy as holy can be, as it gives a fellow human being a second chance to live.

"As Rabindranath Tagore said - Death is not extinguishing the light but putting out the lamp because the dawn has come"

Sixty years ago, scientists were on the cusp of a revolutionary scientific breakthrough. In the preceding decades, researchers had some success transplanting organs in animals, and there had even been a few failed attempts at human organ transplants. Numerous studies showed that human organ transplantation was feasible, and that it would be enormously beneficial to thousands of patients, but nobody had been able to make it work.

Success finally came in the early 1970s, when kidney transplants in India first started within a few years gave new life to ailing patients. In the following decades, doctors learned how to transplant other organs successfully, and they dramatically improved recovery rates. Today, most organ transplants are relatively safe, routine procedures, and transplantation is considered to be the best treatment option for thousands of patients every year.

Organ transplantation - the surgical removal of a healthy organ from one person and its transplantation into another person whose organ has irreversibly failed or was injured - is often lifesaving and gives the recipient a wonderful new lease on life. This removal must follow legal requirements, including the definition of death and consent. The three major processes involved in organ transplantation: the organ distribution system, the surgery itself and the post-surgery recovery.

Pros organ donation:

• Saving Lives.
• You Can Donate While You're Still Alive.
• Consolation for Families of the Deceased.
• Allows Medical Students to Practice.

Cons of Organ donation:

• Illegal organ trade.
• Costly surgery.
• Antibiotic resistance development.
• Potential risk during post surgery.
• Painful and chances of other complications.

Organ transplants are one option when a particular organ is failing. Kidney failure, heart disease, lung disease and cirrhosis of the liver are all conditions that might be effectively treated by a transplant. For problems with the heart, the lungs and other highly sensitive organs, a transplant is typically the course of last resort. But if all other avenues have been explored and the patient is willing and able, transplantation is a good, viable option.

Kidneys and livers may be transplanted from a living donor, since people are born with an extra kidney and the liver is regenerative. Even a lung can be transplanted from a living donor, but this is still very rare. For these procedures, a patient will generally find a willing donor in a friend or family member. If the donor is a match, they can proceed directly to the surgery stage. A smaller number of living transplants come from charitable people donating for the general good.

If a patient needs a heart transplant, a double lung transplant, a pancreas transplant or a cornea transplant, they will need to get it from a cadaverous (deceased) donor. Generally, acceptable donors are people who are brain dead but on artificial life support. Even though they are technically dead, their body is still functioning, which means the organs remain healthy. Organs will deteriorate very quickly after the body itself expires, making them unusable for transplant.

But organ transplantation is also a major surgery that carries potential risks and complications, such as the chance of organ rejection. One of the example, Bone marrow transplants is the only hope for many children and adults with leukemia, aplastic anemia, and other fatal blood diseases and cancers. Unfortunately, nearly 70 percent of these patients cannot find suitably matched marrow donors within their families; they need to find unrelated marrow donors.

Therefore, before you receive a transplant, it is necessary to undergo a series of medical tests to determine whether or not you are a good candidate for transplant. You must be free of cancer, HIV, Hepatitis B, C and have no active infections (sepsis) are some of the contra-indication.

Unfortunately, doctors and patients now face a new obstacle: The demand for transplants has far surpassed the supply of well accepted donated organs. Depending on the organ needed, organs are matched using several characteristics, including blood type and size of the organ needed. Also taken into account is how long someone has been on the waiting list, how sick they are, and the distance between the donor and the potential recipient. Simply put, there aren't matched enough organ donors, so patients must wait months, even years, for their chance at recovery.

Indian Scenario

A recent study shows that 5 lakh people and above are dying every year in India only because of organ failure and lack of available organs. So, organ donation from deceased donors is gaining momentum in India and it is time to take this programme further to help thousands of patients with organ failure get a second chance at life.

