How can we Improve Organ How can we Improve Organ Procurement and Sharing? Procurement and Sharing?

Sunil ShroffSunil ShroffManaging TrusteeManaging Trustee

MMulti ulti OOrgan rgan HHarvesting arvesting AAid id NNetwork etwork

CHENNAI, HYDERABAD, PUNECHENNAI, HYDERABAD, PUNE

HOD & Prof. Dept of Urology & Renal TransplantationHOD & Prof. Dept of Urology & Renal Transplantation

Sri Ramachandra Medical College & Research Institute, ChennaiSri Ramachandra Medical College & Research Institute, Chennai

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In past decade approx. 1100 Cadaver transplants (mostly In past decade approx. 1100 Cadaver transplants (mostly

kidneys) have been performedkidneys) 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

TRIBULATIONS & TRIALS OF CADAVER TRANSPLANTS IN INDIATRIBULATIONS & TRIALS OF CADAVER TRANSPLANTS IN INDIA

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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

TRIBULATIONS & TRIALS OF CADAVER TRANSPLANTS IN INDIATRIBULATIONS & TRIALS OF CADAVER TRANSPLANTS IN INDIA

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Poor Conversion Rate of Brain Death PatientsPoor 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

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Some serious introspection required by -

• Transplant clinicians • Other Medical professionals• Government officials• State health departments• NGO’S • Law department

For Giving Momentum to Cadaver Programme

Cadaver transplant programme success can do away with the need for unrelated donations

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RELIGIOUS ISSUES –

Religious Heads

ETHICAL & MORAL ISSUES Philosophers

SOCIAL ISSUES –

Society & Social Scientists

DRUGS for immunosuppression – Pharmacist & Pharmaceuticals

MEDICAL ISSUES - Physicians

ORGAN REGENERATION -Basic Scientists

SURGICAL ISSUES - Surgeons

IMMUNOLOGICAL ISSUES –

Immunologist

Legal Issues –

Govt. & Lawyers

Media & Publicity – Newspapaers, Ad agencies. TV

The Complex World of Organ Donation & Transplantation

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N““ORGANS SHOULD BE TREATED LIKE NATIONAL ORGANS SHOULD BE TREATED LIKE NATIONAL RESOURCES AND NOT TO BE WASTED”RESOURCES AND NOT TO BE WASTED”

““ORGANS SHOULD BE TREATED LIKE NATIONAL ORGANS SHOULD BE TREATED LIKE NATIONAL RESOURCES AND NOT TO BE WASTED”RESOURCES AND NOT TO BE WASTED”

All State Governments should issue a Government Order to this All State Governments should issue a Government Order to this effecteffect

Mission Statement – INOS Group of MOHAN Foundation

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What is RequiredWhat 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

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NIndian Network for Organ Indian Network for Organ SharingSharing

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Country wide Networking of Hospital doing cadaver Country wide Networking of Hospital doing cadaver transplantstransplants

MOHAN (Multi Organ Harvesting Aid Network 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

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Indian Network for Organ SharingIndian Network for Organ Sharing C0NSTITUTION -C0NSTITUTION -

One Medical and Government Representative from each region or state on the committeeOne Representative from each of the NGO’sOrganisation independent of GovernmentOrganisation function purely as an independent body

MOHAN Foundation will work towards making it happen in the first 3 to 5 years

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RESPONSIBILITYRESPONSIBILITY

Have a common platforms for all organs

(Eyes , Kidneys, Liver, Heart, Lungs, Pancreas, Bone,

Cartilage, Skin ……)

Indian Network for Organ SharingIndian Network for Organ Sharing

MOHAN Foundation has written to Eye Bank of India to have some common

areas of expertise sharing

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Indian Network for Organ SharingIndian Network for Organ Sharing FUNCTIONS 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

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Indian Network for Organ SharingIndian Network for Organ Sharing

FUNDINGFUNDING

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 happenMOHAN Foundation can allocate initial funds to make it happen

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Centralised Organ Sharing RegistryCentralised 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

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Advantages of SharingAdvantages of Sharing

Organs not wastedOrgans not wasted

Good PR exercise for HospitalsGood PR exercise for Hospitals

Larger pool of Recipient. Hence patient gets the Larger pool of Recipient. Hence patient gets the best matched Organ with better long term resultsbest matched Organ with better long term results

