Who's afraid of Cadaver transplants?

Care 360

Cadaver transplants, the one surefire way to save thousands of lives, is in its deathbed in the State. It can’t be anything than that, because in the 14 years since the Human Organ Transplant Act 1994 was implemented, the State has only 11 such transplant cases to show!  When scores of patients die due to organ failure, can we afford to let brain-dead patients die with all their organs intact? 

Despite the pathetically low level of awareness on transplants, at least 310 patients have registered with the Zonal Coordination Committee of Karnataka for Transplantation (ZCCK) for organs. The actual numbers are much more, and could balloon if the State Government were a bit more proactive in its awareness campaign.

While a majority of doctors cite lack of awareness, religious belief is another hurdle in cadaver transplants. As Dr Satish Babu, a neurosurgeon from Sanjay Gandhi Accident Hospital and Research Institute, puts it, "Many relatives feel if the organs are taken out, the deceased would not go to heaven and their journey will remain incomplete.”
Kidney and other organ transplant rackets have fostered another kind of scepticism. Every time an organ transplant racket is busted by the police, the Cadaver transplant programme is taken back by 10 years.

But even if the family agrees for organ donation, getting clearance from the police department becomes a tedious job as it becomes a medico-legal case. As Dr Satish Babu contends, “A majority are road accident victims between the age group of 25 to 45 years - ideal for Cadaver transplant. However, we can't do anything because they become medico-legal cases.”

“Brain-dead” the key issue 

Only if a patient is declared “brain dead” can his organs be retrieved. But that has proved to be a very dicey decision. ZCCK guidelines mandate that a team of four doctors including a neuro-surgeon / neuro-physician, the treating doctor; a specialist approved by the State Appropriate Authority and the Medical Superintendent of the hospital should decide if the patient is brain-dead or not.

After a preliminary examination by each doctor, the team re-examines the patient after six hours before retrieving the organs. But relatives of the brain-dead patient do not wait.  “Once they know that their relative is brain-dead, they are in a hurry to perform the last rites as quickly as possible," says Dr Sikora from Manipal Hospital.

According to ZCCK Transplant Coordinator Jency Antony, patients’ relatives generally look for live donors. “Many recipients’ families are unaware about cadaver transplants, and end up waiting for a long time, making the patient medical case more complicated.”
Brain-dead cases are mostly reported after road accidents, where victims are rushed to hospitals in a critical state. The victim’s family is in a state of shock. "Every hospital should have a grief counsellor, who talks to the family of the brain dead patient. But many hospitals don't have one," says MVN Raj from the Bangalore Kidney Foundation (BKF).

 Raj recalls an episode where a person wished to donate all his organs. But when he died, he was taken to Victoria Hospital where only his eyes were retrieved. The hospital wasn't equipped to harvest other organs.

"There are more than 1,000 accident deaths in a year but hardly any get used. So, the idea of Cadaver transplant looks good on paper but doesn't happen practically," he laments.

Neurosurgeons and intensivists who handle ICU cases and certify patients brain-dead also suffer from lack of awareness. "There is a lack of motivation amongst Intensivists. They are the ones who constantly deal with brain dead patients. Most are reluctant because they either feel it's not their job or they do not want to get into unnecessary hassles,” laments Dr PV Rao, who conducted such cadaver transplants at the Narayana Hrudayalaya.

Five cadaver transplants were performed at this hospital since 1995. Four such  transplants were conducted at the Columbia Asia hospital this year. But only two of the 1,568 kidney transplants conducted by the hospital’s Karnataka Nephrology and Transplant Institute, were cadaver.

Obviously, these numbers are too few and far between. As Dr Rao informs, “At least 40 patients are awaiting heart transplants in our hospital since six months. They will not survive for more than two years if they don't get a donor.”

Now, that remark echoes the scenario in hundreds of hospitals across the State. Cadaver transplants surely require a fresh breath of life!

So, have you pledged your organs yet?

Do you wish to save many lives by pledging your organs? If you aren’t bogged down by social and religious mores, here’s a ready reckoner to make that life-changing decision to donate the organs. Read on, make sure to take your family’s consent before taking the big step.

The procedure is simple. First, inform your family that you wish to donate all your vital organs in the event of you being declared brain-dead or dead. Taking the family into confidence is crucial because they would have to make the key decision before the organs are retrieved.

To pledge your organs, contact Zonal Coordination Committee of Karnataka (ZCCK), No. A1, Neuro-Science Faculty Block, NIMHANS, Hosur Road, Bangalore 560 029. Phone: [phone] or mail [e-mail]. Your could also visit the ZCCK website (www.zcck.in). Patients in need of the organs could also register with ZCCK.

Transplant procedure, simplified

*  The hospital, where the brain-dead patient is admitted, alerts ZCCK and provides all the necessary medical details of the patient.
*  Counselors attached to the hospital or ZCCK informed the patient's family about the imminent organ transplant, and take their formal consent for the retrieval. The patient’s vital organs are kept working under ventilators, during this process.
*  If the donor is an accident victim, then a No Objection Certificate (NOC) will have to be obtained from the police department
*  Once the relatives of the patient agree for the organ retrieval, the suitable recipient and relatives are alerted. The organ recipient is asked to get admitted at the hospital.
*  Meanwhile, the organs are retrieved from the donor. The organs are harvested, if they need to be taken to another place.
*  The harvested organ is then transplanted to the recipient’s body.

Send your suggestions and views to [e-mail]