|Year : 2018 | Volume
| Issue : 2 | Page : 145-147
Deceased organ donation is growing at a slow pace in developing countries: A matter of serious concern?
Amit Kumar Shah
Department of Surgery, INHS Asvini, Colaba, Mumbai, Maharashtra, India
|Date of Submission||25-Nov-2018|
|Date of Acceptance||17-Dec-2018|
|Date of Web Publication||10-Jan-2019|
Lt Col Amit Kumar Shah
Department of Surgery, INHS Asvini, Colaba, Mumbai - 400 005, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Shah AK. Deceased organ donation is growing at a slow pace in developing countries: A matter of serious concern?. J Mar Med Soc 2018;20:145-7
| Introduction|| |
Human organ transplantation has become an established science. The advances in immunosuppression and surgical techniques along with emerging better perioperative management have gone along a long way to make a mythological or even a scientific perception in the past a reality today. A prospective organ recipient for liver and kidney has an option of live donor as well as deceased organ donor. However the same for heart, lung, pancreas with small bowel and corneas usually have an option of a deceased donor. In the west because of the inherent nature of their society, which is not bound with superstitions and other limiting factors, are far ahead in the ratio of deceased organ donation. I would like to draw the attention of readers to the law of Sweden where once the death is certified, the organs of deceased belongs to the state. The law has stood the test of time and had no repercussions from that society, since decades of its existence. Even then, the country has a waiting list because of a low rate of living organ donors. Although we cannot have such laws in our subcontinent because of the population with mixed cultural beliefs, still it should give us sufficient sparks in the society where we can settle to some middle path. Once we realize that our large population is an advantage to us in the present scenario, all of us have a collective responsibility towards this noble cause.
| Supply Demand Mismatch|| |
At present we are facing a problem of supply to demand ratio, in western world the living donation is low hence their endeavour is to increase the live donation and in developing world the ratio of deceased donation is poor. In view of foregoing, the western world is bringing in Minimally Invasive Surgery (MIS) in a big way to promote and encourage living organ donation by quoting advantages of MIS. The ratio of deceased donation per million populations is at a dismal ratio in the third world countries, and we need to work on a warfront to increase our deceased organ donation.
| Where Do We Stand?|| |
In the last 2 years, although we have seen doubling of the deceased organ donation rate from 196 donors in 2012 or 0.16 pmp to 411 in 2014 or 0.34 pmp [Table 1] and [Figure 1] but these figures are of only 10 states and union territories of India, and the donations resulted in 1150 solid organs such as kidney, liver, heart, lung, pancreas, and intestine being retrieved; it does become significant [Figure 2]. Though few states have crossed 1 or 2 donations per million populations, which actually translate to a statistics where solid organ transplantation with deceased donation was responsible for almost 40% of the liver transplants and over 15% of kidney transplants done in the country. Just imagine the realistic rates if our national average even reaches to these individual state levels of 1–2 donations pmp. However, our national average is at an abysmal level. We need to grow as a nation where all the regions need to be included in the national program. It is an uphill task but we need to do it, earlier is the better.
|Table 1: State and UT wise distribution of Solid Organ Deceased Organ Donation for year 2012, 2013 and 2014|
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|Figure 1: Deceased multiorgan donation in India for years 2012, 2013, and 2014. *ODR: Organ donation rate (per million population), **0.34: National organ donation rate|
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|Figure 2: Number of organs retrieved from multiorgan donor in India for 2012, 2013, and 2014|
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The problems we are actually conferred with are as follows:
- Identifying road traffic accident victims as potential organ donor
- Communicating with the next of kin, includes counseling
- Medical management of the brain dead
- Brain dead certification and the committee for certifying
- Carrying out harvest and organ storage and transport.
| Multipronged Approach|| |
In a country like ours, we need to have a two-pronged approach to increase our deceased donation program. First one is a requirement of social paradigm shift in the belief of population of various strata and religious communities. This will take a considerable amount of time as it requires a herculean effort to penetrate all stratum of the society in our country. Though this change is likely to happen but when, remains a question for all socialists to ponder upon.
In the meantime, while the above social engineering is happening, the second front needs to be explored. The article whose commentary I am putting forward has made a step toward this great project. This article brings out a huge shortfall in the awareness among the postgraduate residents across all specialties regarding the recognition of a potential organ donor and the process of converting that potentiality to the reality. The medical community needs to provide that “Big Bang” which will create an explosion toward reducing the “supply-demand mismatch.” At present, the science of organ harvest, preservation, and transplantation is known to the medical professionals who are doing it regularly. To add up to the above, there lies a conundrum of laws and processes. The Government of India has come out with the Gazette notification in 2014 to simplify the process and to provide considerable information and forms in one single release for the entire nation.
