How can we Improve Organ Procurement and Sharing?

1
How can we Improve Organ Procurement and
Sharing? 

• Sunil Shroff
• Managing Trustee
• Multi Organ Harvesting Aid Network
• CHENNAI, HYDERABAD, PUNE
• HOD Prof. Dept of Urology Renal
  Transplantation
• Sri Ramachandra Medical College Research
  Institute, Chennai

2
TRIBULATIONS TRIALS OF CADAVER TRANSPLANTS IN
INDIA

• In past decade approx. 1100 Cadaver transplants
  (mostly kidneys) have been performed
• No lack of Brain Dead organ donors in any of
  the major hospital in our country
• Consent is often given for all organs but due to
  lack of proper infra-structural support system
  (like networking with different regions) only a
  couple of organs are utilised

3
TRIBULATIONS TRIALS OF CADAVER TRANSPLANTS IN
INDIA

• Main reason for failure of Transplantation of
  Human Organ Act is due
• to
• CONVERSION FAILURE of Brain Dead patients in
  the hospitals who actually become organ donors

Definition of Conversion failure FAILURE TO
CONVERT A POTENTIAL BRAIN DEAD ORGAN DONOR TO
ACTUAL ORGAN DONOR - IRRESPECTIVE OF THE CAUSE OF
THE FAILURE
4
Poor Conversion Rate of Brain Death Patients

• In Chennai with a population of over 6 million,
  there are on an average 400 to 500 Brain Deaths
  in a year. Of these only 25 to 30 (less than 10)
  go on to become actual organ donors.

At Ramachandra Hospital the conversion rate is
about 19 Brain Death Forms 1 to 2 of Total
Hospital Death
5
For Giving Momentum to Cadaver Programme

• Some serious introspection required by -
• Transplant clinicians
• Other Medical professionals
• Government officials
• State health departments
• NGOS
• Law department

Cadaver transplant programme success can do away
with the need for unrelated donations
6
The Complex World of Organ Donation
Transplantation
ETHICAL MORAL ISSUES Philosophers
IMMUNOLOGICAL ISSUES Immunologist
SOCIAL ISSUES Society Social Scientists
MEDICAL ISSUES - Physicians
SURGICAL ISSUES - Surgeons
Legal Issues Govt. Lawyers
ORGAN REGENERATION - Basic Scientists
RELIGIOUS ISSUES Religious Heads
Media Publicity Newspapaers, Ad agencies. TV
DRUGS for immunosuppression Pharmacist
Pharmaceuticals
7
Mission Statement INOS Group of MOHAN Foundation
ORGANS SHOULD BE TREATED LIKE NATIONAL
RESOURCES AND NOT TO BE WASTED
All State Governments should issue a Government
Order to this effect
8
What is Required

• Indian Network for Organ Sharing INOS
• A Centralized Organ Donation and
  Transplantation Network
• Streamlining of Organ Donation Process
• Co-ordinators Forum for Transplants

9
Indian Network for Organ Sharing
10
Country wide Networking of Hospital doing
cadaver transplants

• MOHAN (Multi Organ Harvesting Aid Network Tamil
  Nadu and Andhra Pradesh
• ZTCC- Maharastra
• ORBO Others in Delhi
• FORTE Bangalore
• SORT Cochin
• Ahembadabad

MOHAN Found has written to major hospitals from
different states to work closely together and
form affiliations with each other
11
Indian Network for Organ Sharing

• C0NSTITUTION -
• One Medical and Government Representative from
  each region or state on the committee
• One Representative from each of the NGOs
• Organisation independent of Government
• Organisation function purely as an independent
  body

MOHAN Foundation will work towards making it
happen in the first 3 to 5 years
12
Indian Network for Organ Sharing

• RESPONSIBILITY
• Have a common platforms for all organs
• (Eyes , Kidneys, Liver, Heart, Lungs,
  Pancreas, Bone, Cartilage, Skin )

MOHAN Foundation has written to Eye Bank of India
to have some common areas of expertise sharing
13
Indian Network for Organ Sharing

• FUNCTIONS
• Apex decision making body -
• devising organ sharing national criterias
• organ allocation
• standardising retrieval techniques,
• dialogues with government
• Meets once or twice in a year for a day or two
  (can club it with ISOT meeting dates)
• Work like a virtual network

14
Indian Network for Organ Sharing

• FUNDING
• Contributions from Each member organisation
• Project Grants
• Corporate and Public members can pledge money
  for this purpose

MOHAN Foundation can allocate initial funds to
make it happen
15
Centralised Organ Sharing Registry

• Creation of a centralized System to share
  information - first step to share organs
• MOHAN Foundation has fine-tuned a web based
  software for Solid Organ sharing in Tamil Nadu

16
Advantages of Sharing

• Organs not wasted
• Good PR exercise for Hospitals
• Larger pool of Recipient. Hence patient gets the
  best matched Organ with better long term results
• Regular supply of organs
• Protects the programme from scandals and legal
  complications
• Public and Govt. Approves