In India, the potential for deceased donation is huge due to the high number of fatal road traffic accidents and this pool is yet to be tapped. Few hospitals and committed NGOs in the country have shown that deceased donation as a feasible option. The ethics of kidney donation has important bearings on the society as this would form the basis to resolve many conflicts in emerging regenerative sciences.

The legislation called the Transplantation of Human Organ Act (THO) was passed in India in July 1994 to streamline organ donation and transplantation activities. Broadly, the act accepted brain death as a form of death and made the sale of organs a punishable offence. With the acceptance of brain death, it became possible to not only undertake kidney transplantations but also start other solid organ transplants like liver, heart, lungs, and pancreas. The Transplantation of Human Organs Act, 1994 heralded a significant change in the organ donation and transplantation scene in India

The purpose of this act was essentially threefold:

1. To stop commercial dealing in organs especially Kidneys.
2. Accepting Brain death as a definition of death.
3. Define that only the first relative can donate kidneys in case of related kidney transplant operation. In the event of there being no first relative and someone other than first relative was willing to donate; the government advised the formation of a special government committee to study these individual cases of organ donation and make sure that there was no commercial dealings involved in the process of donation. Only on being granted permission from this government committee could unrelated transplants be undertaken by the doctors.

Despite the THO legislation, organ commerce and kidney scandals are regularly reported in the Indian media. In most instances, the implementation of the law has been flawed and more often than once its provisions have been abused. Parallel to the living related and unrelated donation program, the deceased donation program has slowly evolved in a few states. In approximately one-third of all liver transplants, the organs have come from the deceased donor program as have all the hearts and pancreas transplants. NOTTO (National Organ and Tissue Transplant Organisation) works under Ministry of Health Family And Welfare function as apex centre , a few like minded medical professionals and philanthropists hospitals along with committed NGOs Mohan Foundation, Gift Your Organ Foundation, Shatayu and Gift A Life for coordination and networking for procurement and distribution of organs and tissues and registry of organs and tissues donation and transplantation in the country have kept the momentum of the deceased donor program. The MOHAN Foundation (NGO based in Tamil Nadu and Andhra Pradesh) taking the lead in setting up an organ sharing network has facilitated 400 of the 1,300 deceased organ transplants performed in the country over the last 14 years. To overcome organ shortage, developed countries are re-looking at the ethics of unrelated programs and there seems to be a move towards making this an acceptable legal alternative.

On January 21, 2004, 16-years-old Krishnan suffered from haemorrhage within the brain and was declared brain dead at a hospital in Chennai. But his organs today live in six peoples.

The year 2013 has been the best yet for deceased organ donation in India. A total of 845 organs were retrieved from 310 multi-organ donors resulting in a national organ donation rate of 0.26 per million population.

Facts about organ donation:

• 18 people die every day while waiting for a transplant.
• 1 organ donor can save 8 lives and change the lives of more than 50 people.
• Almost anyone can be an organ donor, regardless of age or medical history.
• Donors can still have open casket funerals, and organ donation doesn't cost the donor's family any money
• If a person is hospitalized, the medical staff provides the best possible care, regardless of organ donor status
• Donation is only considered after a patient has died.
• Donors are needed for all races and ethnic groups. Transplant success rates increase when organs are matched between members of the same ethnic background.

Conclusion
Organ donation is a highly admirable and responsible thing to do, and is one of the most genuine ways to do something heroic and to potentially save someone's life; it reaffirms our faith in humanity.
However over the last 25 years the organ donation process is marred in India due to the stigma attached to kidney donation. The law of the land prohibits any commercial dealing in organs - such as purchase of kidney from a donor from economically weaker section, but because the demand is so high, the law is difficult to implement and kidney scandals continue to haunt the country where a donor is not adequately compensated.
The transparent oversight of the health authorities over donation and transplantation activities is also essential to increase the trust of the public in the system. In addition, the decision to be a donor is often based on the understanding that a contribution to the availability of transplant resources may someday benefit the health needs of the donor's family.

Santosh Prakash

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