ORGAN DONATION AND ROLE OF NURSE
INTRODUCTION:-
Organ donation is the process when a person allows an organ of their own to be removed and
transplanted to another person, legally, either by consent while the donor is alive or dead with the assent
of the next of kin. Donation may be for research or, more commonly, healthy transplantable organs and
tissues may be donated to be transplanted into another person. Common transplantations include kidneys,
heart, liver, pancreas, intestines, lungs, bones, bone marrow, skin, and corneas. Some organs and tissues
can be donated by living donors, such as a kidney or part of the liver, part of the pancreas, part of the lungs
or part of the intestines, but most donations occur after the donor has died.
In 2019, Spain had the highest donor rate in the world at 46.91 per million people, followed by the US
(36.88 per million), Croatia (34.63 per million), Portugal (33.8 per million), and France (33.25 per million).As
of February 2, 2019, there were 120,000 people waiting for life-saving organ transplants in the US. Of
these, 74,897 people were active candidates waiting for a donor. While views of organ donation are
positive, there is a large gap between the numbers of registered donors compared to those awaiting organ
donations on a global level.To increase the number of organ donors, especially among underrepresented
populations, current approaches include the use of optimized social network interventions, exposing
tailored educational content about organ donation to target social media users. Every year August 13 is
observed as World Organ Donation Day to raising awareness about the importance of organ donation.
NEED FOR ORGAN DONATION:-
In India, every year nearly 500,000 people die because of non-availability of organs and this number
is expected to grow due to scarcity of organ donors.
The gap between the number of organs donated and the number of people waiting for a transplant
is getting larger.
One donor can save eight lives as he/she can donate up to 8 lifesaving organs.
Around 5000 kidneys, 1000 livers, and around 50 hearts are transplanted annually in India.
There is a need of roughly 2,00,000 kidneys, 50,000 hearts, and 50,000 livers for transplantation
each year.
HISTORY OF SUCCESSFUL TRANSPLANTS IN INDIA
In India-
1967- First successful cadaver Kidney Transplant in India at KEM Hospital, Bombay
1994 - First successful heart transplant done at AIIMS, Delhi
1995 First successful multi-organ transplant done at Apollo -Hospital, Chennai
1998 First Successful Lung transplant, Madras Medical Mission -Hospital, Chennai
1999 First Pancreas Transplant, Ahmedabad
Maximum time span between recovering organs/ tissues and transplantation
Lung (4-6 hours)
Heart (4-6 hours)
Liver (12 hours)
Pancreas (12 hours)
Kidney (12 hours)
Skin (6-12 hours)
Corneas (14 days)
LIVING DONOR REQUIREMENTS
Good physical and mental health
Must be at least 18 years old
Must have a body mass index (BMI) that is less than 35
Must be free from the following:
o Uncontrolled high blood pressure
o Diabetes
o Cancer
o Hepatitis
o Organ diseases
o Infectious diseases
KEY REASONS FOR SHORTAGE OF ORGAN DONORS IN INDIA
Ignorance and lack of knowledge about organ donation.
Lack of registering one's wish to donate.
Myths and beliefs.
SITUATIONS UNDER WHICH ORGAN DONATION OCCURS
Live Donations -
Occurs when a living person wishes to donate organs to some immediate family member in need.
Only first-degree relatives (Parents, siblings & children)
are allowed to be Live Donors.
They can donate one kidney, a portion of pancreas and a part of the liver.
Cadaver/Deceased Donations-
Brain death
Cardiac death/Natural death
PROCESS OF ORGAN DONATION:
BOX USED FOR ORGAN TRANSPORTATION
Just prior to being removed from the donor, each organ is flushed free of blood with a specially
prepared ice-cold preservation solution that contains electrolytes and nutrients. The organs are
then placed in sterile containers, packaged in wet ice, and transported to the recipient's transplant
center.
University of Wisconsin cold storage solution is the gold standard for organ preservation
ORGAN PRESERVATION SOLUTION
Composition of University of Wisconsin (UW) solution
Potassium lactobionate (mmol/L) 100
Sodium phosphate (mmol) 25
Magnesium sulphate (mmol) 5
Adenosine (mmol/L) 5
Allopurinol (mmol/L) 1
Gluthione (mmol/L) 3
Raffinose (mmol/L) 30
Hydroxethyl starch (g/L) 50
Insulin (U/L) 100
Dexamethasone (mg/L) 8
Potassium (mmol/L) 135
Sodium (mmol/L) 35
Osmolality (mosmol/L.) 320
PH 7.4
MAXIMUM AND OPTIMAL COLD TORAGE TIME (approx.)
ORGAN OPTIMUM (hrs) Safe maximum (hrs)
KIDNEY <18 36
LIVER <12 18
HEART <03 06
PANCREAS <10 18
LUNG <03 08
ADVANTAGES
A single donor can save more than one life.
A donor can have normal life even after the transplant.
People who are certified brain dead are capable of donating many body parts.
Organs can be donated after death and can be 'banked'.