The same process includes awareness, compassion, sympathy, and a sound medical knowledge and practice at all levels of the hospital hierarchy. It will be a good practice to issue a guideline where all hospitals running active postgraduation program register them as an “organ harvesting center.” This will be a major step toward our goal. The procedure has been well-guided by the government which is considerably elaborate and exhaustive but at the same time is precise. Once a hospital successfully completes that, they will see that all pieces of jig saw puzzle have fallen in the right place. They will identify their protocols and committees which will automatically create their own “standard operating procedures” and would be able to deliver in practice. The process though exhaustive, starting from counselling to medicolegal clearance and finally realizing to organ harvesting has sufficient space to accommodate compassion, passion and science involved in the human organ transplantations.
| Deceased Donation in Hospitals|| |
The process starts from correctly identifying an organ donor and following all the ethics and moral responsibility to handle a grieved family, where they can voluntarily consent for organ donation even while facing tough time because they would realize the saying “ Don't take your organs to Heaven, Heaven knows that we need them here.” The procedure of medical management of brain-dead patient before organ harvest is well known and practiced worldwide. The relevant details are readily available with MOHAN Foundation. The readers are recommended to visit the home page of this organization which is working selflessly toward awareness as well as helping the hospitals for process of organ donation, and they specialize in deceased donations. To this, there are plenty of protocols available in world literature, and the readers are suggested to refer to the Supplement of British Journal of Anaesthesia issued in January 2012. These will help the clinicians for an overview; however, the readers are advised to search the literature more from the Indian institutes as it also covers the legal aspects applied to our population.,,
| Role of Postgraduate Residents|| |
The residents of the hospitals running a postgraduate program are likely to form the core group in the awareness as well as the implementation of deceased donation. By virtue of their presence in the hospital at all times and all days, it is highly recommended that they should be sensitized to this serious and compassionate issue. Their role should be identified with identification of a brain-dead patient and early involvement of the transplant coordinator in the process of counseling of relatives. It is a practical bearing that the departments which are well versed with these perceptions and practice are labelled with “Conflicts of Interest” and they should rightly keep distance at the initial stages.
At no stage, the relative should ever have the feeling that with their consent the hospital would leave any stone unturned in management of the brain-dead patient and would hasten the process of organ harvest. This is a general misconception that the hospital management has personal interest in organ harvest and the relatives are more pressurized than counseled. This is a problem which can only be managed by mass education on simple graphical or animation-based messages on what does the medical world mean by a brain dead or beating heart and brain dead or nonheart-beating modes of the human body.
The same can be easily designed on animation software, but it needs to penetrate the soul of each countryman which is actually as difficult as it is easy to design. We need to start and no time is better than now.
| Conclusion|| |
We have a long path to tread to develop into a nation with a good ratio of deceased donation. The path has to be covered by all namely society, government, and the medical fraternity. However small a step, it needs to be taken by the hospitals toward the right direction. One point needs to be highlighted that a hospital even with limited resources should get themselves registered for organ harvesting because the neighborhood hospitals actively involved in organ transplant program will always be there around like a “Big Brother” to these hospitals who are willing to take those small positive steps. The medical fraternity should lead this revolution and bring about the radical change. We need to come out of the superstitions and various beliefs without scientific evidence. The society has to come forward, but the medical professionals should take the responsibility of being the torchbearer to the society. Otherwise, we are going nowhere; we would only see the growth of dialysis centers and not of transplant centers.
| References|| |
Navin S, Shroff S. Deceased donation statistics. Indian Transplant Newsletter 2015;14:4-6.
The Human Organ Act 2014. The Gazette of India Notification, Extra Ordinary, Part II - Section 3 - Sub Section (i) No. 161. New Delhi: Government of India; 27 March, 2014.
Smith M. Brain death: Time for an international consensus. Br J Anaesth 2012;108 Suppl 1:i6-9.
Srivastava A, Mani A. Deceased organ donation and transplantation in India: Promises and challenges. Neurol India 2018;66:316-22.
] [Full text]
Pandit RA, Zirpe KG, Gurav SK, Kulkarni AP, Karnath S, Govil D, et al.
Management of potential organ donor: Indian society of critical care medicine: Position statement. Indian J Crit Care Med 2017;(21):303-16.
Kumar L. Brain death and care of the organ donor. J Anaesthesiol Clin Pharmacol 2016;32:146-52.
] [Full text]
[Figure 1], [Figure 2]