JMA Bruno Mascarenhas M.Ch.

, (Neuro)
Asst Professor of Neurosurgery, Madras Medical College
&
Technical Associate, Cadaver Organ Transplant
Programme
Government of Tamil Nadu

31st Oct 2014, Aurangabad

ISOT 2014

31st Oct 2014, Aurangabad

ISOT 2014

 Four

Working Groups:

Cadaver organ donation

Cadaver organ transplantation
Coordinating Organization for organ

sharing
Live donation and transplantation
33

recommendations for follow up

action.

31st Oct 2014, Aurangabad

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 The

participants felt that there were

many grey areas in the
Transplantation of Human Organs Act.
In particular, no guidelines on who
will get the donated cadaver organ
The Government followed up with a
series of consultative meetings held
with groups of doctors by
Mr.P.W.C.Davidar IAS
31st Oct 2014, Aurangabad

ISOT 2014

 Declaration

of brain death made

mandatory
Procedure for declaration of Brain Death
Authorization Committee Procedures
Procedure to be adopted for Cadaver
transplant by the Government and Private
Hospitals
Responsibilities of Transplant centers in
hospital
Convenor, Cadaver Transplant Program
Post-mortem examination in medico legal
cases Procedure prescribed
31st Oct 2014, Aurangabad

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 Prof

Dr J Amalorpavanathan, Professor
of Vascular Surgery, MMC & RGGGH
appointed as Convenor, Cadaver
Transplant Programme in honorary
capacity
Office space provided at the
Government General Hospital
Advisory Committee headed by Health
Secretary, GoTN
Mr Davidar, DMS, DME, TNMSC,
Police Dept, 2 NGOs, 1 Medical Ethicist,
3 Government Hospitals, 4 Private Hospitals
31st Oct 2014, Aurangabad

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 Initiatives

for forming Tamil Nadu

Network for Organ Sharing and
maintaining a common online
waitlist for all potential recipients in
all hospitals who choose to come
under this network in Tamil Nadu and
allotment of organs by the Network
Common Waiting List (based Blood
Group) visible to all stakeholders
Allocation based on waiting List
31st Oct 2014, Aurangabad

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 Identified key champions

Got the State Government involved
Got the Major Hospital Managements

involved
Got the Media involved

31st Oct 2014, Aurangabad

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 THOA

alone is not enough for

Cadaver Transplant
It regulates only who can donate,
where and how
No say on who will get the organs a crucial issue
No progress possible without this first
step
Maharashtra did it first. Karnataka, TN
and AP followed next
31st Oct 2014, Aurangabad

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10

 Because

organs donated
altruistically do not belong to the
donor hospital or to anyone else
They are donated to society at large.
Its representative, the government,
has to decide who gets it.
Worldwide, this is the practice.

31st Oct 2014, Aurangabad

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11

 Should

be based on socially
accepted norms of fairness,
accountability and transparency
Without such authentic framework,
hospitals will not feel confident or
secure to move forward and will
always quarrel with each other

31st Oct 2014, Aurangabad

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12

 TN

regulation is better than of other

states - more practicable
Because it evolved through a wide
process of consultation with
stakeholders
All transplant hospitals called for a
one day consultation, followed by
dozens of meetings with small
groups of specialists
The Framework is evolving still
31st Oct 2014, Aurangabad

ISOT 2014

13

 Hard

Infrastructure existed to some

extent, even if inadequate
Soft Infrastructure knowledge and
skills in brain death certification,
cadaver maintenance, regulatory
compliance etc., developed
Organised training programmes and
prepared detailed protocols for all
activities
Sensitised Police Department
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14

 That

Neuro-specialists do not
cooperate in brain death declaration is
a Trojan Horse
If top managements of hospitals get
involved, all issues get sorted out
Bottom Line is what drives private
hospitals
In TN, Liver Transplant Hospitals are
more motivated than Kidney Transplant
Hospitals
31st Oct 2014, Aurangabad

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15

 Hard

infrastructure provided in key

government hospitals
Developed Kidney, Liver and Heart
transplant capabilities there
Edge in organ allocation
Top down pressure until inertial
barrier is crossed
Because most potential donors arise
here
Also because society looks to see who
gets the organs
31st Oct 2014, Aurangabad

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16

 Immunology

Lab Accessibility 24

hrs
ICU Beds, Ventilators in key public /
charitable hospitals
Ambulances
Debate ethical issues in
infrastructure allocation immediate
vs. distant, visible vs. invisible life
saving
31st Oct 2014, Aurangabad

ISOT 2014

17

 Costs

very little time and effort to

highlight human interest stories in
organ donation
The Hithendran effect in TN
Media brings pressure on hospitals,
doctors

31st Oct 2014, Aurangabad

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18

 Appropriate

Authority more friendly

and effective
Laws interpreted in spirit, not word
Time delays avoided in approving
hospitals and panel of names for BD
certification

31st Oct 2014, Aurangabad

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19

 Cribbing on THOA deficiencies

Complaining about Neurologist

non-

cooperation
Waiting for Central Government to
act
Waiting for State Government
funding
Doing awareness generation
programs (75% consent rate in TN)
31st Oct 2014, Aurangabad

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20

 Convenor
Overseen

runs the CTP

and supported by the
Advisory Committee which keeps
watch and amends Guidelines as
needed
Participating hospitals to keep
providing inputs to improve the
Guidelines
31st Oct 2014, Aurangabad

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21

 Register

willing transplant hospitals

in the organ sharing network
Keep them posted of the regulatory
framework
Convene meetings of the Advisory
Committee and take follow up action