Potential donors are easy to find
TRANSPLANT COORDINATOR
Grief counselling
Talk to the families of potential donors
Address concerns. about the procedure
Ensure that the procedure goes smoothly
Provide information on organ donation
LEGAL ASPECTS OF ORGAN DONATION
1.Transplantation of Human Organ and Tissue Act (THOTA)
Passed in 1994
Amended in 2011, and new rules came into force in 2014.
It aims at regulation of removal, storage, and transplantation of human organs for therapeutic
purposes and for prevention of commercial dealings in human organs.
2.National Organ and Tissue Transplant Organization (NOTTO)
It is a National level organization set up under Directorate General of Health Services, Ministry of
Health and Family Welfare, Government of India located at 4th and 5th Floor of Institute of
Pathology (ICMR) Building in Safdarjung Hospital New Delhi. It has following two divisions:
"NATIONAL HUMAN ORGAN AND TISSUE REMOVAL AND STORAGE NETWORK"
"NATIONAL BIOMATERIAL CENTRE"
FUNCTIONS
At National Level:
Lay down policy guidelines and protocols for various functions.
Network with similar regional and state level organizations.
Compile and publish all registry data from States and Regions.
Creating awareness, promotion of organ donation and transplantation activities.
Co-ordination from procurement of organs and tissues to transplantation when organ is allocated
outside the region.
Dissemination of information to all concerned organizations, hospitals and individuals.
Assist in data management for organ transplant surveillance & registry of organ transplant and
Organ Donation.
Consultancy support on the legal and non-legal aspects of donation and transplantation.
Allocation, Transportation, Storage and Distribution of Organs and Tissues.
Follow-up of post-transplant patients & living donor for assessment of graft rejection, survival rates
etc.
Awareness, Advocacy and Training workshops and other activities for promotion of organ donation.
National Biomaterial Centre (National Tissue Bank)-
The main thrust & objective of establishing the centre is to fill up the gap between 'Demand' and
'Supply' as well as 'Quality Assurance' in the availability of various tissues.
The centre will take care of the following Tissue allografts: -
Bone and bone products e.g. deep-frozen bone allograft, freeze dried bone allograft
Duramater
Fresh frozen human amniotic membrane
High temperature treated board cadaveric joints like knees, hips and shoulders, cadaveric cranium
bone graft, loose bone fragment, different types of bovine allograft, used in orthodontics
Skin graft
Cornea
Heart valves and vessels
Activities
Coordination for tissue procurement and distribution
Donor tissue screening
Removal of tissues and storage
Preservations of tissue
Laboratory screening of tissues
Tissue tracking
Sterilization
Records maintenance, Data Protection and Confidentiality
Quality Management in tissues
Patient Information on tissues
Development of Guidelines, Protocols and Standard Operating Procedures
Trainings
Assisting as per requirement in registration of other Tissue Banks
FORMS FOR ORGAN DONATION AND TRANSPLANTATION
FORM 1-
FOR ORGAN OR TISSUE DONATION FROM IDENTIFIED LIVING NEAR RELATED DONOR
FORM 2-
FOR ORGAN OR TISSUE DONATION BY LIVING SPOUSAL DONOR
FORM 3-
FOR ORGAN OR TISSUE DONATION BY OTHER THAN NEAR RELATIVE LIVING DONOR
FORM 4-
FOR CERTIFICATION OF MEDICAL FITNESS OF LIVING DONOR
FORM 5-
FOR CERTIFICATION OF GENETIC RELATIONSHIP OF LIVING DONOR WITH RECIPIENT
FORM 6-
FOR SPOUSAL LIVING DONOR
FORM 7-
FOR ORGAN OR TISSUE PLEDGING
FORM 8-
FOR DECLARATION CUM CONSENT
FORM 9-
FOR UNCLAIMED BODY IN A HOSPITAL OR PRISON
FORM 10-
FOR CERTIFICATION OF BRAIN STEM DEATH
FORM 11-
APPLICATION FOR APPROVAL OF TRANSPLANTATION FROM LIVING DONOR
FORM-12
APPLICATION FOR REGISTRATION OF HOSPITAL TO CARRY OUT ORGAN OR TISSUE
TRANSPLANTATION OTHER THAN CORNEA
FORM 13-
APPLICATION FOR REGISTRATION OF HOSPITAL TO CARRY OUT ORGAN/TISSUE RETRIEVAL OTHER
THAN EYE/CORNEA RETRIEVAL
FORM 14-
APPLICATION FOR REGISTRATION OF TISSUE BANKS OTHER THAN EYE BANKS
FORM 15-
APPLICATION FOR REGISTRATION OF EYE TRANSPLANTATION CENTRE, EYE RETRIEVAL
TRANSPLANTATION OF HUMAN ORGANS ACT BANK, CENTRE CORNEAL UNDER
FORM 16-
CERTIFICATE OF REGISTRATION FOR PERFORMING TRANSPLANTATION/RETRIEVAL AND/OR TISSUE
BANKING ORGAN/TISSUE
FORM 17-
CERTIFICATE OF RENEWAL OF REGISTRATION
FORM 18-
CERTIFICATE BY THE AUTHORIZATION COMMITTEE OF HOSPITAL
FORM 19-
CERTIFICATE BY COMPETENT AUTHORITY
FORM 20-
VERIFICATION CERTIFICATE IN RESPECT OF DOMICILE STATUS OF RECIPIENT OR DONOR
FORM 21-
CERTIFICATE OF RELATIONSHIP BETWEEN DONOR AND RECIPIENT IN CASE OF FOREIGNERS
FORM 10-FOR CERTIFICATION OF BRAIN STEM DEATH
- To be filled by the board of medical experts certifying brain-stem death.
