Organ transplantation
Dr.
Dwijesh Kumar Panda
Every brain-dead person is a potential organ donor. It becomes possible after the family has
consented for retrieval of organs. Despite growing awareness, the recognition
of brain death to organ donation is unexpectedly low in India. Public hospitals
are not taking interest in identifying and declaring brain deaths. The
conversion rates is less than their private counterparts even with successful
programs. Refusal from the family is often cited as the key reason. Certainly
it is not the sole cause. Hesitancy of the doctors in declaring brain death,
police nods and postmortem will help the count. Accidents, falls, and other
incidents where head injury is common, often leave patients brain dead. Lack of
knowledge about the procedure and absence of counsellors at hospitals hurting
the conversion rates. Over 90% of brain deaths occur in public hospitals. Most
accident patients are rushed there. They don’t run transplant programmes.
Public hospitals participation can double the donor pool.
Every hospital has a brain death committee, involving team
of four doctors to declare a person brain-dead. The team has to perform apnea
tests to check if the patient can breathe without aid, has any pupil response
to light and responds to pain. Tests are repeated twice in six hours. Brain
death can happen only in Intensive Care Units. The brain-stem is situated in
the lower part of the brain. It is connected to the spinal cord and is
responsible for breathing, blood pressure and heart beat. The irreparably
damage of brain-stem is declared brain dead. Brain death results from a severe
brain injury. It may be due to road accident or bleeding in the brain (stroke).
The brain swells up after an injury. It cannot expand much
as it is contained within the skull made of tough bone. When the pressure in
the brain becomes greater than the pressure of the heart, it will be unable to
pump blood to the brain. The lack of blood flow deprives the brain of oxygen
leading to its irreversible death. It is a legal form of death as much as death
by cardiac arrest. A ventilator continues to blow air into lungs, while the
heart receive oxygenated blood. The heart beats for some time. This does not
mean that the person is alive, there is chance of recovery. Tissue may be recovered from donors who die of
circulatory death, as well as of brain death – up to 24 hours past the
cessation of heartbeat. The problems of transplant rejection is the key areas for medical management. The body
has an immune
response to the
transplanted organ. It possibly leads to transplant failure and the immediate
need to remove the organ from the recipient.
Types of donor.
Organ donors may be living
or may have died of brain death or circulatory death.
Living donor.
The living donors donate a
renewable tissue, cell, or fluid (e.g., blood, skin). The donated organ or part
of it can regenerate or take on the workload of the rest of the organ. These
are primarily single kidney donation, partial donation of liver, lung lobe,
small bowel. Regenerative medicine in future may allow for laboratory-grown
organs, using person's own cells via stem cells, or healthy cells extracted
from the failing organs.
Deceased donor.
Cadaveric donors are people
who have been declared brain-dead and whose organs are kept viable by ventilators until they can be excised for transplantation. Brain-stem
dead donors are the majority of deceased donors. Circulatory-death-donors increase
the potential pool of donors as demand for transplants continues to grow.
Living related
donors.
Living related donors donate
to family members or friends in whom they have an emotional feeling. The risk
of surgery is negligible by the psychological benefit of not losing someone
related to them. They do not suffer the ill effects of waiting on a list.
Paired exchange
Diagram of an exchange
between incompatible pairs
A
"paired-exchange" is a technique of matching willing living donors to
compatible recipients. A spouse may be willing to donate a kidney to their
partner but cannot since there is not a biological match. The willing spouse's
kidney is donated to a matching recipient who also has an incompatible but
willing spouse. The second donor must match the first recipient to complete the
pair exchange.
The transplants of skin
grafts have potential to improve survival rate among burn patients. When the
burns affect more than 30% of body surface area, the problem of infection, the
chances of deformity and even death increases. One of the ways of preventing
the complications is by early surgery to remove the burnt skin and cover the
raw area with good skin.
Ethical concerns.
. The World Health Organization encourage transplantations to promote
health. But transplantation tourism has the potential to violate human
rights or exploit
the poor. It violates basic human rights according to Articles 3 and 4 of
the Universal Declaration of Human
Rights .The increasing
supply of organs may constraint for the right to life”. The criterion for legal
death cannot
be adequately defined.
There are some common transplant laws which govern all transplants. The policies for
each organ and the type of transplant for each organ is different. Health is a
state subject. The law has a provision of Appropriate Authority to consider
registration of a hospital who wants to undertake organ transplantation.
References:
1.Manara, A. R.; Murphy, P.
G.; O'Callaghan, G. (2011). "Donation after circulatory death". British
Journal of Anaesthesia. 108: i108–i121. PMID 22194426. doi:10.1093/bja/aer357.
2. WHO Guiding
Principles on human cell, tissue and organ transplantation, Annexed to World Health
Organization, 2008.
Submitted to the secretary, Odisha Bigyan Academy for publication in
“Science Horizon” I declare that the article has not been reproduced.
Dr. Dwijesh Kumar Panda, M.D, Ph.D.
(Medicine), Senior Scientist
M5/12, Acharya Vihar, Bhubaneswar,
Contact: (0674)2543122.