The Gracious Gift

On Organ Donation

People worldwide are becoming increasingly prone towards various diseases with a mounting percentage of people with organ failures. Many are waiting to see if an organ becomes available and for a second chance at life. Such waiting causes suffering and deaths that could be preventable – if someone turns up to pledge their organs - and also add to a huge amount of money to health care costs. Recently, a family volunteered to donate their brain-dead son’s organs in Delhi. The doctors at All India Institute of Medical Science (AIIMS) worked for 10 hours conducting the procedure and harvested 32 different organs which benefited 34 people. Organ donation is a worthwhile, kind and generous decision one could take in their lifetime. It is an ultimate gift which will give an incredible happiness of ‘giving life’ to another person who would otherwise die or have poor health waiting for a transplant.

It is estimated that around 1,00,000 livers and 2,00,000 kidneys are required annually in India and only about 2% get it. There is a distinct lack of awareness and a number of myths due to which people falter to donate their organs. The main barrier is the superstition on death and reincarnation where many people think that organ donation could lead to the body not being ‘whole’. Some people believe that it is against their religion although the world’s major religions – Hinduism, Islam, Christianity, Judaism – deem organ donation as a profoundly humane gesture. Some think that only young adults can pledge their organs. There is no set age limit for organ donation and it is the medical history and not the age which is important. There is a common misconception that the body will be disfigured after the surgery. The procedure is a routine surgery which is similar to any other surgery and doctors maintain utmost dignity and respect for the donor all the time.

One organ donor can save up to 8 lives and can improve the lives of 50 people by donating tissues. The organs that can be donated include heart, kidneys, liver, lungs, intestines and pancreas. The different types of tissues that can be donated include cornea, heart valves, bone and cartilage, skin, veins and tendons and ligaments. The benefits of organ and tissue donations are countless. In organ donation, heart transplants save patients suffering from coronary heart disease, cardiomyopathy and congenital heart disease; lungs transplants save patients with diseases such as pulmonary fibrosis, pulmonary hypertension, cystic fibrosis and emphysema; kidney transplants helps patients suffering from diabetes, polycystic kidney disease and hypertension; pancreas transplants proves to be an effective method to treat diabetes; liver transplants is helpful for patients with hepatitis and biliary atresia; and intestine transplants can be an option for patients suffering from short bowel syndrome along with other disorders. Tissue donation improves the quality of life of the recipients in a number of ways. They include reconstruction of trampled limbs to prevent amputation, prevention of blindness and restoration of vision, skin grafts for burn victims, coronary by-pass surgery and restoration of blood flow using saphenous veins, fusing of spinal defects to reduce pain, repair damaged cartilage and tendons, replacement of benign cystic bone defects and cancerous bone tumours to prevent amputation, replacement of hip bones, dental and reconstruction surgery to restore normal facial appearance, strengthen and straighten backs distorted by scoliosis, replacement of faulty heart valves and creation of shunts for dialysis access with the use of femoral arteries.

There are two types of donations – Cadaver donation and Live donation. Cadaver donation is where a person donates his or her organs after death, when the person is declared brain-dead. Brain-death is a permanent stoppage of all brain activity and different from a vegetative state or coma. It typically occurs few minutes after cardiac arrest and the person can be kept on ventilator support until the organs are retrieved. Live donation takes place when organs and tissues are donated from a living person. The organs which could be used in Live donation are kidney (entire organ), pancreas (portion), intestine (portion), lung (lobe) and liver (segment). This type of donation usually involves one family member donating an organ to another family member where the relative is blood related – a parent, brother, sisters, or child. There can also be ‘altruistic donors’ where the donor is not related to the patient. Kidneys are the common organ donated by a living person. A healthy person can lead a completely normal life with only one normal kidney.

Around 5,00,000 people in India die annually because of non-availability of organs. We are a big nation of over 1.2 billion people and it is a disappointing fact that only 0.08% per million people, which is extremely low, could be called as organ donors. There is a dire need in raising this figure and it is high time we step up our efforts in promoting Organ Donation. I think the first initiative should come from doctors as it is they who know if an organ donation is possible when a person dies. For example, an accident casualty can become a heart donor or a person who dies of a cardiac failure can become a donor of other organs and tissues like liver, bone, eyes, skin, etc. Also, when a doctor realises that a patient’s chances of survival are less than a year regardless of medical treatment, he should suggest the ‘noble cause’ with the patient and his or her family. Hospitals, both government and private, should form a network with an organ registry and a dedicated team, who can talk to the family members about organ donation and also increase awareness among common man. We should have more hospitals capable of organ transplants with well-equipped Intensive Care Units (ICU) and operation theatres to retrieve organs for harvesting. The Government should introduce a system in all the states of the country and make it compulsory to identify the brain-dead patients, thus, increasing the availability of organs. Following the footsteps of the West, the Government could also try an option where adults applying for driving licenses be asked if they are willing to donate their organs upon death. As a result, the driving licenses would serve the purpose of donor cards as well. This would be very useful because as per records, in India, about 90,000 people die in road accidents annually and 40% of those people are left brain-dead. Experts opine that 50% of the organ demands in our country could be fulfilled by using the organs from road accident casualties alone. It would also make a significant impact if the Government and the various stakeholders including NGOs, social workers, medical fraternity and the people run campaigns and presentations, distribute brochures, air advertisements on television and other media, etc to endorse Organ Donation.

In India, the state of Tamil Nadu is the leader in cadaver organ donation and has the most competent programme, called the Cadaver Transplant Programme. Posters can be found outside the ICUs in hospitals stating that the health ministry should be informed immediately when a person dies or is brain-dead for two – three hours. There is an active organ sharing network between hospitals, founded in 2000 by an NGO called the MOHAN Foundation, which has an independent organ procurement team. The NGO also maintains an online registry for organ donation and is being used by the states of Kerala and Tamil Nadu. In 2008, the Government of Tamil Nadu put down guidelines and procedures for organ donation and transplantation which has resulted in considerable increase in the number of transplantation surgeries. It is encouraging to note that the other states of India have such programmes too – Jeevandan Programme of Andhra Pradesh, Zonal Coordination Committee of Karnataka for Transplantation of Karnataka, Mrithasanjeevani of Kerala, Zonal Transplant Coordination Center in Mumbai of Maharashtra. However, it is the need of the hour that rest of the states of the country adopts the Tamil Nadu model to join the mission of saving lives.

Imagine yourself in the shoes of someone who is waiting for a bone to be donated so that he could prevent amputation of his leg. Organ donation is not just a life-saving act; it is also a life-transforming act. By a cadaver donation, a child could grow up with a new heart, a burn victim woman could improve her chances of survival with donated skin, and a man could restore his vision and see sunshine with a new cornea.

Life is beautiful. Pass it on.