Organ Transplantation is a medical procedure in which a failing or damaged organ is removed from patient’s body and replaced with a functioning one. The donated organ may be from a living donor or a deceased donor. In rare cases animal organ or artificial organ is also used.
Organs that have been successfully transplanted include the heart, kidneys, brain, lungs, pancreas, intestine, and thymus. Organ transplantation is often the only treatment for end stage organ failure, such as kidney failure, liver and heart failure.
Organ transplantation is often lifesaving and gives the recipient a wonderful new lease of life.It is also a major surgery that carries potential risks, such as the chances of organ rejection. That is why one needs to gather as much information as possible on organ transplants, before deciding to go for it.
Types of Organ Transplantations
Different types of transplantations are listed below:
- Kidney Transplant
Kidney transplantation is a surgical procedure that’s done to treat kidney failure.
The kidneys filter waste from the blood and remove it from the body through urine. They also help maintain body’s fluid and electrolyte balance. If kidneys stop working, waste builds up in body and result in various issues.
People whose kidneys have failed usually undergo dialysis, which mechanically filters waste that builds up in the bloodstream when the kidneys stop working. In this procedure, one or both kidneys are replaced with donor kidneys from a live or deceased person.
It is one of the most common types of transplants that take place.
In Liver transplant patient’s diseased liver is replaced with a healthy liver graft from a donor. Donor liver graft can be obtained from deceased donors, or a family member may choose to donate a portion of his liver to the patient.
- Heart Transplant
In heart transplantation a healthy heart from a donor who has suffered brain death is used to replace a patient’s damaged or diseased heart.
Due to the complexity of this procedure, strict medical criteria is imposed in assessing whether a donor’s heart is suitable for transplant, and whether a potential recipient is suitable to receive the transplant.
- Lung Transplant
In Lung Transplantation One lung or both lungs from a recently deceased donor are used to replace a patient’s diseased lung or lungs.
- Pancreas Transplant
This type of transplant is commonly done on type 1 diabetic patients whose pancreas doesn’t work properly.
- Cornea Transplant
In Cornea Transplant damaged or cloudy cornea can be replaced surgically with a healthy, normal cornea, donated by another individual. It helps restoring vision to those blinded by corneal disease.
Laws and Rules Governing Organ Transplantation
Transplantation of Human Organs Act (THO) passed in 1994, is theprimary legislation related to organ donation and transplantation in India. This Act is aimed at regulation of removal, storage and transplantation of human organs for therapeutic purposes and to prevent commercial dealings in human organs.
The amendment to the Act was passed by the parliament in 2011, and the rules were notified in 2014.
The essence of this legislation are :
- To accept brain death also as a definition of death
- To stop commercial dealing in organs
- To define the first relative (father, mother, brother, sister, son, daughter and wife) who could donate organs without permission from the government
The main provisions of the Act (including the amendments and rules of 2014) are as follows:
- Brain death is identified as a form of death
- Allows transplantation of human organs and tissues from living donors and cadavers (after cardiac or brain death)
- Regulatory and advisory bodies for monitoring transplantation activity and their constitution defined.
Appropriate Authority (AA): Inspects and grants registration to hospitals for transplantation. It enforces required standards for hospitals, conducts regular inspections to examine the quality of transplantations.
Advisory Committee: It consists of experts in the domain who shall advise the appropriate authority.
Authorization Committee (AC): It regulates living donor transplantation by reviewing each case to ensure that the living donor is not exploited for monetary considerations and to prevent commercial dealings in transplantation. Proceedings are video recorded and decisions are notified within 24 hours. Appeals against their decision may be made to the state or central government.
Medicalboard (Brain Death Committee): It consists of Panel of doctors responsible for brain death certification. In case of non-availability of neurologist or neurosurgeon, any surgeon, physician, anaesthetist or intensivist, nominated by medical administrator in-charge of the hospital may certify brain death.
Living donors are classified as either a near relative or a non-related donor.
A near-relative (spouse, children, grandchildren, siblings, parents and grandparents) needs permission of the doctor in-charge of the transplant center to donate his/her organ.
A non-related donor needs permission of an Authorization Committee established by the state to donate his organs.
Swap Transplantation : When a near relative living donor is medically incompatible with the recipient, the pair is permitted to do a swap transplant with another related unmatched donor/recipient pair.
Authorization for organ donation after brain death
May be given before death by the person himself/herself or
By the person in legal possession of the body. A doctor shall ask the patient or relative of every person admitted to the ICU whether any prior authorization had been made. If not, the patient or his near relative should be made aware of the option to authorize such donation.
Authorization process for organ or tissue donation from unclaimed bodies outlined.
Organ retrieval permitted from any hospital with ICU facility once registered with the appropriate authority. Any hospital having Intensive Care Unit (ICU) facilities along with manpower, infrastructure and equipment as required to diagnose and maintain the brain-stem dead person and to retrieve and transport organs and tissues including the facility for their temporary storage, can register as a retrieval center.
Cost of donor management, retrieval, transportation and preservation is to be borne by the recipient, institution, government, NGO or society, and not by the donor family.
Procedure for organ donation in medico-legal cases is defined to avoid jeopardizing determination of the cause of death and delay in retrieval of organs.
Manpower and Facilities required for registration of a hospital as a transplant center are outlined.
Infrastructure, equipment requirements and guidelines and standard operating procedures for tissue banks are outlined.
Qualifications of transplant surgeons, cornea and tissue retrieval technicians are defined.
Appointment of transplant coordinators (with defined qualifications) made mandatory in all transplant centers.
Non-governmental organizations, registered societies and trusts working in the field of organ or tissue removal, storage or transplantation will require registration.
The central government to establish a National Human Organs and Tissues Removal and Storage Network i.e. NOTTO (National Organ & Tissue Transplant Organisation), ROTTO (Regional Organ & Tissue Transplant Organisation) and SOTTO (State Organ &Tissue Transplant Organisation). Manner of establishing National or Regional or State Human Organs and Tissues Removal and Storage Networks and their functions are clearly stated.
The central government shall maintain a registry of the donors and recipients of human organs and tissues.
Penalties for removal of organ without authority, making or receiving payment for supplying human organs or contravening any other provisions of the Act have been made very stringent in order to serve as a deterrent for such activities.
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