17
Advantages of Sharing

• At MOHAN Foundation in the last four years at
  least
• Two medico-legal cases have been diffused
• In one case husband accused hospital of making
  money by using wives organs, when he was told
  organ shared he didnt proceed
• In another A complaint lodged that a recipient
  had issued an appeal among his bank colleagues to
  donate money to buy a kidney. However he had recd
  a cadaver organs from another hospital and no
  money had been charged for it hence case had no
  basis

18
COMPUTERISED ORGAN SHARING NETWORK OF MOHAN

• AIM
• Donated Organs should be treated as national
  health resource and no organ should be wasted.
• Organ sharing Network may help in curbing this
  wastage
• From 1995 2001 - 166 solid organs wasted

19
What is Required

• Indian Network for Organ Sharing INOS
• A Centralized Organ Donation and
  Transplantation Network
• Streamlining of Organ Donation Process
• Co-ordinators Forum for Transplants

20
How can we improve organ sharing? 

• Centralized Registry of Recipients for all organs
  to help in a Countrywide Networking of Hospital
  doing cadaver transplants
• Streamlining of Organ Donation Process
• Strong Co-ordinators Forum

Better Integration among various Groups promoting
Cadaver Transplants in the Country
21
Streamlining of THO ACT

• Required request Law- Make it compulsory for
  doctors or medical social workers to ask for
  Organs in a Brain Dead Situation
• Mandated Choice During issue of Driving License
  for organ donation
• De-link hospitals. Hospitals should not require
  certification for organ retrieval surgery

Indian Transplant Newsletter Issue 11 of Feb 2002
had a Postcard that doctors could fill to
recommend these inclusions to the Govt of India
22
Pitfalls - THO ACT

• Donors
• Scrapping of Sub Clause (3) , Clause 9 of Chapter
  II
• If any donor authorizes the removal of any of his
  human organs before his death under sub-section
  (1) of section 3 for transplantation into the
  body of such recipient, not being a near relative
  as is specified by the donor, by reason of
  affection or attachment towards the recipient or
  for any other special reasons, such human organ
  shall not be removed and transplanted without the
  prior approval of the Authorization Committee.

Majority of Live kidney transplants patients in
the country use this clause resulting in Legal
Commercialization of kidneys
23
What is Required

• NGO or Groups involved in Organ donation in any
  part of the country have to tackle various issues
  in the field of organ donation and
  transplantation simultaneously
• More Support groups in the Country with common
  objectives are needed
• More visibility - Goodness in the cause of organ
  donation in Media rather than Organ scandals
  needed
• Project success stories of Multi-organ donation
  and transplantation in media to neutralise the
  adverse publicity that keeps coming up
• More resources necessary to Kick start such an
  Initiative

24
Has Current system done enough to encourage
charitable organ gifts!!

• Improving Hospital PR skills - experiences of
  families contribute significantly to decision of
  donating or not.
• Families that opt not to donate also tend to be
  less satisfied with the quality of care received
  while in the hospital and also have a poor
  understanding of brain death

25
Increasing organ donation rates

• Non heart beating donors
• Choice of some indirect benefits - to donor
  families
• Creating Synergy - Higher success when intensive
  care unit and organ procurement organization
  staff work together
• Donating to third party - In situations where
  family member wiling but no match. Make an
  exchange donation to a third party who is in
  similar situation

26
What is Required

• Indian Network for Organ Sharing INOS
• A Centralized Organ Donation and
  Transplantation Network
• Streamlining of Organ Donation Process
• Co-ordinators Forum for Transplants

27
Transplant Co-ordinators Forum

• At present less than 12 to 15 fully or partly
  Trained Transplant co-ordinators in the country
• Decision taken at the 24th INOS meet to help in
  starting such a forum under the Foundation and if
  necessary this group can attain Independent
  status in future
• Two meeting of the Forum has been held
• Mrs.Lalitha Raghuram made in charge of the Forum

28
Improve Conversion Rate

• Transplant coordinator in all Major ICUs
• Grief Counsellors in all Major ICUs
• Counselling for all organs essential

MOHAN Foundation has been granted 100 Tax
exemption from Govt of India for donation to
implement round the clock counselling by social
workers or Transplant Co-ordinators in ICUs in
10 cities
29
(No Transcript)
30
CONCLUSION

• In India, majority of cadaver organs are wasted
  and it is likely to be the same over the next few
  years.
• Creation of a Centralized Organ Sharing Network
  to share organs - net-working can overcome
  problem of organ wastage
• MOHAN has taken the first step in trying to
  Network with other organization and have a web
  based software for Organ Sharing
• Some minor amendments and additions in THO Act
  required
• Organ Donation can be streamlined without any
  cost to the Govt
• A collective effort required to tackle the
  issues- NGOs on their own cannot make this happen

31
Our Mission Statement ORGANS WASTED ARE LIVES
LOST
This presentation has been created using 100
recycled electrons!! Recycle yourself and
become an organ donor
THANK YOU