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A JOURNEY Of Living Organ Donation… One Process to SAVE LIFE

After watching a short film recommended by my classmate, Dr. Raorane, a paediatrician from Kokan, I was deeply moved by a wonderful message. The film conveyed the powerful message of “Donate organs, Save lives.”

In the three(3) minutes short film, presented the story of a woman who donates her part of liver to her husband. Her husband was suffering from liver disease and doctor advised him to undergo for liver transplant. Her family consisted of two school-going children, old aged father in law and mother -in- law, ailing husband and herself. She was the only eligible person in the family to donate her liver to her husband. It was impossible for her to donate her liver may be because of her increased weight. To fulfil the donor selection criteria she has to reduce her weight. As shown in the film she has taken a tremendous efforts to reduce her weight for liver donation. After her strenuous exercise with workout and efforts she had reduced her weight and become eligible for liver donation. Finally she donated her liver to her husband in the hospital. The efforts which she had taken to lose weight were very heart touching and inspiring. It shows her immense love, affection and intimacy towards her husband. Her efforts and struggle to save her husband’s life was very heart touching which was pictured very nicely. The whole family and treating doctors have supported her a lot for her liver donation process.

It’s great to watch this short film, which will effectively communicates the importance of organ donation. Short films can be powerful tools for raising awareness and educating people about important issues like organ donation.

This short film will provides following  comprehensive understanding of organ donation process and will definitely inspire viewers to become organ donors.

  1. Living organ donation, where a healthy individual donates a portion of their liver, is indeed an option for those in need of a transplant. It’s typically considered when a patient can’t wait for a deceased donor organ or when the likelihood of finding a suitable match is low. This approach can save lives and reduce waiting times, but it’s important for both the donor and the recipient to undergo thorough evaluation and counselling to understand the risks and benefits involved.
  2. That sounds like a touching and inspiring storyline. The film highlights the deep bond of love and sacrifice within families, especially between spouses.
  3. It sounds like the film portrays a scenario where a patient’s wife needs to reduce her weight to become eligible for liver donation. It’s good to see a storyline highlighting the importance of health and fitness in such critical situations.
  4. The Transplantation of Human Organs Act (THOTA) of 1994, along with its subsequent amendments, outlines two pathways for living organ donation :
  1. Donation between near relatives, including spouses, children, parents, siblings, grandparents, grandchildren, and more. Permission for such donations is granted by the competent authority of the respective hospital.
  2. Donation between unrelated individuals, both within and outside the state, requires thorough scrutiny and verification by the state/regional authorization committee. This rule also applies to organ transplant cases involving foreign nationals.

6. Promoting organ donation in the film is a noble message, especially when it emphasizes the importance of close family members stepping forward to save lives.

7. The advice of treating doctor is crucial in organ donation and transplantation. They  guide patient and donor the entire process of organ transplant and donation ethical, legal and clinical aspects.

8. The story of a wife donating her liver underscores the importance of the Transplantation of Human Organs and Tissues Act (THOTA) of 1994.This legislation, along with its rules, plays a crucial role in regulating organ transplantation in India. It helps to prevent fraudulent activities and ensures ethical practices in the field. Compliance with THOTA is essential for protecting the rights of both donors and recipients, maintaining transparency, and fostering trust in the medical system. This legal framework is vital for ensuring that organ donations are carried out safely, ethically, and The selection criteria for both recipients and donors in organ transplantation are crucial as they significantly impact the outcomes and prognosis of both.

A) The criteria for being an acceptable liver donor are indeed specific to ensure both the safety of the donor and the success of the transplant. The general criteria often include:

  1. Age 18-50 years: Donors within this age range are generally considered to have lower surgical risks and healthier liver tissue.
  2. ABO compatible blood group: Blood type compatibility between the donor and recipient is crucial to prevent organ rejection and other complications.
  3. No comorbidities: The donor should not have any significant medical conditions such as diabetes, hypertension, heart disease, or infectious diseases that could complicate the surgery or affect liver function.BMI less than 25 kg/m²: A lower BMI is associated with a lower risk of surgical complications and ensures the liver is not excessively fatty, which can impair its function and regenerative capacity.Normal liver function: Confirmed through blood tests and imaging studies.No history of liver disease: Including conditions like hepatitis or cirrhosis.
  4. Psychological readiness: Evaluation to ensure the donor understands the risks and is mentally prepared for the donation process. Non-smoker and no substance abuse: As smoking and substance abuse can impact overall health and recovery.

These criteria helps to ensure that the liver donation process is as safe as possible for both the donor and recipient.

Recipient selection criteria are also crucial for liver transplantation via living donation to ensure the best outcomes. These criteria typically include :

A. Medical Necessity: The recipient must have a liver condition that significantly threatens their life, such as end-stage liver disease or acute liver failure.

