Presentation on theme: "ORGAN DONATION & TRANSPLANTATION- Legal & Social Issues"— Presentation transcript:
1 ORGAN DONATION & TRANSPLANTATION- Legal & Social Issues Dr.Sunil ShroffManaging Trustee, MOHAN Foundation, ChennaiHead of Department - Urology & Renal Transplantation,Sri Ramachandra Medical College & Research Institution, Chennai, India
2 Death is not extinguishing the light but putting out the lamp because the dawn has come- Rabindranath Tagore
4 Types of Organ Donors After Natural Death Living person – related to patientLiving person – unrelated to patientAfter Brain Death
5 Organ Donation by a Living person BloodEyesBone marrowKidneysPortion of LiverPortion of LungPortion of PancreasIddham Shariram Paropkardum(This body is for the use of others) - Shankracharya
6 Organ Donation after Natural Death EyesSkin and fasciaHeart ValvesBones and TendonsCartilageVeins and ArteriesMiddle Ear BonesThe only thing you take with you when you're gone is what you leave behind John Allston
7 Organ Donation After Brain Death Eyes ( 2 )Kidneys ( 2 )Liver ( 1 )Lung ( 2 )Pancreas ( 1 )Small Intestine ( 1 )Voice Box or Larynx( 1 )Hand ( 2 )Penis ( 1 )Middle Ear Bones ( 2 )Skin and fascia - NumerousBone - NumerousCartilage - NumerousTendons - NumerousVeins - NumerousArteries - NumerousNerves - NumerousFingers and Toes ( 20 )
8 COMMMONEST TYPE OF ORGAN DONATION IN INDIA Blood - Living related or unrelatedEyes - After Natural DeathKidney Donation - Mostly unrelated and sometimes relatedAnd he will wipe out every tear from their eyes and death will be no more Revelations 21:4
9 Eye Donation Corneas Retrieved in India 1996- 99 1998-99 1997-98 Corneas Retrieved in India3 million corneally blind people in India. 60% are children below the age of 12. Target retrieval of corneas by Eye bank of India is 150,000 corneas per year.
10 Religious Heads of a Society ORGAN DONATION & TRANSPLANTATIONETHICAL * MORAL ISSUESPhiloshersMEDICAL ISSUES - PhysiciansSURGICAL ISSUES - SurgeonsSOCIAL ISSUES –Social ScientistsIMMUNOLOGICAL ISSUES –ImmunologistRELIGIOUS ISSUES –Religious Heads of a SocietyORGAN REGENERATION -Basic ScinetistsIMMMUNOSUPPRESSIVE DRUGS – Pharmacist & Pharmaceuticals
11 ORGAN DONATION & RELIGION Death is just a beginning of another life - Upanishads
12 Religion & Organ Donation HinduismReligious law does not prohibit Hindus from donating their organs, This act is an individual decision.JainismJain religious leaders consider eye donation as a sublime form of charity and stress a powerful link between ‘daan’ (charity) and ‘moksha’ (salvation). Highest eye donation rate in India among Jains of Gujarat.For that which is born death is certain and for the dead, birth certain.. Therefore grieve not over that which is inevitable Bhagavad Gita
13 Religion & Organ Donation CatholicismCatholics view organ donation as an act of charity, and self-sacrifice. Transplants are ethically and morally acceptable to the Vatican. Pope John Paul IIProtestantismProtestants encourage and endorse organ donation."We accept and believe that our Lord Jesus Christ came to give life and came to give it in abundance. Organ donations enables more abundant life, alleviates pain and suffering, and is an expression of love in the times of tragedy.”- Rev. James W. Rassbach
14 Religion & Organ Donation IslamIn 1983 the Muslim Religious Council initially rejected organ donation by followers of Islam, but it has reversed its position, provided donors consent in writing prior to their death. The organs of Muslim donors must be transplanted immediately and should not be stored in organ banks.Jehovah’s WitnessesJehovah’s Witnesses do not encourage organ donation but Believe it is a matter best left to the individual’s conscienceGod created man to be immortal and made him to be an image of his own eternity - Bible, The Wisdom of Solomon
15 Religion & Organ Donation BuddhismNo written doctrine but founder of a Buddhist Temple of Chicago said: "We honor those people who donate their bodies and organs to the advancement of medical science and to saving lives.”JudaismJudaism teaches that saving a human life takes precedence over maintaining the sanctity of the human body."If one is in the position to donate an organ to save another’s life it’s obligatory to do so, even if the donor never knows who the beneficiary will be,” Rabbi Moses Tendler
17 Is Living Organ donation Ethical ? Hippocratic oath – Do no HarmVoluntarism – Decision to donate in a family may not be voluntaryUsually more woman donate than men - mother or wife are the commonest donorsOne in 1000 living donor is likely to die even in best of surgical hands!!
