How Tamil Nadu Eradicated Organ Sale

7/26/2019 How Tamil Nadu Eradicated Organ Sale

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Dr.J.Mariano Anto Bruno Mascarenhas M.B.,B.S.,M.Ch

Technical Associate, TRANSTAN

Junior Consultant Neurosurgeon, TNGMSSH





















Think about it !e ill re"isit this

#uestion a$ter so%e

ti%e





The other ki&ne' &oes the orkRarel' S'%(to%atic



Acute Renal )ailureChronic Renal )ailure







Relati"es o$ a *atient hose +BrainSte% is Dea& agree to &onate the

(atients ki&ne'sA -i"e Relati"e or So%e one ith an+e%otional bon& Donates one o$ hiski&ne'

A stranger +sells $or %one' This is/--0GA-1



The least (re$erre& route as beingi&el' use&













-a%akers Ju&iciar'





2i&ne's Nee&e&

+ *atients ith Renal )ailures

Nu%ber o$ 2i&ne's A"ailable+ 2i&ne's &onate& b' li"e &onors

+ 2i&ne's &onate& $ro% Brain Ste% Dea&*atient



Chronic Renal )ailure 3 -i"e Donor 4Ca&a"ers

-i"e Donors 3 Chronic Renal )ailure 5Ca&a"ers

Re&uce -i"e Donors

Re&uce the Nee& b' re&ucing Renal )ailure /ncrease Donation $ro% Brain Ste% Dea&

*atients



Re&uce Renal )ailure-i$e St'le Mo&i6cations



A Dead Brain stem in body whoseheart is still beating is hat is BrainSte% Dea& in si%(le ter%s

This has beco%e a realit' because o$a&"ance%ent in intensi"e care 7(har%acothera(' etc.

As (er TH8A 9::; +“brain-stem death”

means the stage at which allfunctions of the brain stem havepermanently and irreversibly ceased



Do all hu%an beings ho &ie (ass throughthis stage<

No=. Only 1% of all death (ass through

this stage



Brain has the $olloing StructuralCo%(onents

*rosence(halon,Mesence(halon,Rho%bence(halon



Brain Ste% > hich co%(rises o$Mi&brain, *ons, Me&ulla

8ther Areas



*ersistent ?egetati"e State an& Co%a are(roble%s in @, 8ther Areas

*roble%s in @9 Brain Ste% are calle&

Brain Ste% D's$unction Brain Ste% D's$unction %a' be Re"ersibleor /rre"ersible.

/rre"ersible Brain Ste% D's$unction iscalle& as Brain Ste% Death Brain &eath

is a "ague ter% $or collo#uial use. /t is notuse& Technicall'1





Brain Ste% Death is /rre"ersible D's$unction,Co%a %a' be re"ersible or irre"ersible

Brain Ste% Death is /rre"ersible D's$unction o$Brain Ste%, hile 8ther areas are in"ol"e& in

Co%a Brain Ste% Death &enotes (er%anent structural

&a%age o$ Brain Ste%, hile Co%a can beeither structural &a%age or Metabolic *roble%

Brain Ste% Reees are lost in Brain Ste%

Death. The' %a' or %a' not be (resent inCo%a



The Centre $or Res(iration breathing1 is in BrainSte%. Those ith Brain Ste% Death cannotbreathe b' the%sel"es. The' nee& arti6cialres(iration. /$ arti6cial res(iration is re%o"e&,

the heart ill sto( in a $e %inutes. 0"en ithArti6cial res(iration, heart beat cannot besustaine& $or &a's. Those ith Co%a canbreathe b' the%sel"es. /$ $oo& is gi"en, the' cane"en li"e $or 'ears.

Brain Ste% Death is recogniEe& as Death as (erla in Most Countries inclu&ing /n&ia1. Ti%e o$Certi6cation o$ Brain Ste% Death a$ter n&A(nea Test1 is consi&ere& to be the ti%e o$Death.

Those in Co%a 7 *?S are li"ing





*ro%(t an& *ro(er certi6cation o$ BrainSte% Death &ecreases the relatives’ agonising ait,

%akes a"ailable /CF $or anotherpatient with treatable conditions an&

relie"es !" nurses (ain o$ cleaning an&&ressing a (atient ith no (ossibilit' o$sur"i"al.