31st Oct 2014, Aurangabad

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22

 Take

calls 24X7 from donor hospitals,

allocate organs and co-ordinate till
transplants take place
Send periodic reports
Maintain database of cadaveric and
live donor transplants
Maintain website www.dmrhs.org
Convene meetings of hospitals for
ideas on improving the framework
31st Oct 2014, Aurangabad

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23

 Hospitals

treating patients with End

Stage Organ Failure (Kidney failure
or liver failure or heart failure)
register those willing for transplant
at the online database www.tnos.org
Waiting List is maintained online and
is watched by all hospitals in the
programme
31st Oct 2014, Aurangabad

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24

 Each hospital
All Government hospitals combined
All private hospitals combined and
All Hospitals Combined

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25

 1st

priority - List of the Government

Hospital where the deceased donor is
located, for liver, heart and one kidney.
The other kidney world be allocated to:
2nd priority - combined Government
Hospitals list
3rd priority - combined Private
Hospitals list
4th priority - Government Hospitals
outside the State
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26

 5th

priority - Private Hospitals

outside the State
Finally, if the organ(s) remains
unutilized by the above criteria, it
may be offered to a foreign national
registered in a Government or
Private hospital within and then
outside state. (This is to ensure that
there is no wastage of organs
donated)
31st Oct 2014, Aurangabad

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27

 1st

priority - the list within the

Private Hospital where the
deceased donor
is located, for
liver, heart and one kidney. The
other kidney world be allocated to:
2nd priority - the combined list of
Government and Private Hospitals
3rd priority - Government / private
hospitals outside the state

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28

 Finally,

if the organ(s) remains

unutilized by the above criteria, it
may be offered to a foreign
national registered in Government
or private hospital within and then
outside the state, provided earlier
information and such a request has
been registered with the Advisory
committee /Convenor, Cadaver
Transplant Program, Tamil Nadu.

31st Oct 2014, Aurangabad

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29

 530

Donors From Tamil Nadu

96 Heart
42 Lung
488 Liver
948 Kidney

1577

Major organs

534 Heart Valve

794 Cornea
10 Skin

2915

Total Organs

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30

 948

Patients with Chronic Renal

Failure have been benefitted
+
948 Healthy patients were not
operated

31st Oct 2014, Aurangabad

ISOT 2014

31

 State

Government Hospital to do
Heart Transplants
And Totally Free of Cost

31st Oct 2014, Aurangabad

ISOT 2014

32

 State

Government Hospital to do
Liver Transplants
And Totally Free of Cost

31st Oct 2014, Aurangabad

ISOT 2014

33

 Deceased

Donation (ie Donation

from Braid Stem Dead patients) Rate
in TN is 1.3/million/year which is 10
times the national average

31st Oct 2014, Aurangabad

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34

 In

July 2010, a 14 nation WHO meet

in Geneva to establish a blue print to
improve organ donation in UN
Countries, put in TN Experience as a
key point in the blue print prepared
Many states have followed TN Model

31st Oct 2014, Aurangabad

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35

 New lives out of deaths

V.K. Subburaj, P.W.C. Davidar, J.
Amalorpavanathan and C.E. Karunakaran Tamil
Nadu shows the way in organ transplantation.
If

your liver has failed and you need a

functioning organ to be transplanted for
you to survive then go to Chennai: this
is the buzz among liver-failure patients
across India The State has done 110
deceased donor liver transplantations in
a period of less than two years. All other
States put together have not done even
half this number.

31st Oct 2014, Aurangabad

ISOT 2014

36

31st Oct 2014, Aurangabad

ISOT 2014

37

 HOW

DECEASED DONOR
TRANSPLANTATION IS IMPACTING A
DECLINE IN COMMERCIAL
TRANSPLANTATION - THE TAMIL
NADU EXPERIENCE
Yuvaram N V Reddy(1), Milly
Matthew(1), Saravanan S(1),
Amalorpavanathan(3), Georgi
Abraham(1,2), Sunil Shroff(4)
31st Oct 2014, Aurangabad

ISOT 2014

38

31st Oct 2014, Aurangabad

ISOT 2014

39

Cadaver

Organs Transplant
Programme is
neither too trivial to ignore and

do nothing
nor too complicated to despair
of.
31st Oct 2014, Aurangabad

ISOT 2014

40

 Deceased

Donor Transplant will

eradicate women slavery
where more than 90% of living
related Kidney Donors are women
This is a social responsibility of
the Doctors for the Society from
which they should not shy away

31st Oct 2014, Aurangabad

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41

 Extremely

dedicated Neuro
consultants
Intensivists who are willing to
manage the patients with severe
Brain Stem Dysfunction
Anaesthesiologists who are willing to
do Apnea testing
Administration who are willing to
support this programme
31st Oct 2014, Aurangabad

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42

 The

contributions made by all the

patients
The relatives who took the noble,
valiant, gallant decision of donating
the organs of the deceased
Transplant Team

31st Oct 2014, Aurangabad

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43

 Officials

31st Oct 2014, Aurangabad

in Government

ISOT 2014

44

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31st Oct 2014, Aurangabad

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31st Oct 2014, Aurangabad

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49

 Dr.Shroff

Mr.CE

Karunakaran
31st Oct 2014, Aurangabad

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50

 Split

Liver : Single Liver for an Adult

and one more child
Utilize More Hearts
Study the Outcome of Transplant
Recipients
Increasing awareness of whole body
donation

31st Oct 2014, Aurangabad

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31st Oct 2014, Aurangabad

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52