B. Surgical Risk: The recipient must be physically capable of undergoing major surgery, with an acceptable risk level.

C. Compatibility: Blood type and size compatibility between donor and recipient are essential to reduce the risk of complications.

D. Absence of Contraindications: Recipients should not have conditions that would contraindicate transplantation, such as active infections, certain cancers, or severe heart or lung diseases.

E. Psychosocial Factors: The recipient must have a support system in place and be able to adhere to post-transplant care requirements, including medication adherence and regular follow-up appointments.

These criteria helps to ensure the transplant’s success and the long-term health of both the donor and recipient. In summary, the meticulous selection of recipients and donors is pivotal in organ transplantation, aiming to maximize the survival and quality of life of recipients while ensuring the safety and well-being of donors.

9. Generally Transplanted  candidates have better results when they receive organs from living donors as compared to organs from deceased donors. Often, transplanted organs from living donor’s have greater longevity than those from deceased donor’s. Genetic matches between living donors and candidates may lessen the risk of rejection.

10. The Donor Risk : As with any other surgery, there are both long term and short term risks involved in living donation. Now a days transplant surgeries are becoming more common and surgical techniques are advancing, risk involved with living donation continue to decrease. Based upon available information, overall risks are considered to be low. Risk can differ among donors and type of organs.

11. Following the patient’s diagnosis by the clinician, the recipient, the proposed donor, and their family members should be directed to the transplant coordinator for initial family assessment and interviews. The interviews conducted by the Transplant Coordinator with the recipient, donor, and their families will result in a preliminary assessment report, aiding in determining the donor’s willingness.

This preliminary report from the Transplant Coordinator will assist in the following ways:

  • Assist in understanding the financial conditions of the recipient and the donor.
  • Determine if the recipient and donor will receive family support for the proposed transplant
  • Assist in establishing the donor’s willingness.
  • Assist in estimating the post-transplant long-term treatment and follow up.

12. Transplantation of Human Organs and Tissues Rules, 2014 makes mandatory for the registered hospitals to appoint a “Transplant Coordinator”. The state appropriate authority i.e. Director Health Services Maharashtra have given the directives regarding the duties of transplant coordinator for living transplants which includes following.

  • Pre and Post transplant counselling to the recipients and donor,
  • Helping them in the process of getting permission from Authorization Committee by guiding them on the required procedure and paper work.

13. After diagnosing a patient’s disease, if an organ transplant is the only treatment option, the organ transplant coordinator will make an initial assessment of the patient, the donor, and their family. The coordinator will then prepare a proposal according to a standard checklist and submit it to the Hospital’s competent authority for the permission.

14. Transplantation of Human Organs Act (THOTA) of 1994 in India regulates organ donation and transplantation. It requires establishing the relationship between the donor and recipient in cases where the donation is between near relatives. This is to ensure transparency and prevent any exploitation or illegal organ trafficking.

15. According to the Organ Transplant Act, genetic testing can be used to verify the relationship between a recipient and a donor.

16. According to the Transplantation of Human Organs and Tissues Act (THOTA) 1994, organ donation and transplantation are permitted only after the Competent Authority of the Hospital/authorization committee verifies the following:

  1. The identity of both the donor and the recipient.
  2. The relationship between the donor and the recipient.
  3. The organ donation by the donor is motivated only by love and affection.
  4. The donor is not under any pressure to donate the organ.
  5. No monetary transaction has taken place between the donor and the recipient for the organ donation.

17. As per THOTA act 1994,the recipient and the donor should submit the necessary documents to prove their identity, relationship and income details to the hospital’s competent authority.

18. The Competent Authority of the hospital should scrutinize the documents submitted by the recipient and the donor for proper authenticity and call them for an interview.

19. The recipient and donor need to be provided with detail information about their surgeries ahead of the Competent Authority  Committee meeting. The treating physician and operating surgeon must provide comprehensive details about the surgery, including potential risks, complications, outcomes, post- operative care, follow-up, and other relevant information in written with respect to the language known to the recipient and donor and their relatives. This will enable the members of the Competent authority to assess the readiness of both the recipient and the donor for the surgery. It also serves to gauge the mental preparedness of the donor and ensures that the organ donation is free from any kind pressure.

20. According to the Organ Transplant Act, surgery on both the recipient and donor can only be performed only after obtaining a written permission/approval from the competent authority/authorization committee; otherwise, it constitutes an offense under the Act.

21. The treating specialist, transplant coordinator and hospital staff should conduct pre- operative and post-operative counselling of the organ transplant recipient, proposed donor and their relatives.

22. Follow-up of both the donor and recipient is crucial after living donor organ transplant operations to monitor for complications, ensure proper recovery, and manage long-term health. Regular check-ups help to detect and address any issues early, such as organ rejection in recipients or complications in donors, and support overall well-being.

