For the first time in Nepal, a Workshop on Deceased Donation for ICU & Transplant Coordinators was organised by MOHAN Foundation and Nepal Transplantation Society (NTS) on 25th& 26th April 2018 at Hotel Radisson in Kathmandu. Over 75 ICU doctors and nurses attended the workshop. This was a pre-conference workshop of the 1st International Conference of NTS and 11th Nephrology, Urology & Transplantation Conference of SAARC. Nepal has recognised brain death as a form of death and is ready to embark on deceased organ donation and transplantation. This workshop will go a long way in promoting deceased donation as all the key stakeholders participated in the programme. The Prime Minister of Nepal, Mr. K. P. Oli, too is keen to promote this form of donation.
The faculty from India included Dr. Kapil Zirpe, Head of the Department of Neurocritical Care, Ruby Hall Clinic, Grant Medical Foundation, Pune, India and the current President of the Indian Society of Critical Care Medicine (ISCCM), Dr. Subhal Dixit, Director, Critical Care, Sanjeevan and MJM Hospital, Pune and President-elect of ISCCM, and Dr. Avnish Seth, Director, Gastroenterology & Hepatobiliary Sciences and Director, Fortis Organ Retrieval and Transplant, FMRI, Gurgaon. The faculty from MOHAN Foundation included Dr. Sunil Shroff, Managing Trustee, Dr. Sumana Navin, Course Director, Ms. Pallavi Kumar, Executive Director Delhi NCR and Ms. Sujatha Suriyamoorthi, MIS and Programme Manager.
Dr. Bhola Raj Joshi, President NTS in his welcome address said that the workshop would help ICU staff understand how to improve the donor pool. The first session of the workshop was an ‘Overview of transplantation in Nepal’ by Dr. Dibya Singh Shah. She said that the first successful living related kidney transplant was performed at Tribhuvan University Teaching Hospital in August 2008. In 2017, 300 kidney transplants were performed in the country. At present, there are 3000 patients on dialysis.
The next session was on the legal framework in Nepal by Dr. Subhash Acharya. He outlined the Human Body Organ Transplant Act, 1998, the Kidney Transplant regulations of 2002, and the amendments in 2016 (braindeath, provision for paired exchange, wide expansion of list of immediate relatives for live donation). He explained that all guidelines have been given regarding certification of braindeath. Dr. Sumana Navin then spoke about the transplant law in India, the amendment and documentation. She shared the learnings, the continuing challenges, and the possible take aways for Nepal.
Dr. Subhal Dixitmade a presentation on identification and certification of brain-stem death. Dr. Gentle Sunder Shrestha explained spinal reflexes in brain death and the role of ancillary tests in certification of brain death. He said that spinal reflexes are present in 40 - 50% of heart beating cadavers. He elaborated on the different ancillary tests. An ancillary test is an ‘alternative test’. The regulation in Nepal requires an EEG. Dr. Kapil Zirpe spoke on the management of a potential organ donor. He said it was important to promote ‘quality’ organ donation. For this, early identification was critical - understand and pick up pathophysiological changes in brain-stem death to ensure donor optimisation. There was also a panel discussion on a case scenario that looked at some of the challenges in donor management – hypernatremia, diabetes insipidus, hypothermia. Dr. Sunil Shroff moderated the session as well as gave an overview on ‘Donation after Circulatory Death. ’Dr. Sumana Navin and Dr. Pramesh Shrestha explained the apnoea test and ABG analysis with the help of a film.
Dr. Avnish Seth explained how to set up a deceased donation programme in a hospital. He emphasised that it was important to have monthly reports of the number of brain deaths in a hospital to start with.Dr. Gopal Kumar Chaudhary in his session on ‘Post-mortem formalities in Nepal’ made the recommendation that post-mortem should be exempted in deceased organ donation as a gesture of respect to the family. Dr. Sunil Shroff spoke about the importance of having an organ sharing system that is equitable and transparent.
The panel discussion on ‘How to create an organ sharing registry and give momentum to the deceased donation programme in Nepal’ was moderated by Dr. Sunil Shroff. The panelists were Dr. Pawan Chalise, Dr. Prabin Adhikary, Dr. Diptesh Aryal, Dr. Amit Sharma Bhattarai, Journalists Kalpana Acharya and Bhagvati Timal Sinha, Raj Kumar Silwal – DSP, CIB, Bimal Basnet - SP, Police HQ Kathmandu, and Dr. Avnish Seth. At the end of the discussion, the panelists shared their thoughts on what they felt were the key areas: Dr. Pawan Chalise– clarify legal framework to facilitate deceased donation, Dr.Prabin Adhikary – all stakeholders need to be onboard, formulate a committee for organ donation, Dr.Diptesh Aryal–identify champion nurses and train them, Dr. Amit Sharma Bhattarai – consider having opt-out system, Kalpana Acharya – media plays a major role and can be a bridge to reach ordinary people, Bhagvati Timal Sinha – media will support he cause and the police should observe the process minutely, Raj Kumar Silwal – educate people and start the deceased donation discourse in Nepal, Bimal Basnet – donation is very important in Hinduism, campaign for awareness first within the family, then society and country, Dr. Avnish Seth – focus needs to be on converting potential donors to actual deceased donors.
The second day focussed on both the theoretical as well as the practical aspects of counselling, grief counselling and coordinating deceased donation in a hospital. Ms. Sujatha Suriyamoorthi gave an overview of the above as well as shared case studies. A film on the right and wrong approach in talking to families about organ donation was also shown. Ms. Pallavi Kumar spoke about the qualities of a transplant coordinator through her personal experiences in the field. She also gave an insight into the need for public awareness campaigns and some of the methods for creating awareness and acceptance about organ donation in the community. A number of activities were also conducted that had active participation from the audience - role play involving various scenarios, organ donation pathway, grief counselling and quiz.
The importance of training programmes in creating effective health care professionals – ICU doctors and nurses, surgeons and transplant coordinators – was explained by Dr. Sunil Shroff and Dr. Sumana Navin. They outlined the various training programmes that are being delivered by MOHAN Foundation.