Organ Donation

Organ Donation

Over the last 50 years, transplantation has advanced dramatically and with each passing day the number of individual waiting for a transplant keep on rising exponentially. The gap between the available organs and the numbers needed has been widening. Though this gap is present for all available organs in each of the transplant centers of the world, there is a significant difference between the patterns of donation between different countries. A rough estimate of the need for Liver Transplant in India is 15000-20000 per year and the current number fulfills only 10% of the requirement. Against a requirement of 1 to 2 Lakh kidneys, only about 7000 transplantations are being done annually.

Types of deceased organ donations

There are three forms of established organ donations which form the source of organs for transplantation; donation after brain death (DBD), donation after cardiac death (DCD) and live related donation. Brain death is defined as the irreversible loss of all functions of the brain, including the brainstem. The three essential findings in brain death are coma, absence of brainstem reflexes, and apnea. This is the most established mode of transplant. To counter the scarcity, the other two modes of donations were introduced.

In DCD, the non-heart beating donors, usually with a significant severe brain injury, have suffered circulatory arrest with the heart no longer pumping blood to the organs. In this situation, organ retrieval has to start as soon as possible after death has been determined – preferably within the 60 minutes of hypotension (defined as a systolic pressure < 55 mm of Hg). Most countries utilize only controlled cardiac arrest as suitable organs and the practice is most developed in the United Kingdom, USA, Canada, Australia, Belgium and Holland. Countries like Spain, France and Italy in addition utilize uncontrolled DCD to achieve liver and renal donations.

One of the “close” relative donates a portion of the liver or one of the kidneys in live related donation. It initially began for pediatric patients and now used even for adults to adult organ donation.

Directions to improve deceased organ donation in India

Public awareness and involvement is the key to increase the rate of organ donation. It is necessary to involve society, NGOs, voluntary organization, religious leaders in this movement to encourage people to donate their organs. Success of eye donation campaigns using famous personalities spreading the message is a great example of that. We need to develop awareness strategy for general public keeping in view socio-psycho-cultural belief of society. In Tamil Nadu, who received the best state award in the area of cadaver organ donation, the state government has taken decisive steps to promote organ donation and transplantation, created patient-centric healthcare and green corridors to facilitate organ transfer and donation for the needy persons.

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