18 Commercial Aspects of Organ Donation Most of the social and Ethical problems in organ donation due to kidney donationA person has a pair of kidneys and can donate one and still be healthyUsually trafficking of organs from the poor to the richOn e-bay the famous Internet Auction websites a Kidney was being auctioned for almost One million dollars!!!
19 Commercial Aspects of Organ Donation Despite Govt. authorization committee to regulate organ donation activity many instances of paid donors are reported!!Regular kidney scandals have become part of accepted newspaper readings in India!!Kidney in Indian society is looked upon as a commodity hence thetask of popularizing the concept of organ donation can be difficult!!
20 Questionable EthicsHuman Rights Violation- in China (1990) – 1670 kidneys transplanted mostly from executed criminalsCommercial Trading of Organs – in India(1990) – 1580 kidneys transplanted mostly from unrelated donorsBizarre instances of kidneys being removed by surgeons from an innocent donor is reported from all over the world regularlyInternet may be facilitating the whole process of organ trafficking
21 Ethical isues & Cost Factors Detractors –Transplant Surgery and patient maintenance -expensive not suitable for India.Transplant surgery adds a few extra years to life but takes away most of the family savings of Middle income group familyOnly rich can benefit with a transplant.No hope for Poor in this fieldKidney Tx – Rs.2 Lakhs for surgery & Rs.1 lakh / year afterwardsHeart Transplant – Rs. 5 Lakhs for Surgery & Rs.75,000 / year afterwardsLiver Tx. – Rs.10 to 15 lakhs for surgery and Rs.50,000 to 75,000/ year afterwards
22 Ethical issues - Is Transplant Surgery Necessary at all in India? Detractors –Transplants benefits a few in India and the same time and resources can be used by the doctors to instead save many other lives
23 Ethical issues - Is Transplant Surgery Necessary at all in India? Evangelist –There are 150,000 Patients with Kidney failure needing transplantsThe only hope for living for an Acute liver failure patient is to undergo a transplantHeart transplant gives an almost immediate improved quality of life to the patientThe long term success of the surgery are better than some of the cancersTransplant practice - “Cutting edge of medicine practice”- keeps us abreast with the latest in the field of research.
25 Aims Transplantation of Human Organs Act, 1994 Regulate removal, storage and transplantation of human organs for therapeutic purposesTo prevent commercial dealings in organsTamil Nadu Assembly passed the Act in May 1995
26 Main Provisions of THO Act Concept of “Brain Stem death” acceptedOnly “Living related Donors” are allowed to donate organs without legal problemsFor unrelated Donors - Permission from “Authority” required prior to surgeryRequires - “Regulation and Registration of hospitals” undertaking transplantation“Punishment for any commercial dealings in organs”1st Relative – Father / Mother / Brother / Sister / Spouse / Son/ Daughter
27 Death is usually a gradual event. Nail and hair can continue to Brain Stem DeathDefinition - Stage at which all functions of the Brain Stem have permanently and irreversibly ceasedCertificationPanel of four doctorsTwo sets of tests to be carried out - minimum of six hours in between the testsForm No. 8 to be used for certificationDeath is usually a gradual event. Nail and hair can continue toGrow even after death !!