*ro%(t an& *ro(er certi6cation o$ BrainSte% Death hen (ro(erl' netorke&, 0ach Brain

Ste% Death Certi6cation gi"es a freshlease of life to %an' suering $ro%CR), -i"er )ailure an& Car&iacD's$unctions necessitating trans(lants





Doubts in %e&ical circles on theauthorit' b' hich &octors %a'&eclare Brain Ste% Deathhene"er re#uire&.

Certain Gre' areas o$ TH0 TRANS*-ANTAT/8N 8) HFMAN

8RGANS ACT 5 9::;*roce&ural Diculties 7 -ack o$

*rotocol 7 ho to &o hat







)our orking Grou(s>

Ca&a"er organ &onation

Ca&a"er organ trans(lantation Coor&inating 8rganiEation $or organ

sharing

-i"e &onation an& trans(lantation

## recommendations $or $ollo u(action.



Trau%a Centres Trans(lant Centres-ack o$ Co or&ination Mechanis%



The (artici(ants $elt that there eremany grey areas in the Trans(lantationo$ Hu%an 8rgans Act.

/n (articular, no guidelines on who willget the donated cadaver organ

The Go"ern%ent $olloe& u( ith a serieso$ consultati"e %eetings hel& ith grou(s

o$ &octors b' Mr.*..C.Da"i&ar



Brain &eath I Declaration of brain deathmade mandatory in Go"ern%ent Me&icalCollege Hos(itals in Chennai I 8r&ers /ssue&.

Brain &eath I Declaration o$ brain &eath

%a&e %an&ator' in Go"ern%ent Me&icalCollege Hos(itals in Chennai I $rocedurefor declaration o$ brain &eath I or&ersissue&.

Health )a%il' el$are De(art%ent I 8rgan

Trans(lant I uthori&ation !ommittee*roce&ures I A&&itional res(onsibilities IDetaile& instructions I or&ers issue&.



Health )a%il' el$are De(art%ent I8rgan Trans(lant I Ca&a"er 8rgan

Trans(lant *rogra% I $rocedure to be

a&o(te& $or ca&a"er trans(lant b' theGo"ern%ent an& *ri"ate Hos(italsa((ro"e& $or organ trans(lant b' theA((ro(riate Authorit' I or&ers issue&.

Health an& )a%il' el$are De(art%ent

I 8rgan Trans(lant I 'esponsibilitiesof (ransplant centers in hos(itals IDetaile& instructions I 8r&ers issue&.



*ro$ Dr J A%alor(a"anathan, *ro$essor o$?ascular Surger', MMC RGGGHa((ointe& as Con"enor, Ca&a"er Trans(lant *rogra%%e in honorar'ca(acit'

8ce s(ace (ro"i&e& at the Go"ern%entGeneral Hos(ital

A&"isor' Co%%ittee hea&e& b' HealthSecretar', GoTN Mr Da"i&ar, DMS, DM0, TNMSC, *olice De(t, NG8s, 9 Me&ical 0thicist, L Go"ern%ent Hos(itals, ; *ri"ate Hos(itals



/nitiati"es $or $or%ing “ Ta%il Na&uNetork $or 8rgan Sharing” an&%aintaining a co%%on online

aitlist $or all (otential reci(ients inall hos(itals ho choose to co%eun&er this netork in Ta%il Na&u an&allot%ent o$ organs b' the Netork

Co%%on aiting -ist base& Bloo&Grou(1 "isible to all stakehol&ers

Allocation base& on aiting -ist



)*O* +,s .o* /0 Dated 2#*2#*32245ealth and 6amily 7elfare +81Department

)or% o$ the TH8 Act an& Rules as $oun&in the Anneure5/ to this or&er are(rescribe& as the brain &eath certi6cation$or%at to be utilise& $or an' gi"ensituation re#uiring certi6cation that a

(erson is &ea& on account o$ (er%anentan& irre"ersible cessation o$ all $unctionso$ the brain ste%.

The tests (rescribe& therein an& the6n&ings re#uire& shall re%ain the sa%e.



