Dr.Sunil Shroff, MS, FRCS (UK), D.Urol (Lond.) Managing Trustee, MOHAN Foundation  (Multi Organ Harvesting Aid Network)  A-113, Annanagar, 3rd Avenue, Chennai [email protected]

Prof. and Head of the Department Urology & Renal Transplantation Sri Ramachandra Medical College & Research Institution,  Chennai - 600116

PREAMBLE

Organ transplantation has been one of the greatest advances of modernscience that has resulted in many patients getting a renewed lease oflife. It was included in the top five medical miracles of the lastcentury. Transplantation would not be possible but for organ donation.Organs can be donated by a living person, after natural death and after Brain death. Brain death is relatively a new concept of death thatwas first recognized in Paris in 1959.

The Government of India recognizedthis as legal form of death in 1994 and passed an act calledTransplantation of Human Organ (THO) Act. This legislation was alsoenacted to streamline the activities of live transplants especiallykidneys. This transplant has achieved considerable notoriety in Indiawith frequent commercial organ scandals where the brokerage for kidneyscan be considerable leading to exploitation of the poor in the country.The Govt. through this act wished to wipe away this practice by makingthis illegal and a punishable offence. 

Since this act was passed it hasbeen possible to undertake multi-organ transplant activity from braindead donors in India. After natural death, only a few tissues can bedonated (like cornea, bone, skin and blood vessels) whereas after braindeath almost all the organs and tissues can be donated includingcritical organs such as kidneys, heart, liver and lungs. At any giventime, there are 8 to 10 brain dead patients in different Intensive careunits in any major city of the country. There is hence a huge pool ofpotential brain dead donors available in India. This pool of patientscan easily meet the demand of organs for not only India but alsoperhaps our neighboring SAARC countries and help in wiping out thecommercial dealing in kidneys, which continues to haunt the countrydespite the legislation now for almost nine years to prevent it.Almost, 90% of all transplants done across the world originate fromorgans from brain dead donors. 

The critical care clinicians form an important section of doctors whoseinput in the intensive care is critical for success of such aprogramme. The brain dead patient is haemodynamicaly an unstablepatient, however once the family agrees to donate the organs of theirloved one; it is paramount to keep these unstable patient in a state tomake organ retrieval possible and also for the organs to be in optimumworking condition to be used on a recipient. I have hence tried to give overall perspective of this theme in this presentation and wish tosensitise these key personnel with these issues. 

Cadaver Transplants in India and MOHAN (Multi Organ Harvesting Aid Network) Foundation)

In India since the act was passedthe Total Cadaver Transplants activities for various solid organs are as follows (Jan 1995 to Jun 2001): 
Kidney 379
Heart 34
Liver 12
Pancreas 02
Besides the above organs, other organs and tissues also have beenprocured and include almost over 600 corneas (Eye Bank of India getsabout 15,000 corneas per year, mostly from its home retrieval plan),about 50 heart valves and occasionally skin donation. In the last 6years, 35 hospitals in the country from various regions have undertakencadaver transplants. Chennai has done the maximum number of cadavertransplants in the country (189). Besides Chennai the other cites wherethe cadaver organ transplantation is taking place include New Delhi(68), Ahmedabad (46), Pune (32), Bangalore (32), Vellore (22), Mumbai(20) and Coimbatore (12).

To undertake this cadaver program successfully an adequate hospitalInfrastructure and Support Logistics are essential. The organs need tobe properly matched and distributed and ideally the donated organsshould be distributed universally to the patients who require it and who may be in a critical need of the organ. These available organs should be treated as national health resource, they should not be treated as belonging to any particular hospital. To achieve these objectives a computerized Registry has been set up in the country by MOHAN (Multi Organ Harvesting Aid Network). This serves dual purpose of storage of data of patients waiting to undergo transplants from various centers in the country (this waiting list is for all organs) and when an organ is available the registry correctly matches the organ so that it can be sent to the hospital to be transplanted into the needy patient. 

Currently there are over 200,000 patients needing solid organ transplants in India, however only approx. 3,500 transplants are being done. There are also three million corneally blind people in India.Sixty percent are children below the age of 12. Target retrieval of corneas by Eye bank of India is 150,000 corneas per year. Compared to home retrieval the hospital cornea retrieval programme gives much better quality of corneas. The need for organ can be one of the most desperate or critical emergencies in medical science and only a well-organized organ harvesting and distribution system can save lives. MOHAN (acronym for Multi Organ Harvesting Aid Network) was formed to be a facilitator of cadaver organ donation and transplant programme in the country and has tackled various issues in this field. It has over the past six years offices in Chennai, Hyderabad, Delhi and Mumbai. It is a registered NGO with 80G Income tax exemption. MOHAN hence has many activities in the field of organ donation and transplantation. These include: 

1.INOS (Indian Network for Organ Sharing) first started in Tamil Nadu and now has its presence in Andhra Pradesh, MOHAN is the process of creating a nationwide affiliation with like-minded organizations and soon few hospitals in Delhi and Bangalore will join their registry. It operates a computerized net-based registry. The different hospitals in the group have so far shared 85 kidneys, 5 hearts and 4 livers. Similar network of hospitals has started in other regions and include FORTE (Foundation for Organ Transplantation and education) at Bangalore & ZTCC (Zonal Transplant Co-coordinating Committee) at Mumbai. These also have similarly shared organs between different hospitals. 

2. Patient Support Group (PSG) - This sub-unit of the foundation meets once in 2 months with patients of organ failure and post-transplant to discuss their problems and for them to share with their fellow patients. There are about 300 members in the group both in Chennai and Mumbai. An affiliate NGO in Chennai called TANKER helps with subsidized dialysis for kidney failure patients.

3. Public Education for organ Donation  A constant public awareness campaign on brain death and organ donation is undertaken by the Foundation volunteers. A credit card sized universal Donor Card and literature on organ donation and brain death are given out free of cost. Over 150,000 donor cards have been distributed in English, Tamil, Marathi and Hindi. An organ donation awareness movie of 30 seconds by south Indian heart-throb- Madhavan is available for television in English, Tamil and Hindi and is run on television channels from time to time, The Foundation also has literature on organ donation, prevention on diseases ( almost numbering 100) .

4. Indian Transplant Newsletter - This has been published since 1998. This newsletter has an executive committee of doctors from the transplant field from all over the country and some well-wishers of Indian cadaver programme from overseas. Over 2000 copies of the newsletter are dispatched every quarter to transplant clinicians in India and abroad. 

MOHAN Foundation has conducted regular symposiums on issues related to Brain Death at different hospitals in Chennai, Vellore and Hyderabad and has compiled a 200 pages manual for ICU for this purpose.