The above organ transplant procedure is a comprehensive journey involving several key steps. It includes the patient’s examination and diagnosis, the determination of the need for an organ transplant, finding a suitable organ donor, and collecting necessary documents from both the recipient and donor to obtain transplant permission/approval. Approval from the competent authority/authorization committee is required before the actual transplant surgery can take place. Throughout this process, the roles of the recipient patient, donor, their relatives, treating doctors, hospital staff, and the transplant coordinator are crucial.

In recent days, there have been reports of patients and their relatives using bogus and forged documents to obtain permissions for organ transplants. These fraudulent activities have undermined the integrity of the organ donation and transplant system, damaging the reputation of the campaign and potentially jeopardizing the lives of those in genuine need of organ transplants.

Therefore, the documents of the recipient and the donor required for permission of organ transplantation of related cases should be checked very carefully. The authority of the registered hospital, the treating doctor, and the transplant coordinator should review these documents with utmost responsibility.

Identification of living related as well as unrelated donor in organ transplant and their documents verification is a very difficult task. The hospital and the authorization committee do not have expert in this regard. Due to which some remedial measures can be carried out at all levels by taking collective responsibility.

The following are the some measures which can be planned to take necessary precautions.

  1. In the living organ transplant program hospitals should strictly follow the government’s checklist.
  2. To prove the relationship between recipient and donor, they must obtained a relationship certificate from Tahsildar and Gram Panchayat.
  3. To confirm the relationship between the recipient and donor, genetic testing can be included.
  4. Additional affidavits can be obtained from the next of kin of the recipient and donor, confirming their permission for the transplant and organ donation.
  5. A legal opinion may be obtained from a notary to review the documents submitted by the authorized notary advocate for both donors and recipients.
  6. For residential proof, besides the Ration Card, Aadhar Card, and Voter’s Cards, the following documents may also be collected:
  • Residential Certificate of Donor and Recipient from Gram Panchayat
  • Domicile Certificate of Donor and Recipient
  • Birth Certificate of Donor and Recipient
  • Photos of donor, recipient and their families
  • Bank Passbook and Statement. If the AADHAAR is linked with Bank Account will be ideal.

7. Self Certification of Donor and Recipient in prescribed format which are attested by the notary advocate.

8. Develop a new protocols at hospital level for related, unrelated /distant relatives as a organ donor.

9. Family photos play a crucial role in illustrating the relationship and attachment between the recipient and the donor. The recipient and donor should provide photos from wedding ceremonies, family events/functions, birthdays, and family trips. A minimum of 5-10 distinct instances of photos must be submitted. Additionally, if there are videos of any instances must be submitted. The recipient and donor should provide descriptions for each instance photo the interview. To ensure authenticity of submitted photos, and whether they have been altered or not, should be verified if possible by external third party agency.

10. Hire a expert in the competent authority/Authorization committee.

11. Identifying the donor before surgery in the operating theatre is crucial. In this context, the Aadhaar card and other ID proof such as PAN Card, Driving Licence, Voter ID of the donor available in the case file should be thoroughly checked, confirmed and recorded in the OT register.

12. In the Competent Authority/Authorization Committee meeting, separate individual interviews should be conducted with the recipient, donor, and their close relatives. Conducting separate interviews for each individual will assist the members of the Competent Authority/Authorization Committee in several ways.

  1. Providing privacy, particularly for the donor, ensures that donor feels less pressured.
  2. Conducting separate interviews aids in understanding the relationship, attachment, and bonding between the recipient and the donor.
  3. It helps verify that the organ donation is motivated solely by love and affection only and no financial transactions are involved.

13. Trainings, Workshops, CMEs : The persons involved in the process of organ transplant/donations like doctors, transplant coordinators and the members of the competent authority/authorization committee should be given training through Workshops and CME from time to time regarding the provisions of the Transplant Act.

14. Public Awareness: NGOs and voluntary organizations play an important role in creating public awareness and promoting social causes. Newspapers, magazine, films and short films are one of the best mediums to reach people and spread social work in today’s scenario. All these media should be used to create awareness about organ donation.

15. A document verification system will be integrated into the MAHAAYUDAAN software. Verified documents, initially checked by a third-party agency appointed by the hospital, can be reviewed by the competent authority anytime. The verification reports must detail the documents, verification methods, proof, and results. Physical verification is also important.

16. Registered transplant hospitals will use an external agency to verify documents submitted by donors, recipients, and their relatives. This agency should keep the documents securely, either in its own infrastructure or in government facilities. The agency will verify the documents, prepare verification reports, and submit them to the hospital. If requested by the donor, recipient, or their relatives, the hospital must provide these reports. Using a third-party agency helps reduce fraudulent activities.

Based on the past experience, there are  the suggestions, and these suggestions can be followed by the transplant registered hospitals.

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