Accor&ing to )or% o$ the sai& Actan& Rules, hen such certi6cation isre#uire&, there shall be twomedical e9aminations con&ucte&b' a team of doctors a$ter a%ini%u% inter"al o$ si9 hours an&

the 6n&ings %a&e base& on thetests prescribed therein.



8ne as(ect o$ the abo"e $or%re#uires $urther clari6cation an& thisis (ro"i&e& in Anneure5// o$ thisor&er as )uidelines for pnoea(ests (G.O. (Ms) No. 75 Dated :03.03.2008 Health and Family

Wela!e ("#) De$a!tment)



Manage%ent o$ the (atient at the*ost Anaesthetic Care Fnit un&er theAnesthetists or other /CFs.

8r&ers o$ Hos(ital A&%inistrationenabling the 0lecti"e 8(erationtheatre to be use& at the Night Ti%e

an& 8&& Hours $or 8rgan har"estingan& Trans(lants



Counseling the relati"es an& Arranging aRoo% in the Hos(ital $or the berea"e&$a%il'

Co 8r&inating ith the RM8 8ce, Matron8ce, Theatre, -abs etc $or arrangingsurgeries at short notice e"en at o&&hours

Arranging 0arl' *ost%orte% an& )ree 7

subsi&iEe& trans(ortation o$ the &ea&bo&' to the ho%e. /n$or%ing Trans(lant Co 8r&inators o$

8ther Hos(itals /n"ol"e& an& kee(ing intouch





Go"ern%ent 8r&ersNoble Gesture o$ Dr. Ashokan

Alu%ni o$ Chengal(et Me&icalCollege 9: Batch1 an& Dr.*ush(anOali, ThirukaEhukun&ra%,

More Brain Dea& Certi6cation

More DonationMore reci(ients bene6te&



Con"enor runs the CT*8"erseen an& su((orte& b' the

A&"isor' Co%%ittee hich kee(satch an& a%en&s Gui&elines asnee&e&

*artici(ating hos(itals to kee(

(ro"i&ing in(uts to i%(ro"e theGui&elines



Register illing trans(lant hos(italsin the organ sharing netork

2ee( the% (oste& o$ the regulator'$ra%eork

Con"ene %eetings o$ the A&"isor'Co%%ittee an& take $ollo u( action



Take calls ;PQ $ro% &onor hos(itals,allocate organs an& co5or&inate tilltrans(lants take (lace

Sen& (erio&ic re(ortsMaintain &atabase o$ ca&a"eric an&

li"e &onor trans(lantsMaintain ebsite .&%rhs.org Con"ene %eetings o$ hos(itals $or

i&eas on i%(ro"ing the $ra%eork

http://www.dmrhs.org/

http://www.dmrhs.org/



Hos(itals treating (atients ith 0n&Stage 8rgan )ailure 2i&ne' $ailureor li"er $ailure or heart $ailure1register those illing $or trans(lantat the online &atabase .tnos.org

aiting -ist is %aintaine& online an&

is atche& b' all hos(itals in the(rogra%%e

http://www.tnos.org/

http://www.tnos.org/



0ach hos(italAll Go"ern%ent hos(itals co%bine&All (ri"ate hos(itals co%bine& an&All Hos(itals Co%bine&



9st (riorit' 5 -ist o$ the Go"ern%ent Hos(italhere the &ecease& &onor is locate&, $or li"er,heart an& one ki&ne'. The other ki&ne' orl& beallocate& to>

n& (riorit' 5 co%bine& Go"ern%ent Hos(itals list Lr& (riorit' 5 co%bine& *ri"ate Hos(itals list ;th (riorit' 5 Go"ern%ent Hos(itals outsi&e the

State, th (riorit' 5 *ri"ate Hos(itals outsi&e the State )inall', i$ the organs1 re%ains unutiliEe& b' the

abo"e criteria, it %a' be oere& to a $oreign

national registere& in a Go"ern%ent or *ri"atehos(ital ithin an& then outsi&e state. This is toensure that there is no astage o$ organs&onate&1



9st (riorit' 5 the list ithin the *ri"ate Hos(italhere the &ecease& &onor is locate&, $orli"er, heart an& one ki&ne'. The other ki&ne' orl&be allocate& to>

n& (riorit' 5 the co%bine& list o$ Go"ern%ent an&*ri"ate Hos(itals

Lr& (riorit' 5 Go"ern%ent 7 (ri"ate hos(italsoutsi&e the state

)inall', i$ the organs1 re%ains unutiliEe& b' theabo"e criteria, it %a' be oere& to a $oreign

national registere& in Go"ern%ent or (ri"atehos(ital ithin an& then outsi&e the state, (ro"i&e&earlier in$or%ation an& such a re#uest has beenregistere& ith the A&"isor' co%%ittee 7Con"enor,Ca&a"er Trans(lant *rogra%, Ta%il Na&u.



