Organ Transplantation- The What Why When and More….
~ Anish Shyadligeri,Goa Medical College.
Ten minutes is a very short amount of time. In 10 minutes, you would possibly go for a run, pick up a book that might potentially change your life, or break a Guinness record, And yes you could also make yourself a hot bowl of Maggie. (Trust me. It ALWAYS takes longer than 2 minutes.)
In fact, you’ll probably be done reading this within the next 10 minutes.
In those same 10 minutes, someone within the country will be added to the transplant waiting list.
So in The Next 10 Minutes, you are going to be learning everything that you need to know about Organ Transplantation. Let’s get started?
WHAT is Organ Donation/Transplantation all about?
Organ transplantation is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or dysfunctional organ, thus restoring its original functionality. The donor and recipient may be at the same location, or organs may be transported from a donor site to another location. Transplant is the final medical resort in cases of organ failure and is undertaken only in critical cases, when medication falls short of making a difference in lifestyle or lifespan of the patient. A healthy organ/organs from a person- living or deceased when transplanted into the recipient, drastically improves the quality of life of the patient providing them a new lease of life.
Organ transplant donation helps people suffering from chronic illnesses to live a more fulfilled life and a healthier one up to an average lifespan. Organ transplantation could also be required in cases of genetic organ defects such as congenital heart defects or polycystic kidney disease. Chronic or acquired conditions such as diabetes or physical injuries can also be reasons for the requirement of organ transplant surgery. The National Organ and Tissue Transplant Organization (NOTTO) is a National level organization set up under Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India. NOTTO functions as apex center for All India activities of coordination and networking for procurement and distribution of Organs and Tissues and registry of Organs and Tissues Donation and Transplantation in the country, with the objectives to facilitate Organ Transplantation in the safest way in shortest possible time and to collect data to develop and publish a National registry
As per latest available NOTTO records, India saw around 10,340 organ transplantation procedures in the year 2018. Kidney transplantation was most common with 7936 procedures, followed by Liver-1945, Heart-241, Lung-191, Pancreas-25, Small Bowel-2.
WHY do we need Organ transplants?
The human body is an incredible machine.
The Heart, It beats about 101-thousand times each day, about 3-billion times in a lifetime and over that time it’ll pump 800-million pints of blood. Your Lungs on the other hand help you breathe about 23-thousand times a day.
The various Organ systems in our Body come together to work in perfect harmony in order to sustain what we call “Life”. Each Cell, tissue, organ and Organ System has its own role to play.It is impossible to survive and to live a good quality of life without each of our Organs.
It’s amazing how efficiently our body works and when some things break down it has the ability to fix itself. However in cases where the organs are not healthy anymore and their functioning has deteriorated to such an extent that normal homeostasis cannot be maintained,the life of an individual may be at risk. Despite great advances in medical science we are yet to produce devices that can replicate the functioning of a natural organ with the same efficacy.
That’s where an organ transplant comes into play. To prevent the death of a patient when a critical organ in the body is functioning very poorly, and may ultimately fail and cause mortality, doctors will suggest organ transplantation as an end stage measure, after determining the suitability of such a procedure on the patient.
Transplantation medicine is one of the most challenging and complex areas of modern medicine. Some of the key areas for medical management are the problems of transplant rejection, during which the body has an immune response to the transplanted organ, possibly leading to transplant failure and the need to immediately remove the organ from the recipient.
What are the types of transplant?
Many people think of heart, lung, and kidney transplants when they think of organ donation, but there are a number of organs and tissues that can be donated:
- Organs such as the kidneys, liver, lungs, heart, pancreas, and intestines
- Corneas (the outermost layer of your eyes)
- Tissues such as heart valves, skin, bone, and tendons
- Blood stem cells, cord blood, and bone marrow
- Blood and platelets
1. Heart transplant
The recipient is provided a healthy heart from a donor who has suffered brain death, often in the case of an accident. The donor’s healthy heart replaces the recipient’s damaged or diseased heart and offers them a completely new one to afford them a chance at an extended life.
2. Lung transplant
One lung or both lungs from a recently deceased donor are used to replace a patient’s diseased lung or lungs. Due to the dearth of donors and the criticality of transportation time, lung transplants also remain rare across the globe.
In cases of irreversible liver disease, a patient’s unhealthy liver is removed and replaced with either a portion of a liver from a living donor, such as a relative, or with a complete healthy liver from a deceased donor. End-stage liver disease, especially cirrhosis of the liver due to alcohol abuse, is the most common reason for organ transplant surgery for the liver. The organ transplant success rate for liver transplants is relatively high, and 75% of patients are alive after five years of a liver transplant.
