E-Journal Dadhichi Deha Dan Samiti Vol. 32 : Organ donation: The silver lining of road accidents

Organ donation: The silver lining of road accidents

Dr. Smriti Sharma Bhatia
Assistant professor, Miranda House, University of Delhi-110007

There are millions of people in our country who suffer from end stage Liver or Kidney Disease or any organ failure and await their death helplessly, in a desperate need of an organ transplant. They die painfully and in vain as there is seldom any solution to procure an organ for them and save their lives. With advancement in medical sciences, human organ donation is fast developing into a major treatment protocol and is accepted as the best line of treatment for wide range of fatal diseases. Organ donation is the most rewarding medical care which has saved many lives. The rate of organ donation in India has increased from very low 0.05 per million population to 0.8 per million population in a span of few years. But still organ donation rates in India are minuscule compared to Croatia's 36.5, Spain's 35.3, and America's 26 per million, respectively. The vast difference between the demand for organs and their poor supply is the main issue of concern. Main reasons behind the lack of donors are:

Ignorance/ lack of knowledge about organ donation.
Myths and beliefs.
Lack of guidance in registering one’s wish to donate.

In India, about five lakh road accidents were reported in 2015, killing about 1.5 lakh people. As per World Health Organization (W.H.O.’s) first global status report on “ Road Safety”, our country witnesses over 1,30,000 deaths annually due to road traffic accidents and is number one in terms of the accidents worldwide. Often, such victims are declared ‘brain-dead’ where the brain loses all its function from the resulting trauma due to the accident. These individuals can save others by donating their functional organs, like eyes, kidneys, heart, lungs and liver. Thus, road accident is extremely tragic event but it has a silver lining. If the patient is declared brain dead, he or she can donate their organs.

Once removed from a donor, an organ is only viable for transplant for a few hours. Kidneys may last up to a day, while livers are limited six to 10 hours; hearts are good for perhaps four. To prevent rejection, a donated organ’s tissue antigens must be as closely matched to those of the patient as possible. But because organs can only stay viable outside the body for a few hours, the pool of recipients is limited to the geographical area around the donor. In practice, that means patients often receive organs that are not their ideal match immunologically. Ideally, the transplant of organs should be done as soon as possible from the brain dead certified patient with the beating heart taken care of in ICU setting on respiratory support system who had suffered roadside accident or brain stroke.

The problem of organ going to a suitable recipient is very important. Sometimes this doesnot happen because of geographical constraints. This is especially true in the cases of traffic accident deaths. Let’s say, for example, a patient donates a heart in Delhi. It might be the perfect immunological match for a patient in Kerala, but because of geographical constraints, that perfect heart might go to a less suitable transplant recipient in Chandigarh instead. The patient in Kerala might get a less-than-perfect heart from a donor in Tamilnadu. In the past, someone had to manually call each potential surgeon to see if they wanted a newly available donor organ. The first patient to receive an offer was always the one who had been waiting the longest, not necessarily the one best matched to the organ or the patient who needed it the most. But now we take the help of technology to expedite the process of matching donated organs to the patients who most need them.

In 1994, brainstem death was legalized in India. The Transplantation of Human Organs (THO) Act of 1994 and the subsequent amendments in 2011 and 2014 form the legislative foundation for brain death declaration and organ donation. The criteria for brainstem death declaration in our country is based on United Kingdom guidelines.

Figure 1: A protocolized and multisystem approach for organ donation

The possibility of organ donation basically means that the person is still technically alive, ie, primarily, his heart is beating and most of his organs are still functioning, but there is still some cause for us to say that he won’t be able to recover anymore. The part of our body which decides this recovery is the brain. The fact is that even if a person’s brain is not functioning anymore, we can still somehow sustain the rest of their body and keep their vital organs functioning for some more time. It is certainly not possible in all cases, but it is still theoretically possible, by means of administration of medicines, to keep the body alive for some more time. We have rules and criteria to decide for sure that a person’s brain is totally non-functional and will certainly not make any recovery anymore. These rules and criteria are set by the government agencies and all organ donation cases are of legal importance as well. Once we do those tests and confirm that the person’s brain is not functional anymore, we term the person as ‘brain dead’. Brain death means that the person’s brain is not functional anymore, but the rest of their body (few/some/all organs) are still functioning - Their heart is still beating and their vital organs are still functioning.

When an accident causes brain injury to a person, which cannot be treated anymore, doctors perform tests on the person to check whether there is any brain function left at all and after doing extensive tests and following protocols doctors certify brain death. After this relatives are informed and are explained about the procedure of organ donation. If the relatives are willing to go for it, many internal organs like the heart, lungs, kidneys, liver, pancreas, intestine, cornea and even skin and hands can be harvested and transplanted. Depending on the need for such organs, and also after testing how much they have undergone damage over time, if these organs are still viable and healthy enough, they are harvested and transplanted in those needing them.

There is need for effective legislation and improvement in infrastructure so that the organs from road accident victims can be harvested and can be used to help those who need them.Some changes at the policy level need to be made.

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