CoT*5GoTN is no TRANSTAN Trans(lant Authorit' o$ Ta%il Na&u







This is a huge nu%ber This is better than %an' estern countries

ith "oluntar' &onation



Q Donors )ro% Ta%il Na&u 9L Heart Q -ung

9 -i"er 99 2i&ne' L MaOor organs 9 Heart ?al"e 9 Cornea

9Q Skin 9 Bloo& ?essel

LQ Total 8rgans



99 *atients ith Chronic Renal)ailure ha"e been bene6tte&

499 Health' (atients ere not

o(erate&



8nl' State Go"ern%ent Hos(ital to&o Heart Trans(lants

An& Totall' )ree o$ Cost



8nl' State Go"ern%ent Hos(ital to&o -i"er Trans(lants

An& Totall' )ree o$ Cost



Decease& Donation ie Donation$ro% Brai& Ste% Dea& (atients1 Ratein TN is 9.L7%illion7'ear hich is 9ti%es the national a"erage



/n Jul' 9, a 9; nation H8 %eetin Gene"a to establish a blue (rint toi%(ro"e organ &onation in FNCountries, (ut in TN 0(erience as ake' (oint in the blue (rint (re(are&

Man' states ha"e $olloe& TN Mo&el



.ew lives out of deaths %.&. '!a*+ ,.W.-. Daida!+ /.

malo!$aanathan and -.1. &a!naa!an amilNad sho4s the 4ay in o!an t!ans$lantation.

/$ 'our li"er has $aile& an& 'ou nee& a$unctioning organ to be trans(lante& $or'ou to sur"i"e= then go to Chennai> thisis the buEE a%ong li"er5$ailure (atientsacross /n&ia= The State has &one 99

&ecease& &onor li"er trans(lantations in a(erio& o$ less than to 'ears. All otherStates (ut together ha"e not &one e"enhal$ this nu%ber.



CADAVER TRANSPLANT PROGRAM, TAMIL NADU



:uvaram . ; 'eddy+1< ,illy ,atthew+1< =aravanan =+1< malorpavanathan+#< )eorgibraham+1<3< =unil =hro>+?

bstract /n&ia ith a (o(ulation o$ 9. billion has a renal trans(lantation rate o$ L. (er %illion (o(ulation. The %aOor cause o$ chronic ki&ne' &isease is h'(ertension an& &iabetes. The cru&e an& agea&Ouste& inci&ence rates o$ 0SRD are esti%ate& to be 99 an& L (er %illion (o(ulationres(ecti"el' in /n&ia. There as a re%arkable lack o$ knole&ge in the (ublic about &ecease& organ&onation until a &eca&e ago. Hoe"er, the role (la'e& b' the %e&ia an& Non Go"ern%ental8rganiEations in (artnershi( ith the go"ern%ent has e%(hasiEe& an& i%(le%ente& &ecease&

&onor trans(lantation in certain states in /n&ia 5 to %ention (articularl', the Ta%il Na&u %o&el. /nthe last to 'ears, &ecease& organ &onation has reache& 9.L (er %illion (o(ulation in Ta%il Na&uthereb' eecti"el' eli%inating co%%ercial trans(lantation. There is no religious bar $or organ&onation. A central trans(lant coor&inator a((ointe& b' the go"ern%ent o"ersees legiti%ate an&trans(arent allocation o$ &ecease& organs both in the (ublic an& (ri"ate $acilities as (er thetrans(lant aiting list. This %o&el also takes care o$ the (oor sections o$ societ' b' con&ucting&onation an& trans(lantation through go"ern%ent run (ublic $acilities $ree o$ cost. /n the last to'ears, &ecease& &onor trans(lantation has been (er$or%e& through this netork (rocuring organssuch as the heart, heart "al"es, lung, li"er, ki&ne's, cornea an& skin. The in$rastructural lack o$i%%unological sur"eillance 5 inclu&ing &onor s(eci6c antibo&' %onitoring, H-A t'(ing, (anelreacti"e antibo&' ece(t in a $e tertiar' care centres 5 (re"ents allocation accor&ing to thei%%unological status o$ the reci(ient. This (ri"ate5(ublic (artnershi( (ro%oting &ecease& &onortrans(lantation has eecti"el' eli%inate& co%%ercialiEation in trans(lantation in the state o$ Ta%ilNa&u ith a (o(ulation o$ Q %illion hich is a %o&el $or other regions o$ South Asia an& &e"elo(ingcountries.













