On August 8, 2015, Fortis Memorial Research Institute, Gurgaon organized a summit on Organ Donation After Circulatory Death (DCD), in association with MOHAN Foundation, NATHealth and NOTTO.
Doctors from Spain, the UK, Australia and India came together in India's first DCD Summit and discussed ways to take it forward. Dr Jagdish Prasad, DG, DGHS, Ministry of Health & Family Welfare was the chief guest.
It is felt, DCD can help bridge the wide gap between demand and supply of organs. Unlike brain death cases, where a person is declared clinically dead on neurologic criteria, donation after cardiac death (DCD) is considered in cases where there is irreversible cessation of circulatory and respiratory function. It is also called circulatory death, and retrieval process has to be initiated within minutes. Experts say that the outcome for organs transplanted after cardiac death is almost similar to those for organs transplanted after someone is brain dead (BD). Dr Avnish Seth, director FORT (Fortis Organ Retrieval and Transplant), said, "Once the heart stops beating for five minutes, there is no possibility of a person coming back to life, but his/her organs such as kidneys, liver, pancreas, lungs and even heart can be retrieved and transplanted. Unfortunately, the concept is not very popular in the country. It has taken 20 years for us to make some headway in
organ donation after BD. It is time for the next logical step: DCD."
Talking about the emergence of DCD in his country some two decades ago, Dr Marti Manyalich, president, TPM-DTI Foundation, Spain, said, "We started DCD in 1995, by making it mandatory for hospitals to have a designated team for organ donation. Also, mass media played an important role in educating people about organ donation. However, in India, it is still not happening. DCD will be possible if the government and private sector work together and there is more healthcare cooperation between India and countries that have been practising DCD."
Asked about the infrastructure required for DCD, Dr Prabhat Dutta, senior consultant, cardiac anesthesia at Fortis, said, "ECMO (Extracorporeal Membrane Oxygenation) is required to support blood circulation and oxygen supply in organs such as kidney, lung, liver and pancreas. ECMO can be used for four to 12 hours and then organs need to be transplanted."
For many the summit helped in clearing myths regarding laws for DCD in the country. Dr Kumud Dhital, who is credited with performing the first dead heart transplant in the world, said, "Laws in India don't permit withdrawal of life support system. However, there is nothing in the law that doesn't permit DCD in India. Lack of expertise and apprehension of doctors in performing DCD seems to be a major issue here. I think DCD needs to be considered carefully in the country till there is more clarity on laws related to end of life care."
Dr Darius Mirza, Professor of Hepatobiliary & Transplant Surgery, QE Hospital & Birmingham Children's Hospital, UK spoke about various aspects of DCD, as in, how to do DCD kit, DBTL catheter, perfusion & retrieval and DCD liver transplantations.
Dr Sunil Shroff, Managing Trustee, MOHAN Foundation discussed the current status of organ donation in India. He talked about how initially challenging and demanding a task it was to set the roots for the concept of organ donation in our country. He then emphasized how statistics have improved in the southern parts of India as compared to others.
Apart from this the Ethics & Law as applicable to DCD in India were presented by Dr R K Mani, ( Critical Care & Pulmonary Medicine). Dr Sandeep Dewan, Senior Consultant & Head Critical Care, FMRI spoke about Role of ECMO in Death after Circulatory death and Death after Brain Death (DBD). Apart from this, there was a panel discussion about DCD and DBD in India. The panelists included the international faculty present and some other eminent persons like Dr Arti Vij (Faculty In-charge, ORBO), Dr Harsha Jauhari (Head Urology, SirGanga Ram Hospital), Dr Anil Kumar (CMO, DGHS, Ministry of Health & Family Welfare) etc.
Approximately 100 delegates from different hospitals of Delhi-NCR Region attended the summit during the course of the day.
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