New Delhi: Zainab Husain was 5-years-old when she was diagnosed with End Stage Renal Disease. Her parents were informed that dialysis would help them temporarily, but the only permanent solution was a kidney transplant. Months later, Zainab received a kidney from a child who had just died. For Zainab, it was almost like an ‘angel’ had given her a new lease of life.
In another part of the country, 20-year-old Anmol Juneja met with a fatal road accident. When he was declared brain dead with no chance of survival, his grieving father took the tough call to donate his organs. His kidneys, liver, bones, eyes and skin gave 34 people a new beginning. Both Zainab and Anmol are two sides to the same coin. One gave life in his death, and one got the gift of life from the death of a stranger.
The decision to donate organs is a life-saving one helping people in dire need of transplants. These people are hanging by threads of hope – the hope of a new organ; the hope of living a wholesome life; the hope of not dying.
Their wait and the shortage of organs can only be closed by urging more people to take up organ donation and spreading more awareness about the cause. However, just that is not enough.
“Convincing people to donate has never been our biggest challenge”, says Dr. Sunil Shroff, the Founder of MOHAN Foundation, an NGO that works to promote organ donation. “Six out of ten families we or our transplant coordinators speak with agree to donate organs. Even an illiterate person, when explained about the goodness of the cause, and given enough time to get over their grief usually agrees to donate. The biggest challenge is identification and certification of brain-death, and maintaining brain-dead patients in hospitals.” A brain-dead patient can be kept artificially alive for anything from a few hours to a couple of days.
Then there is the issue of surrounding the idea brain-death itself. On one hand, doctors need to be adequately trained to diagnose brain death on time, while on the other hand, grieving families need to be counselled about it too. “When the heart is beating, and vitals are stable, it’s very difficult for the family to believe that the patient is no more. Many-a-times, they confuse brain death with coma and hope for the patient to revive consciousness”, says Mukesh Kumar, Transplant Coordinator at Organ Retrieval Banking Organisation (ORBO), AIIMS, New Delhi.
The clock starts ticking once the patient has been diagnosed with brain death and the family has agreed to donate organs, because their quality progressively deteriorates. The hospitals need to match the donor’s organs with potential recipients and allocate them accordingly.
All of this needs to be done on a tight schedule, keeping in mind that a grieving family is waiting to perform the last rites of the deceased. In the case of a multi-organ retrieval, the surgery lasts for 3-4 hours.
“In the case of a multi-organ donor, about 30 teams need to be mobilised with an hour for the transplant”, says Dr. Aarti Vij, Faculty Incharge, Organ Retrieval Banking Organization (ORBO), All India Institute of Medical Sciences, New Delhi. “It involves heart, kidney, liver, skin, bones, pancreas, skin, and eyes’ transplant teams; people at blood banks and operation theatres need to put into action as well.” If the organs need to be transported to another hospital in the same city, or to some other city or state, then the police need to be alerted to create green corridors.
Because brain-dead patients are more often than not medico-legal cases like road accidents, injuries or falls, it is mandatory to conduct a post-mortem too, which can take up to one-and-a-half hours. “Families are anxious about the time it takes, especially if the harvesting finishes in the middle of the night and they have to wait for the post-mortem to be performed in the morning”, says Dr Aarti. Many times families are also apprehensive about several incisions being made.
Organ Donation: Need of the Hour
From believing that their religion doesn’t permit it, to fearing mutilation of the body, to being afraid of getting into some organ donation scam, to assuming that the transplantation cost will have to borne by the donor’s family, people have myriads of reasons to opt-out of donating organs. But all of us must collectively work toward enabling a friendlier environment for organ donation.
There are three crucial aspects that can push for organ donation, says Dr Avnish Seth, Director, of Gastroenterology at FMRI. People need to actively promote the cause, the government must take initiative, which it has by setting up the National Organ and Tissue Transplant Organisation (NOTTO) and introducing new rules and laws in 2014. Most crucially, he feels, the infrastructure needs to be strengthened.
Dr Aarti agrees and says that infrastructure and capacity-building facilities need to be improved upon. “We need more no. of trained transplant surgeons and certified transplant centres. People in small cities and towns have no access to transplant facilities. They need to travel to metropolitan cities for the same”, she adds.
Earlier this week, Union Health Minister JP Nadda too stressed on the need for more trauma centre units and ICU facilities to be linked with hospitals having transplantation facilities as they are both potential retrieval centres. He reiterated the government’s commitment towards strengthening the organ donation program in the country.