Before 1994, the only way to get a heart transplant for Indians suffering from end-stage heart failure was to go abroad –a luxury that most could not afford. After the Transplantation of Human Organs Act was passed on July 8, 1994, a group of surgeons led by Dr P Venugopal successfully performed India’s first heart transplant at the All-India Institute of MedicalSciences (AIIMS) on August 3, of the same year. It was a landmark legislation that recognized brain death as a type of death and laid the regulatory framework for the removal, storage and transplant of human organs fortherapeutic purposes. Dr Venugopal, Chief of Cardiothoracic and Vascular Surgery at AIIMS and his team had been perfecting transplant surgery techniques on animals.
Devi Ram, a 40-year-old heavy industry worker suffering from cardiomyopathy, had been admitted to AIIMS for three months. He belonged to the AB+ blood group, a universal recipient blood group. A 35-year-old lady who had suffered a brain haemorrhage was brought into the hospital and declared braindead. Her family agreed to donate her heart. All the conditions were suitable and compatible, and the team was ready. On August 3, 1994, in a 59-minute procedure, a team of 20 surgeons led by Dr Venugopal conducted India’s First successful heart transplant surgery. Devi Ram lived on for 15 more years until he died of an unrelated issue.
Kidney failure is likened to a ‘silent tsunami’. The symptoms may not show up till the end–stage and by the time it gets detected, it deals a big blow to the patient and his/her family. Incidents of alcoholic and non-alcoholic liver failure are on the rise. Estimatedly, more than a million Indians suffer from end-stage organ failure annually and are waiting to receive a life-saving organ. However, at least 10 patients die every day while waiting. Every ten minutes, a new name is added to the waiting list. More than 2,50,000 patients undergo dialysis every year.
In Goa alone, there are many undergoing dialysis and around 60 on the waiting list for a kidney transplant. This waiting list is maintained by a body called SOTTO (State Organ and Tissue Transplant Organisation), located at GMC Goa. The deceased organ donation program iscalled ‘Nave Jivit’.
An organ transplant is the only way of reversing end-stage organ failure. The transplant enables them to lead normal lives. However, a transplant would need thedonation of a healthy organ by a living or a deceased (dead) person (Donor). Organ donation is legal. The Transplantation ofHuman Organs Act (THOA) allows for organs of a Brain-dead person to be donatedprovided their family members consent to it. In India presently, more than 90 percent of the transplants take place thanks to a living donor – invariably a close family member. We need to work on increasing the rate of deceased organ donation so that over time, we stop relying on the goodness of another wise healthy person to donate their organs or a part thereof.
What can be donated after death?
Death is of two types – Circulatory death or Cardiac Death and Brain Death.
Circulatory death/Cardiac death - This is when the heart stops, due to which blood circulation also stops - what we all commonly understand as death. After this type of death, tissues can be donated i.e.,eyes (Cornea), skin, heart valves, bones, tendons, cartilage and others. Eye donation can happen even at home. The eyes of the deceased must be closed, and moist cotton placed over the closed lids, the head must be elevated by the use of a pillow, an air conditioner must be switched on if possible and overhead fan must be switched off to prevent drying of the corneas. The family needs to inform the nearest eye bank, give their written consent and the donation must happen within six hours of demise.
In Goa, eye donation has yet to be taken off. In states such as Telangana, Tamil Nadu, and Gujarat, eye donation is an extremely successful programme, which enables the gift of sight to lakhs of corneally blind individuals. Voluntary body donation is also possible at a medical college. Family consent is mandatory.
Brain Stem Death / Brain Death – This is caused by severe and irreversible injury to the brain. The brain is made of three parts –the cerebellum, the cerebrum and the brain stem. The brain stem controls involuntary functions of consciousness, breathing, maintaining blood pressure, digestion etc. If the brain stem stops functioning the patient will not be able to breathe and therefore die. Brain death is permanent and irreversible. A person whose brain stem is functioning but hasl ost consciousness due to other parts of the brain getting affected is said to be in a state of coma, which may or may not be reversible. A person in a coma is still alive and breathing by themselves; therefore, the question of organ donation does not arise. Coma is not to be confused with brain death. THOA mandated a series of tests that 4 doctors from the hospital’s committee, empanelled by the State’s Department of Health Services (DHS) have to perform to confirm and certify brain stem death. One of the doctors has to be a neurologist, neurosurgeon intensivist or anesthetist.
It is also mandated that these tests are to be repeated after a minimum gap of 6 hours for adults and longer for children, after which only the patient can be certified to be Brain dead. The main causes of brain death are tumours in the brain, brain injury due to road traffic accidents or falls, and intra-cerebral haemorrhage. A Brain-dead donor’s vital organs such as heart, lungs, liver, kidneys, pancreas, small intestines and recently even hands can be donated. Furthermore, tissues such as corneas, skin, bones, heart valves etc., can also be donated.
Power of Organ Donation
One brain dead person can save up to 8 lives through organ donation and enhance around 50 lives through tissue donation thus passing on the ‘Gift of Life’ to many. No religion is against organ donation as the act of donating organs is a supreme form of charity and love for fellow human beings. Deceased organ donation is a sustainable way of putting an end to illegal organ trafficking and organ sales. The best way to become eternal and to be remembered is to recycle our organs by donating them when we don’t need them anymore, rather than burying them or burning them away to ash.
The Challenges
Brain death is not easy to accept. Even though the brain-dead person is dead, he/she is on the ventilator which facilitates artificial respiration, due to which the heart continues to beat, as a result of which blood continues to circulate in the body. As long as blood circulation continues, the organs remain healthy. Such a unique condition can continue for a few more hours or a few more days, as the organs are kept functioning by the ICU doctors, with the help of medicines and the ventilator.
When one touches it, the brain-dead person’s body will feel warm due to blood circulation.The relatives believe that their loved one is still alive as it appears as if the heart is still beating, the patient is still breathing, and the body is still warm. This makes it extremely difficult for families to accept the brain death of their loved one. When such families are approached to consider organ donation, they end up refusing, as they hope and pray for their loved one to recover to better health.
Organ Donation is a family wish
Even if a person has pledged to donate his or her organs, the family’s consent is a must and legally required to go ahead withthe donation. Hence after signing up for a Donor Card, we inform the Pledger of his/her responsibility to talk to their family about this wish. This helps the family not only get to know about their loved one’s wish but also get familiarized with a new concept of brain death. It may not be an easy conversation to have, but it is a necessary one, because it is our right to decide how our body - our biggest asset - should be treated after we leave this earth, and we need to entrust this responsibility to our loved ones.
(Gabriel Pereira is an Organ Donation Ambassador, MOHAN (Multi Organ Harvesting Aid Network) Foundation, Mapusa)