New lease of life with organ transplant

Dr Noble Gratious | 28-December-2013

Detailed News

Organ transplants, especially heart, liver and lungs, are not so common in India at present but the advantages of this treatment  are steadily gaining ground in the country with more patients and donors- both live and deceased- coming in favour of this medical facility. People need not worry about organ failures in the future as surgeons could be able to replace it with new ones without much pain. Here, Future Medicine takes a look at the current status of this treatment and its possibilities in our society              

By Dr Noble Gratious

Organs and tissue transplant can happen in three situations. First and foremost is live donation which means a healthy person can donate blood, bone marrow, one kidney and a portion of the liver. Other organs like heart, pancreas, lungs and eyes are taken from dead donors, more specifically brain dead. Cornea and skin can be taken even after death, but as early as possible. The tissues which can be stored and used later are cornea, heart valves, blood vessels etc. At present, there are no solid organ banks as many people think. 


In brain death situations there is a hope for organ donation.Brain death usually results from a severe brain injury or brain haemorrhage. This can happen after a major road accident or a bleeding in the brain due to stroke. In brain death, there is no possibility of recovery and the patient is clinically and legally dead.

 

Legal aspects


Four doctors should sign the legal certificate. They include the medical practitioner in charge of the hospital, a medical practitioner and a neurologist nominated by the hospital and approved by the appropriate government authority, and the medical practitioner treating the patient.

 

Organ retrieval


The first degree relatives of the brain dead patient have to give the consent for organ retrieval in the presence of two witnesses in the prescribed form. In India, we practise a system called ‘required request’. We have to ask for the consent of the relatives (legal possessor of the body) to retrieve organs for transplantation even if they have signed Form 5 (donor card).

  

The organs have to be retrieved soon after the second brain death declaration because after brain death, somatic death (cardiac arrest) can occur at any time making retrieval of organs impossible. The process may take between 3-9 hours. The hospital takes care of all the logistics and the transplant coordination team carries out the entire process till the relatives receive the body of the deceased. The body is given back to the family in a dignified way. There is no disfigurement. The body can be viewed as in any case of death and funeral arrangements need not be delayed or changed.

 

Live transplant


One kidney and a portion of liver can be donated when the person is alive. The live related and live unrelated are the two options. Unrelated donations can happen only after the documents verification and approval by the authorisation committee nominated by the government. Organ donation is the most wonderful legacy you can leave behind.

 

Mrithasanjeeavani

For promoting deceased organ donation in Kerala, the government launched Mrithasanjeeavani which maintains a list of patients in need of organs and selects them according to the severity of their disease and availability of organs.            

 

Activities


For proper maintenance of the waiting list and to ensure unbiased, equitable distribution of harvested organs, a web portal is launched.

www.knos.org.in.

Ph: 0471 2528386

Successful transplants

  • 1823: First skin autograft-transplantation of skin tissue from one location on an individual’s body to another location (Germany)
  • 1905: First successful cornea transplant by Eduard Zirm (Czech Republic)
  • 1908: First skin allograft-transplantation of skin from a donor to a recipient (Switzerland)
  • 1950: First successful kidney transplant by Dr Richard H Lawler (Chicago, US)
  • 1954: First living related kidney transplant (identical twins) (US)
  • 1955: First heart valve allograft into descending aorta (Canada)
  • 1962: First kidney transplant from a deceased donor (US)
  • 1966: First successful pancreas transplant by Richard Lillehei and William Kelly (US)
  • 1967: First successful liver transplant by Thomas Starzl (US)
  • 1967: First successful heart transplant by Christian Barnard (Cape Town, South Africa)
  • 1981: First successful heart/lung transplant by Bruce Reitz ( US)
  • 1983: First successful lung lobe transplant by Joel Cooper  Canada)
  • 1984: First successful double organ transplant by Thomas Starzl and Henry T Bahnson (US)
  • 1986: First successful double-lung transplant (Ann Harrison) by Joel Cooper ,Canada)
  • 1995: First successful laparoscopic live-donor nephrectomy by Lloyd Ratner and Louis Kavoussi (US)
  • 1998: First successful live-donor partial pancreas transplant by David Sutherland (US)
  • 1998: First successful hand transplant by Dr. Jean-Michel Dubernard (France)
  • 1999: First successful tissue engineered bladder transplanted by Anthony Atala (US)
  • 2005: First successful ovarian transplant by Dr PN Mhatre (Wadia Hospital, Mumbai, India)
  • 2010: First full facial transplant by Dr Joan Pere Barret and team in Barcelona, Spain
  • 2011: First double leg transplant by Dr Cavadas and team (Spain)
  • 2013: First successful entire face transplantation as an urgent life-saving surgery at Maria Skłodowska-Curie Institute of Oncology branch in Gliwice, Poland.

 

(The writer is a Nodal Officer, Mrithasanjeeavani, Kerala Network for Organ Sharing, and Assistant Professor, Thiruvananthapuram Medical College)

      

 

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