Innovations and Challenges in

Deceased Donor Transplants in

Government General Hospital,
Madras Medical College, Chennai
Sundar.V, Deiveegan.K, Arunkumar.R, Ramesh.V.G,
Maheswar.K, Sekar.C, Bruno-Mascarenhas.JMA

19th Annual Conference of Neurotrauma Society of India

20th to 22nd August 2010. Chennai.
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 Why Deceased Donor (or
Cadaveric) Transplantation?
 Because it saves lives
 Because it can eliminate illegal organ trade
 Because most people are willing to donate
cadaveric organs when aware
 Because technology and physical
infrastructure are in place
 Because India lags far behind world
average in such transplantation

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 How much does India
lag?
As one can see here,
India’s economic
prosperity is not as
far behind other
countries (in
purchasing power
parity terms) as its
record is in cadaver
donation – one
twentieth that of
Thailand.

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 Reasons for Low Number of
Deceased Donor Transplants
 Before 2008
 Even when the medical condition
(clinical and medical criteria have
been met for) of a patient has
reached a brain death stage, brain
death certification was not done
 Lack proper mechanism for
identifying the recipients

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 Brain Death not being
certified
 Reasons
 Brain death is not declared when it has occurred.
 Doubts in medical circles on the authority by which
doctors may declare "Brain Death" whenever required.
 Certain Grey areas of THOA 1994
 Procedural Difficulties / Lack of Protocol / Who to do
what
 Issues of not certifying brain death
 Several patients who are brain dead were kept on life
support systems that could have been utilized by other
patients who are not in a similar state and have a better
chance of recovery.
 Prolonged anxiety for all family members and friends of
the brain dead patient.

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 Lack of proper mechanism
for identifying the recipients
 All Hospitals treating head injury
patients were not doing Kidney, Liver
or Heart Transplants
 Many Hospitals doing Liver, Heart
Transplants do not admit Head Injury
Patients !!
 Lack of Co ordination Mechanism

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 Initiatives in Tamil Nadu
 Initiatives for Certification of Brain Death
 Initiatives for forming “Tamil Nadu Network
for Organ Sharing”
http://www.dmrhs.org/tnos/ and
maintaining a common online waitlist ( at
http://tnos.org/ ) for all potential recipients
in all hospitals who choose to come under
this network in Tamil Nadu and allotment
of organs by the Network

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 Initiatives for Certifying
Brain Death
 A series of GOs (Government Orders) by the
Government of Tamil Nadu (available at
http://www.dmrhs.org/tnos/orders-of-tn-govt)
 Establishing clear guidelines for brain death
certification and organ sharing
 Creation of awareness among the neurosurgeons
 Appointment of Transplant co ordinators by a NGO
under Public Private Partnership for counseling the
relatives
 Early Postmortem of the deceased
 Free / subsidized transportation of the dead body
to the home.
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 Initiatives for Transplantation
from Deceased Donors
 Appointment of Transplant co ordinators by
a NGO under Public Private Partnership
who also network with transplant co
ordinators from other hospitals
 Management of the patient at the Post
Anaesthetic Care Unit under the
Anesthetists,
 Orders of Dean, MMC & GGH enabling the
Elective Operation theatre to be used at
the Night Time and Odd Hours for Organ
harvesting and Transplants
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 Procedure for declaration of
brain death
 G.O. (Ms) No. 75 Dated : 03.03.2008
Health and Family Welfare (Z1)
Department
 Form 8 of the THO Act and Rules as found
in the Annexure-I to this order are
prescribed as the brain death certification
format to be utilised for any given situation
requiring certification that a person is dead
on account of permanent and irreversible
cessation of all functions of the brain stem.
 The tests prescribed therein and the
findings required shall remain the same.
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 Who, When, What, Why
 According to Form 8 of the said Act
and Rules, when such certification is
required, there shall be two medical
examinations conducted by a team
of doctors after a minimum
interval of six hours and the
findings made based on the tests
prescribed therein.

