Janice Rodrigues| NT BUZZ
Saving lives is an act that is generally attributed to a medical doctor, but in the context of organ donation, every single person can be a part in this very humane act. Saving or improving the condition of another person’s life can be done by you and me, by pledging to be an organ donor.
“Organ transplant is a miracle of the 20th century. First 50 years, 1900 to 1950 it required a lot of surgical innovations of how to do the transplant. In 1954, the first transplant happened in Boston between identical twins, since then till today there is not much change in surgical technique as it is a standard surgery, established across the world. The advancement has taken in the form of medicines so we can do transplants beyond twins and other relations, though the major blood groups have to be respected,” says Amol Mahaldar, consultant nephrologist of the Manipal Hospital-Goa who is hosting a talk to create awareness about organ donation.
There are two types of donations that can happen—living and cadaver (dead). Living transplants are possible for kidney and liver, the other organs need to be harvested within a stipulated time frame. In the wider context, almost every organ from the heart, to the liver and kidney even skin can be donated. However, narrowing it down to our geographical location, in Goa there are currently donation of only two organs possible – kidney and eyes.
Kidney transplants in the state are restricted to that of family members, or in certain rare cases altruistic donations are also given sanction. “Living donations are governed by a committee with health secretary as the chairman and the board consists of 14 other members,” says Mahaldar further stating that this board minutely scrutinise the case so as to negate any presence of monetary transaction. Therefore preference is given to parents, siblings or spouses.
Living donations, although very good is very limited for various reasons. “We have a burgeoning number of people who are on dialysis, because of diabetes and the increasing life expectancy. Two hundred and thirty people every year suffer from kidney failure, and a thousand or two who are on dialysis. As against this only 4 to 5 transplants are being done every year. In Goa, we have small families, and thus the number of donors in a family is very small. Secondly the advancing marriage age, thus if a young person suffers from kidney failure, his parents are unable to give the kidney for their advanced ages.
This coupled with lack of awareness, emotional stress where family issues crop up do affect the number of living donations that happen. Thus the way forward is cadaver (recently dead or brain dead) donations.”
While kidney transplants are taking place on a slow but steady pace, that of eye or cornea transplants are not seeing a bright picture even though the Rotary Eye Bank of Goa has been functional for the past eight years and operational at Goa Medical College, Bambolim. “Eye donation is very much possible in Goa but numbers are small. Almost every person who dies is a candidate to donate eyes and thus help a large number of blind people with corneal blindness,” says Mahaldar.
The brainchild of eye bank, Vijay Priolkar, the then president of the Rotary Club, Panaji, who continues to chair the bank, the Rotary Eye Bank was set up in 2008, with all the clearances and permissions required under the organ donation act. “Initially we put it up in Vrindhavan Hospital but later they found it not viable so we had to shift it to GMC, who by then were looking forward to doing transplants by surgeon Mansi Prabhudesai. We had a MoU with GMC with all the equipment and the certification,” says Priolkar.
Corneas are the outer covering that covers the iris, it is similar to the contact lenses that people wear. Though the eye bank has been around for close to a decade, the progress in transplants and procuring the corneas seems to be a snail’s speed in Goa. Most of those procured are sent out of the state, “We established a conduit for supplying corneas to a hospital in Pune, called Desai Eye Hospital. Unless we have a recipient here, we send the corneas there. So far we have procured corneas from 40 people and three cornea transplants have happened in Goa so far,” says Priolkar.
Priolkar who is passionate about the cause, states that the corneas that are procured from one person are used to give sight to two blind people and they follow a very streamlined process in procuring the corneas. “We started a streamlined the process. Among the Rotarians we have five rapid action member enucleation teams. Enucleation is the process of removing the cornea. If a person is not trained well, they will remove the eyeball, bring it to GMC and then remove the cornea. In Enucleation the cornea is only sliced off the eyeball.”
Since the time frame to procure the cornea is only six hours, whenever a call comes in that a person has died at home or anywhere else these teams are mobilises. “We go to GMC pickup a junior resident from the ophthalmology dept on duty, take the necessary surgical equipment, take the doctor to the deceased person’s house, and the cornea is harvested. The documents have to be collected, the family permissions, death certificates, a blood sample is taken and then the two corneas are stored in separate containers, and put in a cool box. And is taken to GMC, where it is stored till it is despatched to Pune,” says Priolkar. Even though the cornea is a part of the body that doesn’t have any blood vessels, it can transmit communicable diseases and thus the blood samples are taken to check if the patient has got any disease – hepatitis, HIV, septicaemia, and other viral diseases like bird flu, swine flu. “There is then a 72 hour window for transplantation. Each pair of cornea are given to sight to two people. With 1.5 million cornea deficient people, number of corneas harvested for a year in only five to six thousand in India,” says Priolkar.
Out of the number of cornea that are procured, there are many are often wasted as the donors are over 65 years of age and their corneas cannot be used to give sight. “There are three different uses – to give sight for which we need healthy young cornea, second is for therapeutic use for corneas that are physical damaged after birth as a protection to the iris, and the third is for research,” says Priolkar.
The way forward
Amol Mahaldar gives the example of Tamil Nadu which turned the table around when the state was targeted for illegal transplant operation: “In 2008 they started a programme called TransTan
(transplantation Network of Tamil Nadu) which works on public private partnership between hospitals, lobbying for cadaver transplants. 1600 transplants have been done in the last six to eight years. Donation rates have increased from .03 per million population (India avr) to 1.3 per million population (TN average). We are pushing for something like this in the Goa.”
With the number of accidents that happen in Goa, there are many young people who die, “these cadavers can be harvested. If a person is brain dead and their families agree, there are chances of saving many other lives. We are not doing anything with the organs anyways, they are either buried or burnt, thus a lot of awareness has to be built to save lives through transplants,” says Mahaldar.
Goa has very limited facilities too. “We don’t have a cross match lab. For cadaver transplants we don’t have time to send the samples to Mumbai, we have a window of only 12 hours for harvesting all the organs. The test has to be available in Goa. We as a hospital have the facility to do the test, but need to train manpower. The government have not been able to start this test for the last five to six years after starting the transplants. Here the public private partnership will work.”
Priolkar is also working towards a similar aim especially in medico-legal cases, like accidents and murders, they need post mortem, but that takes time. “The law says that no organ can be harvested until the post mortem is done. We are working towards the amendment of the law so that at least the corneas can be removed in these cases.”
When collection of the death certificates, the presence of a person who can counsel the family donate the organs could be helpful too. “In Singapore, everyone is an organ donor until pledged otherwise; you have an option by your beliefs to not donate the organs. The government is entitled to take the organs to if there is a recipient in need of one. Something similar should be the law here too, to enable people save lives,” says Priolkar
(An awareness programme on organ donation will be held at Goa Manipal Hospital today on August 13 at 11a.m. It is open to all)