As the world celebrated Organ Donation Day on Sunday, the medical fraternity has called for widening the organ pool by promoting Donation after Circulatory Death or DCD to bridge the wide gap between the demand and supply of organs. Presently, organs are allowed to be harvested from brain dead patients.
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 estimated that the number of donor organs could rise impressively through the expanded use of DCD, making it inevitable in an era of universal shortage of donors.
The practice is quite common in foreign countries, but In India there are currently no protocols regarding organ donation following the cardiac arrest, after elective withdrawal of life support in terminal conditions. Moreover, the law does not permit controlled DCD due to the Euthanasia debate.
However, as the demand for organs' grow in view of increased life expectancy and increased non-communicable diseases such as heart attacks, doctors here feel it is high time that DCD is promoted.
Dr Sunil Prakash, Senior Consultant and Director, Nephrology Department, Delhi-based BlK Super Specialty Hospital says, the medical fraternity in the country can and needs to take upon itself the challenge of promoting non heart beating organ donations so as to increase the donor pool, said Dr Sunil Prakash,."Acutely grief stricken relatives of brain dead patients always find difficult to accept the inevitability of the tragedy and they live on a very slim hope of a miracle coming through to save the life of their dear one.
"However once heart stops they will be more amenable to donate organs. The need of the hour is to promote DCD along with brain dead retrievals to increase the organ donation rates," he explained
The Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh claims to be the first institute in the country to successfully perform organ transplants by retrieving organs from cardiac dead patients.
Dr Ashish Sharma, Professor and Head Institution Department of Renal Transplant Surgery, PGIMER said, "In India, the biggest challenge to DCD donation is lack of clarity in the law, and there is no practice of withdrawal of life support in end of life situation, thereby limiting this mode of donation."
He suggested withdrawal of care guidelines for terminally ill patients for promoting DCD donations. These guidelines would also provide a dignity of death in an end of life situation and not keep these individuals in an ICU on a ventilator for an extended period, he added.
According to an estimate, there are about 2,00,000 lakh people who suffer kidney failure annually in India and just one in 30 who require kidney is able to get one.
India's annual liver transplant requirement is 1 lakh but just about 1,000 patients are able to secure a liver.
The annual requirement of hearts is estimated to be around 50,000 and lungs about 20,000. But the rate of organ donation is as low as 0.3 per million population (PMP).
Dr. Vivekanand Jha of The George Institute for Global Health - India called for reforms in organ retrievals in the context of both living as well as deceased organ donations. "Also, there is need to develop an ethical & equitable organ donation program in our country. There are a large number of potentially transplantable organs remain unutilized because of lack of awareness on the part of ICU physicians," he said.