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 How ??
 One aspect of the above form
requires further clarification and this
is provided in Annexure-II of this
order as Guidelines for Apnoea
Tests

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 Transplant co ordinators
 Appointment of Transplant co ordinators by a NGO
under Public Private Partnership
 Counseling the relatives
 Informing Transplant Co Ordinators of Other
Hospitals Involved and keeping in touch
 Arranging a Room in the Hospital for the bereaved
family
 Co Ordinating with the RMO Office, Matron Office,
Theatre, Labs etc for arranging surgeries at short
notice even at odd hours
 Arranging Early Postmortem
 Free / subsidized transportation of the dead body
to the home.
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 First Certification
 26th Oct 2009
 First Brain Death Certification
following the GOs issued
 Kidneys were transplanted
 One at GGH
 One at Stanley Medical College Hospital

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  Nov 2009 : 2 Donors
 Dec 2009 : 4 Donors
 Feb 2010 : 3 Donors
 Of these 2 Donors happened on the
same day and 3 kidneys were used in
GGH and 1 for Stanley.
 3 Kidney Transplants were done on
the same day in GGH (when the 175th
Year Celebrations were going on)

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  Mar 2010 : 3 Donors
 This includes a tragic, yet heartwarming
story of a 10 year old girl who Sustained
head injury following RTA
 Child’s father was undergoing Dialysis at
GGH
 As the father was not the number 1 in
waiting list, permission of Government
was obtained As a special case and the
child’s kidneys were transplanted to the
father
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  April 2010 : 4 Donors in GGH and 2 in
Stanley
 June 2010 : 1 in GGH and 2 in
Stanley
 July 2010 : 4 in GGH
 GGH did 2 heart transplants

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 Transplant Done in Government
Setup (Oct 2008 to Jul 2010)
 Kidneys (72)
 GGH :
 22 : From GGH Donors
 19 : From Donors from other hospitals

 Stanley Medical College Hospital

 05 : From Stanley Medical College Donors
 26 : From Donors from other hospitals

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 Transplant Done in Government
Setup (Oct 2008 to Jul 2010)
 Livers (11)
 Stanley Medical College Hospital
3 : From Stanley Medical College Donors
 8 : From Donors from other hospitals

 Heart (4)
 Government General Hospital
2 : From Government Hospital Donors
 2 : From Donors from other hospitals

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 In a Nut Shell
Kidneys Livers Heart
GGH Contribution 42 18 05
Used within GGH 22 00 02
Given to Stanley 15 06 00
Given to Govt Hospitals 37 06 02
Government Hospitals to 05 12 03
Private Hospitals in Network
Private Hospitals to 21 02 02
Government Hospitals in
Network

20-Aug-2010 Got 16
Neurotrauma 2010 Given 10 Given 01
22
 Tamil Nadu (Oct 2008 to Jul 2010)
Donors From TN 111
Heart 25
Lung 02
Liver 98
Kidney 213
Total Major organs 338
Heart Valve 122
Cornea 174
Skin 1
20-Aug-2010 Total Organs
Neurotrauma 2010 635 23
 Increasing trend in TN

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  Because of the Proactive action by
the Government of Tamil Nadu,
Cadaver Transplant Programme has
taken a big leap forward in Chennai
and also in the rest of Tamil Nadu
 This is a prototype model which
may be followed by other
states / institutes.

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  Relevant Government Orders are
available at http://
www.dmrhs.org/tnos which can be
used as reference to start similar
programme
 The Data Base is built with open
source products

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 Take Home Message

 Remember that there is Life even

after Brain Death
 For the patient who can be given that
life support withdrawn from brain death
patient
 For the Recipients

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 Declare Brain Death, Save five

 By Proper and Timely Certification

of Brain death, we are giving life to
 (1) Patient Who is going to use this
life support system
 (2), (3) Two Patients with End Stage
Renal Diseases
 (4) One Patient with Liver Failure
 (5) One Patient in need of Heart
transplantation
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 Acknowledgements
We gratefully acknowledge
 The contributions made by all the
patients
 The relatives who took the noble,
valiant, gallant decision of donating
the organs of the deceased

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 Acknowledgements
We gratefully acknowledge
 Government of Tamil Nadu
 Thiru.V.K.Subburaj IAS, Principal
Secretary, Health and Family Welfare, Government
of Tamil Nadu
 Thiru.P.W.C.Davidar IAS, Principal
Secretary, Information Technology and Principal
Secretary i/c Energy, Government of Tamil Nadu

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 Acknowledgements
We gratefully acknowledge
 Dr.J.Amalorpavanathan, MS MCh, Professor of Vascular
Surgery and Convenor, Cadaver Transplant
Programme, Govt of Tamil Nadu
 NNOS http://nnos.org/
 MOHAN Foundation
http://www.mohanfoundation.org/
 Director of Medical and Rural Health Services
 Director of Medical Education
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