Regular supply of organs Regular supply of organs

Protects the programme from scandals and legal Protects the programme from scandals and legal complications complications

Public and Govt. ApprovesPublic and Govt. Approves

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Advantages of SharingAdvantages of Sharing

At MOHAN Foundation in the last four years at least At MOHAN Foundation in the last four years at least Two medico-legal cases have been diffused –Two medico-legal cases have been diffused –

In one case husband accused hospital of making In one case husband accused hospital of making money by using wives organs, when he was told money by using wives organs, when he was told organ shared he didn’t proceedorgan shared he didn’t proceedIn another – A complaint lodged that a recipient had In another – A complaint lodged that a recipient had issued an appeal among his bank colleagues to issued an appeal among his bank colleagues to donate money to buy a kidney. However he had recd donate money to buy a kidney. However he had recd a cadaver organs from another hospital and no a cadaver organs from another hospital and no money had been charged for it hence case had no money had been charged for it hence case had no basisbasis

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NAIM• 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

COMPUTERISED ORGAN SHARING NETWORK OF MOHAN COMPUTERISED ORGAN SHARING NETWORK OF MOHAN

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What is RequiredWhat is Required

Indian Network for Organ Sharing – INOS

A Centralized Organ Donation and

Transplantation Network

Streamlining of Organ Donation ProcessStreamlining of Organ Donation Process

Co-ordinators Forum for Transplants

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How can we improve organ sharing?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

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Streamlining of THO ACTStreamlining of THO ACT

““Required request Law”- Make it compulsory for doctors or Required request Law”- Make it compulsory for doctors or medical social workers to ask for Organs in a Brain Dead medical social workers to ask for Organs in a Brain Dead Situation Situation

““Mandated Choice” During issue of Driving License for Mandated Choice” During issue of Driving License for organ donation organ donation

““De-link hospitals”. Hospitals should not require De-link hospitals”. Hospitals should not require certification for organ retrieval surgerycertification 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

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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.

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.

Pitfalls - THO ACT

Majority of Live kidney transplants patients in the country use this clause resulting in “ Legal Commercialization of kidneys”

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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

What is RequiredWhat is Required

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Improving Hospital PR skillsImproving 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

Has Current system done enough to encourage Has Current system done enough to encourage

charitable organ gifts!!charitable organ gifts!!

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Increasing organ donation ratesIncreasing organ donation ratesNon heart beating donors

Choice of some indirect benefits - to donor familiesCreating 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

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What is RequiredWhat is Required

Indian Network for Organ Sharing – INOS

A Centralized Organ Donation and

Transplantation Network

Streamlining of Organ Donation Process

Co-ordinators Forum for TransplantsCo-ordinators Forum for Transplants

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Transplant Co-ordinators ForumTransplant 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

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Improve “Conversion Rate”Improve “Conversion Rate”

Transplant coordinator in all Major ICU’s

Grief Counsellor’s in all Major ICU’s

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 ICU’s in 10 cities

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CONCLUSIONCONCLUSIONIn India, majority of cadaver organs are wasted and it is likely to be In India, majority of cadaver organs are wasted and it is likely to be

the same over the next few years.the same over the next few years.

Creation of a Centralized Organ Sharing Network to share organs - Creation of a Centralized Organ Sharing Network to share organs -

net-working can overcome problem of organ wastage net-working can overcome problem of organ wastage

MOHAN has taken the first step in trying to Network with other MOHAN has taken the first step in trying to Network with other

organization and have a web based software for Organ Sharingorganization and have a web based software for Organ Sharing

Some minor amendments and additions in THO Act required Some minor amendments and additions in THO Act required

Organ Donation can be streamlined without any cost to the GovtOrgan Donation can be streamlined without any cost to the Govt

A collective effort required to tackle the issues- NGO’s on their own A collective effort required to tackle the issues- NGO’s on their own

cannot make this happencannot make this happen

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THANK YOUTHANK YOUTHANK YOUTHANK YOU

Our Mission StatementOur Mission Statement““ORGANS WASTED ARE LIVES LOST” ORGANS WASTED ARE LIVES LOST”

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