There is a big ga( beteen &e%an& su((l' o$ organs in *atients ith Renal,He(atic an& Car&iac )ailure.

The TH8A 9::; authorise& Decease&&onor trans(lantation DDT1. But in ourcountr' the national a"erage is .9 7%illion (o(ulation 7 'ear

DDT has great (otential to abolish illegaltrade o$ Hu%an 8rgans



9 -akh *atient ith 0n& Stage -i"erDisease in /n&ia at (resent

8$ hich 9 -akh are aiting $or -i"er

Trans(lant Aroun& : li"er trans(lants ca&a"er 4

li"e relate&1 are &one in /n&ia e"er'



North /n&ia Sr creat 9.1 Q (%( S2Agaral,1

South /n&ia Q (%( M2 Mani, 1

Central /n&ia I /nci&ence o$ 0SRD 0n&Stage Renal Disease199 I L (%( Mo&i Jha, 1

S002 co%%unit' ca%(s,(re"alence 9Q.;U

,, &e"elo( 0SRD annuall'



The Bur&en o$ Chronic 2i&ne' Disease on De"elo(ing Nations> A 9st Centur'Challenge in Global Health Rachel A. Nugent, Sana ). )athi%a, An&rea B.)eigl, Doroth' Ch'ung Ne(hron Clin *ract 99V99>c:IcQQ D8/>9.99:7L9L







hat ill 'ou &o hen the can&le isabout to etinguish









Re%e%ber that there is @ife evenafter Brain =tem Death )or other nee&' (atients ho can be

gi"en li$e su((ort instea& o$ it beinguse& $or the brain &ea& (atients

)or the Reci(ients



B' *ro(er an& Ti%el' Certi6cation o$Brain Ste% &eath, e are gi"ing li$eto 91 *atient ho is going to use

this life support system 1, L1 To *atients ith 0n& Stage

'enal Diseases

;1 8ne *atient ith @iver 6ailure 1 8ne *atient in nee& o$ 5eart

trans(lantation



An' Surger' Carries a Risk,-etWs not subOect a health' hu%an to

a risk b' being a &onor

Discourage -i"e Donors0ncourage Registration in TN8S

an& ait $or Ca&a"er Donor



Decease& Donor Trans(lant ill eradicatewomen slavery here %ore than :U o$li"ing relate& 2i&ne' Donors are o%en

This is a social responsibility o$ theDoctors $or the Societ' $ro% hich the'shoul& not sh' aa'

Though Ta%ilna&u is a' ahea& other

states in Decease& Donor Trans(lant estill ha"e to ork har& to %o"e $orar& inother states an& centres



8cials in Go"ern%ent0tre%el' &e&icate& Neuro

consultants

/ntensi"ists ho are illing to%anage the (atients ith se"ereBrain Ste% D's$unction

Anaesthesiologists ho are illing to

&o A(nea testingA&%inistration ho are illing to

su((ort this (rogra%%e



The contributions %a&e b' all the(atients

The relati"es ho took the noble,

"aliant, gallant &ecision o$ &onatingthe organs o$ the &ecease&

















Dr.Shro Mr.C0

2arunakaran



S(lit -i"er > Single -i"er $or an A&ultan& one %ore chil&

FtiliEe More HeartsStu&' the 8utco%e o$ Trans(lant

Reci(ients /ncreasing aareness o$ hole bo&'

&onation



How Tamil Nadu Eradicated Organ Sale

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