Deceased Donor Program

TRANSPLANTATION

Transplantation is the transfer of an organ or tissue from one person to another for the purpose of replacing recipient’s damaged organ or tissue.

Yes. Transplantation of many organs and tissues has now been established as a routine procedure with good outcome. In fact, in many situations it is the only option available to save a patient's life.

Organ transplant is usually performed when any organ of a person has stopped functioning properly leading to severe limitation in regular activities and high likelihood of early death.

Despite a lot of advances in scientific knowledge and technology, only organs from other people can be used for transplanting into a patient, to date. These organs or tissues may be obtained either from a living or a deceased person. A living person may donate from the paired organs such as kidney, or a piece from his organ such as liver. Blood, bone marrow, skin or bones may also be donated by living donors. Multiple organs and tissues may be obtained from a deceased person including kidneys, liver, pancreas, heart, lung and intestine and other tissues.

ORGAN DONATION

Organ donation is a complete process which starts with a person expressing their will to donate their organ, either during their lifetime or after their death in order to save or improve a patient's life.

It is carried out as a proper surgical procedure in an operation theatre, in all the cases.

In case of a living donor, a kidney or part of a liver is removed from the donor and placed into a specific patient, usually a close relative.

Donation after death is an even more selfless act, whereby multiple organs from a donor are considered a national resource and transplanted in to a number of patients, based on who needs it the most. Again the process of removal of organs is carried out as proper surgical procedure in an operation theatre.

There is extreme shortage of organs all over the world due to which a lot of patients die while waiting for an organ. In Pakistan, an estimated 50,000 people die each year due to end stage organ failure. This figure includes 15,000 people with kidney failure, 10,000 with liver failure and 6500 with heart failure. Majority of these patients can be saved if the organs are available for transplantation.

A. living organ donation

B. deceased organ donation

Living Organ Donation

Living organ donation means donating an organ or part of an organ for transplantation to a patient during life. The living donor may be a family member such as a parent, child, brother or sister, directly related to the patient.

A number of tissues, organs or part of an organ may be donated during life. This includes,

Blood – May be donated every few months.

Bone Marrow – May be donated to a person with bone-marrow failure.

Bone – After total hip replacement surgery, part of bone that is going to be removed from the body may be donated. Kidney, part of the liver, and part of the lung – May be donated to a close relative.

Skin – Excessive skin removed during surgery may be donated.

DECEASED ORGAN DONATION

Deceased organ donation means acquiring organs from a person after death to be transplanted into other persons in order to save or improve their lives. It is an established medical procedure, which is legally, morally and socially considered as an act of profound generosity.

Deceased organ donation involves either making a declaration during life time to be an organ donor authorizing a competent authority and hospital to remove organs after death or involves a situation when no such declaration was made during life time but the family of a brain dead patient desires that the organs may be removed to save lives of others.

All over the world thousands of people, suffering from organ failure, die each year while waiting for a donated organ. The living organ donation program, despite advancements, has failed to cope with this enormous burden. Globally the increase in transplant activity has only been possible due to increasing numbers of deceased organ donations.

The exact figure for Pakistan is not available but according to a conservative estimate more than 50,000 people die each year due to end stage organ failure. This figure includes 15,000 people with kidney failure, 10,000 with liver failure and 6500 with heart failure. Majority of these patients can be saved if the organs are available for transplantation.

Anyone can be an organ donor. There is no absolute age limit for deceased organ donation. Despite this only a handful of people can become organ donors. This is because if someone dies at home the blood clots immediately, making it impossible to use their organs for transplantation. On the other hand if someone fatefully meets an accident, is taken to a hospital, put on a ventilator and when all efforts to save his life fail and the person becomes brain dead, that person’s organ may be saved and transplanted to save the lives of several others.

Organs that can be donated include kidneys, heart, liver, lungs, pancreas and intestine.

BRAIN DEATH

When part of the brain responsible for control of breathing stops functioning, heart beat stops permanently, that person dies. This is called brain death.

If at the time of brain death the patient is on a ventilator, their heart beat and breathing may be maintained artificially for some time—this person may become an organ donor.

Brain death is suspected when the following conditions are present:

• Deep irreversible coma
• Absence of cerebral functions
• Absence of brain stem functions including spontaneous respiration Irrefutable cause of catastrophic brain damage from brain trauma, cardiac arrest, etc.

Examination is performed by an experienced medical professional and confirmed by a specialist (neurologist, neurosurgeon, intensivist, and anesthetist).

The examination must be repeated after a suitable interval (6-48 hrs). All brain stem signs should be absent on both occasions.

It is important that no doctor related to organ harvesting is a member of the brain death certification team.

• Loss of spontaneous eye movements
• No papillary reaction to light
• No corneal reflex
• No occulo-cephalic reflex
• No vestibule- ocular reflex
• No gag reflex
• Unresponsiveness of respiratory centre to high CO2 tension (Apnea test)

Coma and brain death are two separate conditions.

Coma is a condition when a person who is alive has severe brain dysfunction making them completely unresponsive. They are alive but unconscious. Their brain is able to carry on the automatic control of breathing. There is a possibility that they may recover their brain function and regain consciousness.

Patients who are brain dead, on the other hand, have no chance of recovery. Their brain is not able to carry on the vital function of breathing.

There is no possibility what so ever that this process may be reversed.

It is also important to understand that patients in coma may deteriorate further and die manifesting as brain-death.

PVS describes a condition in which there is severe brain damage and patients do not respond significantly to most stimuli. However they may respond to some pain and has some reflexes, but do not respond to voice and do not communicate. They mostly breathe on their own. This is a potentially reversible condition. So organs cannot be retrieved from a patient with PVS.

NO! This is not possible. Once brain death is established this process is irreversible like any other death. Simply stated such a person has died.

Donor related issues

There is no absolute age limit for deceased organ donation. In general organ may be donated from someone as young as newborn or as old as 75 years. Depending on the tissue in question, the age limit for donation is below 80 for cornea, and between 16- 60 years for long bones. There is no age limit for skin donation.

There are very few absolute contraindications for organ/tissue donations. For example, patients with some infectious diseases or cancer (except brain cancer that has not spread) may not be suitable for organ donation. The medical team in charge of the transplant will assess all potential donors individually for suitability of the organs/tissues for donation.

It is important as it will help the family to give permission for donation. However if you have not expressed a contrary will in your life, the family may still consent for donating your organs once you pass away. You may also help by registering as an organ donor and filling in a donor card.

Deceased Donation in Muslim Countries

Almost all Muslim countries with organ transplant facilities are performing deceased organ transplantation including Saudi Arabia, Iran, Turkey, Kuwait, Lebanon, Malaysia, Egypt, and Bangladesh among others.

On 8th April 2015 Sheikh Zayed Islamic center in collaboration with Sindh Institute of Urology and Transplantation organized a seminar on "Organ Transplantation and Donation in the Light of Quran and Sunnah". Many Scholars and Ulemas of different fiqahs presented their views and highlighted their importance on the given issues and explained the complexities. The proceeding was compiled and recorded in a form of a book namely "Majmoo-e-Khutbaat" and was launched on 29 January 2016. The book can be available free of cost at SIUT to read further about the views kindly visit the link mentioned below.
Download Book here