FAQ's on Deceased Donor Related Transplant

What is Cadaver/Deceased?

The Oxford Dictionary defines 'Cadaver' as 'a dead human body'. Medically a 'Cadaver' is a corpse used for dissection and study. In the area of Organ Transplantation, 'cadaver' refers to a brain-dead body with a beating heart, on life support system.

What is Deceased Donor Organ Donation?

A person can donate multiple organ and tissues after brain-stem death. His/her organ continues to live in another personӳ body.

What Organs and Tissues can a Deceased donor donate?

If different organs and tissues are in medically fit conditions, following organs and tissues can be donated:

What is Brain-stem Death?

Brain stem death is cessation of function of the brain stem due to irreversible damage. It is an irreversible condition and the person has died. It is also called Brain Death in India.

A brain stem dead person cannot breathe on his own; however the heart has an inbuilt mechanism for pumping as long as it has a supply of oxygen and blood. A ventilator continues to blow air into lungs of brain stem dead persons, their heart continues to receive oxygenated blood and medicine may be given to maintain their blood pressure. The heart will continue to beat for a period of time after brain stem death - this does not mean that the person is alive, or that there is any chance of recovery.

The declaration of brain stem death is made with accepted medical standards. The parameters emphasize the 3 clinical findings necessary to confirm irreversible cessation of all functions of the entire brain, including the brain stem: coma (loss of consciousness) with a known cause, absence of brainstem reflexes, and apnea (absence of spontaneous breathing). These tests are carried out twice at the interval of at-least 6-12 hours by the team of Medical Experts. Brain-stem Death is accepted under the Transplant Human Organ Act since 1994.

Is Brain-stem Death legally accepted as death?

Yes, As per the Transplantation of Human Organs Act 1994 Brain Stem Death is legally accepted as death.

Who will certify the Brain-stem Death?

As per THOA Board of Medical Experts Consist of following will certify Brain-stem Death:

1. Doctor in charge of the hospital (medical superintendent)
2. Doctor nominated from a panel of Doctors appointed by the Appropriate Authority
3. Neurologist/neurosurgeon/intensivist nominated from a panel appointed by the Appropriate Authority.
4. Doctor treating the patient.

The panel of four doctors carries out the tests together to certify brain death.

Who explains to the family about the brain-stem death?

The doctor (Intensivist/ neurologist/neurosurgeon) who is treating the patient will explain to the family about brain-stem death.

If the family is willing to donate organs of the potential donor, how can they proceed for more information in terms of brain-stem dead?

The family can approach the counselor of the hospital, the transplant coordinator or the doctors and nursing staff of the ICU.

What are the reasons for time delays in deceased organ donation?

Confirmatory tests for brain death have to be done twice within an interval of six hours between the tests. Once consent for organ donation has been obtained, coordinating the process of organ retrieval takes time.

Organ retrieval from deceased donors involves many hospitals , and transplant teams should ensure that the donated organs match as perfectly as possible with the recipient. If it is a medico-legal case, a post-mortem has to be performed and this involves both the police as well as the Forensic Medicine department.

How quickly should the donated Organs by a deceased donor, be transplanted?

Healthy organs should be transplanted as soon as possible. Different organs can be transplanted within different time frame as mentioned below:

• Heart : 4-6 Hours
• Lungs : 4-8 Hours
• Intestine : 6-10 Hours
• Liver : 12-15 Hours
• Pancreas : 12-24 Hours
• Kidneys : 24-48 Hours

Who will receive my organ?

Your vital organs will be transplanted into those individuals who need them most urgently. Gifts of life (Organs) are matched to recipients on the basis of medical suitability, urgency of transplant, duration on the waiting list and geographical location. NOTTO and its state units (ROTTO & SOTTO) will work round the clock, every day of the year and cover the whole of the country. Tissue is very occasionally matched, e.g. for size and tissue type, but otherwise is freely available to any patient in need of a transplant.

Who can give consent for organ donation after brain-stem death?

A person legally in possession of the deceased person can sign the consent form. This is usually done by a parent, spouse, son/daughter or brother/sister.

By signing a consent form the family says that they do not have any objection to the removal of organs from the body of their loved one. It is a legal document. This form is kept with the hospital.

If my family refused cadaver organ donation, will my treatment be affected?

No. Even though your family refuses for organ donation, the treatment will be carried out as per the clinical condition. Organ donation process is never linked with your appropriate treatment.

These two are separate entities. A completely different team work, for donation. Also, doctors involved in transplant operation are never involved in the donation process from the family of potential donor.

Can I be sure doctors will try to save me if I am registered as a potential organ donor?

Yes, its Health professionalӳ duty to save life of patient first. Despite of all efforts, if the patient dies, organ and tissue donation can then be considered and a completely different team of retrieval and transplant specialists would be called in.

If I carry a donor card, will my organ be taken out without my family being asked?

No. Even though if you carry a donor card, your immediate family members and close relatives will be asked for donation of organs and tissues. The consent is mandatory from the person lawfully in possession of the dead body, before donation can be carried out. If they refuse, then organ donation will not take place.

Is it possible that I can express my wish to donate organs to some people and not to others?

No. Organs and tissue cannot be accepted unless they are freely donated. There is no such conditions that can be accepted in terms of potential recipients. You can express your wish to donate specifically which Organ &/or Tissue, you want to donate.

Is there any charge to my family for organ/tissue donation?

No. There is no additional charge to family of potential organ donor. Potential donor needs to be medically maintained in ICU till the time of donation. From the time family agrees to donate organs and tissue, all charges are borne by the treating hospital and donor family is not charged any further.

Does organ/tissue removal affect cremation/burial arrangements or disfigure the body?

No. The removal of organs or tissues will not interfere with customary funeral or burial arrangements. The appearance of the body is not altered. A highly skilled surgical transplant team removes the organs and tissues which can be transplanted in other patients. Surgeons stitch he body carefully, hence no disfigurement occurs. The body can be viewed as in any case of death and funeral arrangements need not be delayed.

Can organs be removed, after death, at home?

No. It can only be removed when a person is declared as brain stem dead in the hospital and is immediately put on a ventilator and other life support systems. After death at home, only eyes and some tissues can be removed.

What, if I had pledged to donate Organs, but my family refuses?

In most situations, families agree of donation if they knew that was their loved oneӳ wish. If the family, or those closest to the person who has died, object to the donation when the person who has died has given their explicit permission, either by telling relatives, close friends or clinical staff, or by carrying a donor card or registering their wishes on the NOTTO website, healthcare professionals will discuss the matter sensitively with them. They will be encouraged to accept the dead personӳ wishes. However, if families still object, then donation process will not go further and donation will not materialize.

Is there difference in organs between heart beating donor or donor after cardiac death?

Yes. Heart beating donor means the patient has been declared as Brain-stem Dead, and his /her organs can be retrieved when heart is still beating with the assistive devices. Beating heart keeps the blood supply intact to organs and there is no damaging affect of low blood supply to organs.

In case of donation after cardiac death, heart has stopped beating and there is no blood supply to organs. Because of that, donation after cardiac death has to be done immediately, as without blood supply, the organs will not be viable for use after certain period of time.

Why can organs of a brain dead patient be used for transplantation and not those of a patient who has died of a cardiac arrest?

Solid organ donation (heart, lungs, liver, pancreas, kidneys) requires blood circulation to be maintained in these organs until retrieval. This is possible in brain-stem death where the functioning of these organs can be supported for some time.

However organ after cardiac death can also be harvested, provided the time gap is minimal.

Source : NOTTO