- 4 members sign the certificate of brain stem death:
1. Medical administrator incharge of the hospital
2. Authorized specialist.
3. Neurologist/Neurosurgeon
4. Medical officer treating the patient
- The certificate includes patient details, details, and preconditions such as diagnosis, date and time
of accident/onset of illness, date and onset of non- reversible coma and 2 medical examinations.
- The minimum time interval between the first and second testing will be 6 hours in adults. In case of
children 6 to 12 years of age, 1 to 5 years of age and infants, the time interval shall increase
depending on the opinion of experts.
TRANSPLANT REJECTION REACTION
Hyperacute
Occurs minutes to hours after transplantation
No treatment (organ must be removed)
Acute
Occurs days transplantation (one week) to months after
T- cytotoxic lymphocytes attack the transplanted organ
Chronic
Occurs over months to years
Most common signs & symptoms-
Pain at the site of the transplant
Feeling ill
Flu-like symptoms
Fever
Weight change
Swelling
Decreased urine output
IMMUNOSUPPRESSIVE THERAPY
1. Triple therapy (all PO/IV)
Cyclosporine-Prevent a cell-mediated attack (helper T-cells) against the organ
Corticosteroid: prednisone-methylprednisolone (Solu-Medrol)-Suppress inflammatory response
Cytotoxic drug: mycophenolate mefetil (CellCept) or cyclophosphamide (Cytoxan) -Suppress
immune response by inhibiting proliferation of T and B cells
1. Monoclonal Antibodies: muromonab-CD3- Used for preventing and treating acute rejection
episodes
2. Polyclonal Antibodies: Atgam - Used as induction therapy or to treat acute rejection.
Immunosuppressive Therapy: Side Effects
Nephrotoxicity
Increased risk of infection
Lymphoma
Hepatotoxicity
Neutropenia
Thrombocytopenia
Diarrhoea/nausea/vomiting
GREEN CORRIDOR
Green corridor is a demarcated, cleared out special road route created for an ambulance that
enables harvested organ(s) meant for transplant to reach the destined hospital.
It is a special corridor created without any stoppages
The prime objective of creation of these green. corridors has arisen from the fact that organs have a
short preservation time; henceforth, within few hours, the entire process, right from harvesting,
interinstitutional transportation, and final transplantation surgery must be completed.
In the past few years, this concept of green corridors has taken up across the nation and has
successfully managed to save a number of lives through timely delivery of organs.
ROLE OF NURSE
Registered professional nurse are often the primary care givers for patients approaching the final
stage of life.
It is the nurse who facilitates the coping of patients and their families. In general, the work of
transplant nurse is anchored on counselling and facilitating the process for organ or tissue donation
by educating and guiding to the donor families without doubt, a difficult, heart wrenching process.
The nurses stay with the patients and help the family to understand the organ donation process,
which includes keeping the brain-dead patient's body functioning until the organ been collected.
There are guidelines for nurses who work in areas where organ donation and transplant occur. She
should be the "whistle blower" if any unethical things happen.
1. The nurses first obligation is the well-being of the patient entrusted to our care.
2. The act of procuring organs should never be the explicit causes of a person's death.
3. Nurses understand the good of organ donation itself.
SUMMARY AND CONCLUSION
As discussed throughout the presentation, learning about organ donation will help nurses to care
for patients who want to donate organ and who require organ transplant.
Nurses can facilitates the coping of patients and their families.
Nurses can also counsel the patients and their family for various options available in organ
donation.
BIBLIOGRAPHY
1. Cleveland clinic. Organ Donation and Transplantation. Available from
https://my.clevelandclinic.org/health/articles/11750-organ-donation-and-transplantation [cited 10
jan 2020]
2. The Times of India. ORGAN DONATION DAY. Available from
https://timesofindia.indiatimes.com/topic/organ-donation-day [cited 10 jan 2020]
3. Organ donation Current Indian scenario. Journal of the Practice of Cardiovascular Sciences.
Available fromhttp://www.jpcs.org/article.asp?
issn=23955414;year=2018;volume=4;issue=3;spage=177;epage=179;aulast-Nallusamy [cited 9 jan
2020]
4. Frequently Asked Questions. Finger Lakes Donor Recovery Network. Available from
http://www.donorrecovery.org/learn/frequently-asked-questions/#q1 [cited 9 jan 2020]
5. Organ donation. Available from https://www.slideshare.net/sandipandhar/organ-donation-
9534178?next_slideshow=1 [cited 9 jan 2020
