Despite India being a highly populated
nation, there is a deficit in organ donation which is attributed to lack of
awareness, negative attitude due to religion, caste, etc, fear and
misunderstanding, legal aspects and media reports on scandals involving organ
rackets. Awareness about kidney donation begins with the emphasis that kidney
transplant is always a better and safer treatment option for kidney failure
than staying on dialysis. Simply put, if done through the right channels,
kidney donation is safe.
Public education through lectures, media
coverage and various awareness campaigns, celebrating Organ Donation Day,
felicitating organ donors and their families, distributing organ donor card,
celebrities’ participation can spread the knowledge of organ donation.
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Dr Shital Lengade, Consultant Nephrologist
and Transplant Physician, answers some pertinent questions concerning organ
donation:
Herald Café: Who can be a donor and what is
the process to determine a suitable candidate for organ donation?
Dr Shital Lengade: Any healthy individual
between the age group of 18-65yrs, without any significant medical illness like
diabetes mellitus, hypertension, heart disease, chronic infections or any
kidney disease can be a kidney donor.
Living kidney donation in India is
regulated under the Human Organ Transplant Act 1994 which allows kidney
donation only within the family. Hence only near relatives of the patient
(grandparents, parents, siblings, spouse) can be donors. Blood group matching
is the initial step to kidney donation, with ‘O’ group being universal donor
and ‘AB’ group universal recipient.
Altruistic donation or kidney donation by a
well wisher or friend is not permitted in India.
HC: What are the risk factors involved in
donating a kidney?
Dr SL: The living donor candidate is
completely evaluated and clinically cleared of the chances of the donation
affecting his/her lifespan. Considering the risks associated with any surgery
and anesthesia, globally, the risk of having a life-threatening problem with
donating a kidney is 1 in 3,000. The risk of minor complication such as minor
wound infection is 2-4 per cent.
HC: What are the odds the donor’s kidney
won’t be rejected?
Dr SL: The chances of rejection are less
than 5 per cent in living kidney transplant and 8-10 per cent in cadaver
transplant. A detailed laboratory and radiological assessment of the patient
and the candidate donor is done, including special tissue matching test (HLA
typing and Cross match) before transplant surgery; the matching of kidneys is
well assured nowadays. In case if the kidney match is poor, modern medicines
ensure that the transplanted kidney does work.
HC: How does kidney donation affect the
lifestyle of donor?
Dr SL: Living kidney donation does not
change the lifestyle nor affects life expectancy of the donor. The single
normal kidney will increase in size to compensate for the loss of the donated
kidney. Activities like heavy lifting, sports like boxing, football, martial
arts, wrestling, is not recommended for about 6 weeks following the surgery.
A urine examination, blood pressure check
along with kidney function test should be done yearly, with good long term
follow up with primary doctor.
Pregnancy after donation is possible but
recommended 6 months after the surgery.
HC: Discuss the scene of kidney donation in
Goa?
Dr SL: In Goa, approximately 800 people are
suffering with kidney failure and undergoing dialysis, with addition of 80-100
new patients every year. Kidney transplant would have rehabilitated 60-70 per
cent of these patients who are forced to survive on dialysis, the reason being
lack of kidney donation from family members and cadaver transplant not yet
available in the state. On average, 15-20 patients undergo kidney transplant at
a national level. Of these, almost 90 per cent of the donors of a live kidney
transplant are female (mother/sister/wife).
HC: Could you throw some light about
cadaver kidney donation?
Dr SL: Cadaver kidney donation means
kidneys from an ICU patient on ventilator support who has been declared ‘Brain
Dead’ by a panel of expert doctors after careful evaluation. Once there is no
chance of survival and if the close family members consent, then cadaver
donation of various organs like kidneys, heart, lung, liver etc happens for
transplantation into desiring patients.
The scope for cadaver kidney transplants in
Goa is huge, especially as the state records around 350 deaths due to road
accidents each year, with a minimum estimate of 75-80 brain stem deaths (Brain
death); even if 10 per cent of the family consent for organ donation, 15-20
patients with kidney failure would get a new lease of life every year.
However there is a lot of work to do if
cadaver transplant has to be a reality in Goa. There is a need to set up a
tissue typing laboratory, to cross-match potential brain dead organ donors and
recipients, forming a brain dead declaration committee, training and employment
of social workers as ‘grief counselors’ and engaging more hospitals in the
state as transplant or retrieval centers.
Most importantly, Goans will have to summon
up the courage to pull the plug on a loved one and then generously donate his
vital organs to a complete stranger.
HC: Differentiate between cadaver and
living donor kidney transplant.
Dr SL: Kidney transplant from a living
donor provides major benefits for patients with kidney failure like better long
term kidney survival, faster access to transplant (especially in children, even before starting dialysis) and
less risk of rejection. Living donor kidneys not only function better, but last
longer than a cadaver kidney.
HC: What is swap transplant?
Dr SL: Swap transplant or kidney paired
donation is an option for living donor pairs who are not compatible with each
other; kidneys can be “exchanged” between pairs so as to have a successful
compatible transplant. On October 1, 2014 an interstate swap transplant was
performed between a donor-recipient pair from Goa and Maharashtra.