28 Organ DonorPerson may authorize removal of any human organ before his death.Person may express his wish to donate his organs in the event of his death, through a ( Form No. 5 )“Informed Consent” of Family is crucial to cadaver organ donation.“Presumed Consent” – In some countries the law demands organ donation from its citizens, unless they express otherwise in writing
29 Offences and Penalties Commercial dealings in organsImprisonment : 2 to 7 yearsFines : Rs.10,000/- to Rs.20,000/-Penalties for DoctorsFirst Offence : Name struck off State Medical Register for 2 yearsSubsequent Offence : Name struck off permanentlySince the Act was passed there has been two criminal prosecution against doctors
30 Pitfalls - THO ACT Donors Scrapping of Sub Clause (3) , Clause 9 of Chapter IIIf any donor authorizes the removal of any of his human organs before his death under sub-section (1) of section 3 for transplantation into the body of such recipient, not being a near relative as is specified by the donor, by reason of affection or attachment towards the recipient or for any other special reasons, such human organ shall not be removed and transplanted without the prior approval of the Authorization Committee.Majority of kidney transplants in the country use thisclause resulting in “ legal commercialisation of kidneys”
31 Is There a solution to these Legal & Ethical Problems Restrict the number of Live unrelated kidney transplantsPush the “Brain death organ donation” Programme forwardMake amendments in the THO ActMake punishments for offences more stringent and effective
32 Brain Death ConceptsFirst recognised in 1959 in Paris in Intensive care units (coma de passe )Formally accepted as a form of death in 1968 by the ad hoc committee at HarvardAccepted by Govt. of India in 1994 as a form of deathIn Babies under one year brain death concept not applicable
33 Brain dead Pool of Donors No wastage of organs if organ donation from brain dead donors undertakenAlmost 95% of organ donors in western world originate from Brain Dead DonorsLargest pool of organ Donors in the world
34 In India Road traffic Accidents the commonest cause of brain death Common Causes of Brain DeathIn India Road traffic Accidents the commonest cause of brain death
35 Brain dead Pool of Donors in India In any of the metropolitan city in IndiaThere are at least on an average between 10 to 20 patients admitted in different ICUs who are brain DeadEven Doctors often fail to diagnose or recognise this condition!!
36 Transplant Statistics Number of transplants done throughout the world - 5,50000Number of patients on transplant waiting list - 1,50000Number of Transplants worldwide ,072Annual transplant figures are not rising. Though Waiting lists though are perpetually going up.
37 Transplant Activity of Western World (1985 to 1992) 1989
38 TOTAL TRANSPLANT ACTIVITY IN INDIA (1998 – 1999) Golden IT triangle of India Hyderabad, Chennai, Bangalore are also famous as “Kidney Bazaars” in the western world
