To be? Or Not to be?
By: Taj Prabhugaunker, GMC-Goa
“We tried our best but we have lost him, I am sorry”.
A meer ferocious whisper, dreaded by every kin of the ailing patient lying on the death bed. While their green-clad saviour lays the weight of this void onto their tired shoulders, it seems unfathomable to take in.
“Oh, he was so young. Gone too soon”, does further worsen the fresh wound.
As the bitter truth takes a while to make peace with his loved ones and there comes a dilemma. A choice to let the vital body die with his bygone soul or the possibility of his body saving multiple lives – Organ Donation.
Organ Donation: A breathtaking wonder when one decides to give an organ to save or transform the life of someone else. A concept often sparsely touched upon during the curriculum of MBBS in most institutes, would surely be a pioneer in the medicine of my dreams.
Broadly of 2 types:
- Living organ donation: when an organ retrieved from a healthy living person is transplanted into a patient suffering from the end-stage disease of the said organ. Eg: liver or kidney (has the ability to regrow)
- Cadaveric organ donation: when one pledges their organs to be retrieved for transplantation when he/she is declared brain stem dead by a team of authorised doctors in a hospital. Eg: cornea, heart.
While the former is commonly practised since the donors mostly comprise near/distant relatives or friends of the patient, the practice of the latter is seemingly the elephant in the room: resulting in a major dearth of donors and exponentially increasing waiting lists of the recipients.
Hence, counselling the kin becomes a precarious situation for the doctor owing to the sensitivity of the circumstances. And yet there are certain measures that could aid in efficiently bringing them on board with dignity and empathy.
- Eliminate the misconception that the organs of any cadaver / dead body can be harvested for transplantation.
Fact: cadaveric donors are only those who are declared brain stem dead. And organ harvesting needs to be done within a specific time limit for the organ to render viable.
- Explain the urgency of the situation
Fact: The Best results are obtained if the organs are salvaged while the circulation is present or immediately after the cessation of circulation.
| The organ | Time period within which the viable organ should be harvested after Brain death |
| Cornea | 6 hours |
| Skin | 24 hours |
| Bone | 48 hours |
| Blood vessels | 72 hours |
| Kidneys | 45 minutes |
| Heart | 1-hour |
| Lungs & liver. | 15 minutes. |
- Explain the repercussions and importance of consent of the family and kin (for cadaveric organ donation) even after the donor has pledged the organs. A single decision can make or break multiple lives.
- Can a person without a family pledge for organ donation?
Fact: Yes, one can pledge, but they would be required to inform a person closest to them in life, about their decision of pledging. As, during the brain stem death, the attending healthcare professionals will need to consult this person to obtain consent for the same.
- Educate regarding the age bar for cadaveric organ donation for normal and viable organs, when the potential donors are cleared to donate after running certain screening tests (with the knowledge of the kin) for transmissible diseases.
| Organ | Age Bar for cadaveric donation |
| Kidneys, liver | Upto 70 years |
| Heart, lung | Upto 50 years |
| Pancreas, intestine | Upto 60-65 years |
| Corneas, skin | Upto 100 years |
| Heart valves | Upto 50 years |
| Bone | Upto 70 years |
- Inculcating the theoretical and practical knowledge regarding organ donation from the UG MBBS curriculum onwards through DOAP* sessions and peer-to-peer awareness campaigns of the available facilities of organ donation and transplantation should be propagated.
- Spread awareness on the various government and non-governmental authorised websites that provide information on organ donation and portals for registrations.
- notto.gov.in
- Sotto.nic.in
With the ball in our court, ethically sensitizing society about organ donation would definitely pave the way to affirmative action and response. To cancel the dilemma, to answer the question, to be? Or not to be?
*DOAP = Demonstration-Observation-Assistance-Performance
Resources:
- notto.gov.in
- sotto.nic.in
- Review of forensic medicine and toxicology 5th edition by Gautam Biswas.
