MOHAN Foundation successfully conducted a CME at Fortis Hospital, Bannerghatta Road, Bengaluru on 18th February 2017. The focus was on ‘Practical and Technical Aspects of Brain Death and Organ Donation.’ There were 70 health care professionals for the CME that included doctors, ICU staff, transplant coordinators, hospital administrators, and Accident & Emergency staff.
The guest of honor, Dr. K C Tan, Consultant Hepatobiliary & Liver Transplant Surgery, Asian Centre for Liver Diseases and Transplantation, Gleneagles Hospital, Singapore inaugurated the CME. Dr. Kapali Neelamekam, Director HPB & Liver Transplant Surgery, Fortis Hospital was also present on the occasion. Dr. Tan said that along with living donation and transplantation, there should also be emphasis on the deceased donation programme.
A short film on brain stem death was played to set the tone for the sessions. The first session was taken by Dr. Sunil Karanth, Chairman – Critical Care Services, Manipal Hospital, Bengaluru. He described the ‘Identification of Brain stem death in ICU’ and ‘Adult and Paediatric Brain stem death testing.’ He also explained the challenges (for e.g. doing apnoea test in an unstable patient) and solutions in identification and certification as well as the different ancillary tests. He also elaborated on the pathophysiological changes following brain stem death and maintenance of a potential deceased organ donor.
The following session was taken by Dr. Sunil Shroff, Managing Trustee, MOHAN Foundation. He explained the ‘Legal Aspects of Brain Stem Death’ - the current provisions for deceased donation in the Transplantation of Human Organs (Amendment) Act, 2011, and the Transplantation of Human Organs and Tissues Rules, 2014.
Ms. Sujatha Suriyamoorthi, MIS & Programme Coordinator, MOHAN Foundation in her session focused on End of Life Care in ICU including the vital roles of the critical care nurse, grief counsellor and transplant coordinator. She used case studies to drive home her point.
The last session was taken by Dr. Kishore Babu, Honorary Secretary, Zonal Coordination Committee of Karnataka for Transplantation (ZCCK). He outlined the role of ZCCK, the protocol for deceased donation and transplantation & organ allocation, and the protocol for organ donation in medico-legal cases.
Panel Discussion – Q & A
The panel discussion was moderated by Dr. Sunil Shroff with Dr. Sunil Karanth, Ms. Sujatha Suriyamoorthi, Dr. Kishore Babu and Dr. Sumana Navin, Course Director, MOHAN Foundation on the panel.
Some of the questions that were raised were regarding allocation of liver and the hospital rota system followed by ZCCK. The panelists felt that it should be patient wise based on the MELD in the future.
Another question was about whether the family should be approached for organ donation after the first certification of brain stem death or after the second. The opinion was that each hospital needs to evolve a protocol. Some felt that the approach after the first certification afforded the in-house team more time to get all the recipient hospitals on board. Of course, it was paramount to first gauge the stage of grief in which the family was before broaching the subject of organ donation. It was pointed out that if it was a medico-legal case it would take longer to carry out the necessary procedures as compared to a non-medico-legal case.
A question was raised that if the interval between the two certifications exceeded 12 hours in adults whether the first certification was null and void. The panelists said that it was not.
There was also a question about the requirements to be considered a Non Transplant Organ Retrieval Centre (NTORC). Dr. Shroff said that as per the amended law it is called a ‘Human Organ Retrieval Centre’ (HORC) and it means a hospital which has adequate Intensive Care Unit facilities for treating seriously ill patients who can be potential donors of organs in the event of death and is registered for retrieval of human organs. Form 13 is the application for registration as a retrieval hospital.
The CME was made possible through the efforts of Dr. Yamini K R, Ms. Arsha Sasikumar and Mr. Vishukumar of Fortis Hospital, Bannerghatta Road.