Kidney and pancreas double transplant is the most common type of organ transplant surgery requiring a pancreas transplant; it is seldom carried out alone. Type 1 diabetes causing kidney failure is the reason for this type of organ transplant surgery, and in most cases, both organs come from a single deceased donor. It is possible, however, that in the kidney-pancreas double transplant, the kidney comes from a living donor, usually a relative, and only the pancreas from a deceased donor. The transplanted pancreas can help produce adequate insulin in patients previously suffering from Type 1 Diabetes. Thus providing relief from chronic Diabetes Mellitus and its associated damage on other organs.
In cases where corneal tissue is scarred or otherwise irreparably damaged due to disease or injury, a corneal transplant is suggested. The organ transplant statistics for this type of organ transplant surgery shows a high rate of success and this is one of the more commonly performed organ transplantations. Since corneal eye disease is one of the most common reasons for blindness, corneal transplants are becoming more commonly suggested, and the advances in this organ transplant type has been immense from a surgical perspective.
Renal disease affects a large part of the population today. Kidneys are an essential part of the human mechanism, helping to filter out toxins from the blood, and ensuring an electrolyte balance that allows the body to function normally. Kidney failure can be contained by either dialysis or kidney transplants. In cases where dialysis is ruled out for the patient due to the severity of the kidney failure or overall health conditions, an organ transplant surgery proves to be a miraculous blessing. Either one, or both kidneys may be replaced for such patients. Patients with cancer, hepatitis or cardiovascular disease are not chosen as candidates for most organ transplant processes, including kidney transplant.
Receiving a kidney from a living relative reduces the chance of rejection of the organ and is suggested as a better choice of organ transplant. This also enables the patient to bypass the wait of many years to receive the organ transplant.
One of the least conducted organ transplant surgeries, tracheal transplant is performed when the trachea or the airway hardens or is scarred due to disease or injury. Tracheal transplant helps patients who are unable to have a normal life due to trauma from tracheal dysfunction to have a more normal life. The trachea is procured from a deceased donor and transplanted to the recipient.
Burn or other skin injuries that are too severe to be repaired by the body’s own system can be helped through skin transplants. This type of organ transplantation involves grafting of donor skin onto a patient’s body and the use of immunosuppressive drugs to prevent graft rejection.More often, however, organ transplantation involving the skin does not require a donor, and healthy skin is grafted from the patient’s own body onto the burnt area. The injured skin can be more easily replaced as chances of rejection of the organ transplant is lowered.The donor Skin is used only in cases of severe injury where a patient’s own skin cannot be grafted.
Who Can Donate?
A.Living Donor Transplant
Living donation takes place when a living person donates an organ (or part of an organ) for transplantation to another person. The living donor can be a family member, such as a parent, child, brother or sister, grandparent or grandchild (living related donation). It can also come from someone who is emotionally related to the recipient, such as a good friend, a relative, a neighbor or an in-law (living unrelated donation).
The process typically involves extensive testing before the donation, including psychological evaluation to find out whether the would-be donor understands and consents to the donation. A transplant may take place only after the donor’s medical compatibility with the recipient is confirmed by a doctor. After organ retrieval has taken place, the donor will need to stay under medical care for a few days.
It may be noted that a living donor may only donate a limited list of organs and tissues such as a single kidney, part of liver/pancreas etc.
B.Deceased Donor Transplant
While death takes you away, your organs can stay and save another life.The need for organ donors has never been greater. More than half a million Indians are estimated to be in dire need of an organ transplant.Some of these people will find a donor who will donate an organ to them. The remainder will probably die waiting for an organ. Experts believe that India’s organ deficiency is mainly due to the fact that families are still not considering organ donation owing to various misconceptions or ignorance, although organ donations are legal by Indian law.
Any Individual (usually upto the age of 90) regardless of gender, race, ethnicity can be a potential donor.There are two ways to donate organs:
1. By pledging for organ donation when a person is alive.
2. By consent of family after death.
One organ donor can up donate up to twenty five different organs and tissues for transplantation. This can save up to nine lives!
During a lifetime, a person can pledge for organ donation by filling up a donor form and registering themselves with the National Organ and Tissue Transplant Organization (NOTTO) or the State/Regional Organ and Tissue Transplant Organization (SOTTO/ROTTO). Upon Registration you will receive a donor card with an Unique ID Number which expresses your will to donate some/all of your organs upon death.
However it is to be noted that the Donor card does not carry any legal weight. Registration is merely an expression of intent. By Indian law-upon brain death, organ and tissue donation cannot take place without the written consent of the next of kin.
Thus it is advisable that upon registration you talk to your family about your desire to donate your organs,helping them take an informed decision if the need arises in future.