39 DON’T TAKE YOUR ORGANS TO HEAVEN FOR HEAVEN KNOWS THEY ARE NEEDED HERE !!
41 Unusual Social Situations & Dilemmnas In certain brain death situations despite the consent of the family organ donation was not possible -Two wives where first legal wife raised an objection to organ donationAsking for money by family for organsDeath by hanging in recently married girlBrain death in a destitute where no relatives were available for consent
42 Problems with Cadaver Organ Donation Programme in India Govt. ProblemNo Funding for programmeHospital problemNo efforts to identify & maintain “Brain Dead” donorsCommunity ProblemNo Awareness of “Brain-Death” ConceptSpain has the highest number of brain death patients goingon to organ donation – 32 per million population
43 Streamlining of THO ACT Make it compulsory for doctors or medical social workers to ask for Organ Donation in a Brain Dead SituationIdentify doctors or senior nurses to work as Transplant Coordinators in each ICUIn Medico-legal cases it should be possible to perform Post-Mortem at same time as organ retrieval in presence of a Forensic ExpertNo financial costs involved in the above recommendations
44 Organ Donation Awareness Programmes Mandated Choice on Driving License about organ donationEducation at School and College LevelFree Air time on Doordarshan and Private Channels for films on Organ DonationTax Exemption for documentaries on Organ DonationIndirect incentives to donor familiesHonoring cadaver donor familiesIn states of Maharastra & Gujarat slogans about “Eye donation” displayed on National Highways
45 MOHAN Foundation - Objectives ( Multi Organ Harvesting Aid Network ) Formed in 1997Spread Message of Organ DonationWorks as a support group for Patients, Public & PhysiciansFoundation subgroups –Organ Sharing Group – INOSCounselling unit – ManashanthiPatient Support GroupPublishes “Indian Transplant Newsletter”
46 Organ Donor Cards by MOHAN Foundation Carry the card in the walletServes also as an emergency cardThe Foundation has distributed almost 100,000 cards in India. Cards are available in English, Tamil. Hindi and Marathi
47 Give Life a SECOND Chance… Organ Donor Cards by MOHAN FoundationGive Life a SECOND Chance…Carry a Donor Card
48 MEMORIAL SERVICE 31ST OCT 1999 Loyola College, Chennai HONOUR OF CADAVER ORGAN DONORS ORGANISED BY MOHAN FOUNDATIONSaplings Planted in Memory of cadaver Organ Donors by their family members in the Campus of Loyola College on 30th Oct organised by MOHAN FoundationPainting Completion on Organ Donation theme organized for schools by MOHAN Foundation in March 2002Movie in English, Hindi and Tamil for Television ChannelsMade by MOHAN Foundation
49 INOS - Initiative for organ sharing Group Formed in Nov’1999 by MOHAN FoundationEssence of INOS – “Not to Waste Any Organ”Hospital in group includes – Apollo, CMC Vellore, Sri Ramachandra Hospital and Sundaram Medical FoundationAbout 30 different organs shared between hospitalsUNOS in USA is the largest organization such organizationand is partly funded by the government
50 Counselling Unit- Manashanthi Formed in April 2001As a support group for emotional failureLocated at AnnanagarCounselling available between 10AM and 1PMOrganises counselling lectures and workshops
51 LIFE PASS IT ON !!At a certain moment a doctor will determine that my brain has ceased to function and that, for all intents and purposes, my life has stopped…… When that happens don't call this my “DEATHBED”, call it my"BED OF LIFE" and let my body be used by others to lead fuller lives
52 LIFE PASS IT ON !!Give my blood to the teenager who has been pulled from the wreckage of his car, so that he might live to see his grandchildren play
53 LIFE ......PASS IT ON !! Give my eyes to a man who has never seen…. SunriseA baby’s faceor Love in the eyesof a woman
54 LIFE PASS IT ON !!Give my kidneys to one who depends on a machine to exist from week to weekGive my heart to a person whose own heart has caused nothing but endless days of pain
55 LIFE PASS IT ON !!Explore every corner of my brain, take my cells and let them grow so that someday….a speechless boy will shout at the crack of a bat and a deaf girl will hear the sound of rain against her window
56 LIFE PASS IT ON !!Take my bones, every muscle, every fibre and everynerve from my body….……..to find a way to make a crippled child walk
57 LIFE PASS IT ON !!Burn what is left of me and scatter the ashes to the winds to help the flowers growIf you must bury something, let it be my faults, my weaknesses and all my prejudice against my fellowmen
58 LIFE PASS IT ON !!Give my sins to the devil and give my soul to God,If you do what I have asked, ………I WILL LIVE FOREVER ( The above is a Legacy of Robert N.West written in 1976 )
59 “THANK YOU” In my end is my beginning - T.S.Eliot, Four Quartets A MOHAN FOUNDATION PRESENTATIONIn my end is my beginning - T.S.Eliot, Four QuartetsFor further information about organ donation contact us at:Multi Organ Harvesting Aid NetworkA -113 Annanagar,3rd Avenue, Chennai – , IndiaTel: 044 –