Make a life-saving difference

The prestigious Army Hospital (Research and Referral) in Delhi has broken the threshold of organ transplantation in the country. Now, Indian soldiers with organ failure can hope for a new, healthy and active life  
Prateek Chauhan Delhi

Had soldier Vikram Singh damaged his liver three years back, he wouldn't be alive today. Today, the situation has dramatically changed. With a 90 per cent success rate, Indian soldiers or para-military force ex-servicemen need not die due to organ failure. Ditto with his family members. One of the finest state-of-the-art hospital doing specialised research in India will now directly take care of organ transplant of Indian soldiers, until now largely an inaccessible, difficult and highly expensive affair. Clearly, this has ushered in a wave of relief and happiness among the armed forces.

It all began three years ago. The fabulously equipped organ transplant facility at the prestigious Armed Forces Organ Retrieval and Transplantation Authority (AORTA), at the Army Hospital (Research and Referral- R&R), in Delhi, inaugurated in 2007, is pioneering the 'craft' of organ transplant for current and former Indian soldiers from all over India, and their families, across the rigid hierarchies of the Indian army, air force, navy, para military forces, and ex-servicemen. Said Group Captain Dr Bhaskar Nandi, (R&R), who is instrumental in getting the organ transplantation centre going, "Only eye-donation has matured in India, while organ-donation is still in its infancy. We are trying to make more and more people aware that organ donation is a noble act." 

AORTA is the country's largest organ donation centre with a success rate better than AIIMS. Records show that AIIMS started its organ transplantation programme in 1992 and till date they have done only 10 liver transplantations, whereas R&R started much later in 2007, but it has already done 41 liver transplantations successfully.

Organ-recipient Vikram Singh, a jawan from Jammu, doesn't know who donated his liver to him before his death or what his religious beliefs were. "I thank him and pray to god for him," he said, his eyes melting with gratitude. 

Of the 41 cases of liver transplantation at R&R, 29 were facilitated by people who had donated organs from 2007 to 2010. There have been 89 cases of brain-death of individuals at the facility of which 66 could safely donate organs; 30 cases were committed for organ transplantation. Organ donor ratio in other countries is 30-32 per ten lakh while in India, it is very less in comparison - 0.5 per ten lakh, according to the hospital's official data.

Soldier Jeen Tilo from Tamil Nadu, also an organ-recipient, had come to the hospital with a damaged liver due to jaundice. He has been cured with a liver transplant and has rejoined duty with his unit at Tamil Nadu. "Organ transplantation is a boon to the medical industry as it has helped in saving my life, otherwise I would have been dead by now. I keep coming here after every six months for rechecks and feel thankful to the person who donated his liver to me," he told Hardnews

R&R hospital started functioning as India's best facilitated multi-organ transplantation few years back with state-of-the-art technology and a competent team of physicians and surgeons. While accurate statistics are hard to come by, it is known that thousands of Indian soldiers and officers' families could gain from timely organ transplantation. It is estimated that there are more then 80,000 cases of renal failure annually, and probably thousands of cases of liver, heart or lung failure, where timely organ transplants could make all the difference.

For instance, Colonel Dod died of brain hemorrhage on March 22, 2010, but his family decided to donate his organs and helped save lives of many people subsequently. His heart went to a soldier who was on death-bed. "This was the third successful heart transplantation in the hospital," said Nandi. Dod's liver was transplanted into a soldier's father while his kidneys were used for two other patients.

Similar is the case of death of hawaldar Laxman Singh's 18-year-old son Ajay, who died on 27 March, 2010. Not willing to let his son's death go in vain, Singh consulted other family members and decided to donate Ajay's organs. His liver and one kidney were transplanted into two soldiers and his second kidney was given to another soldier's daughter.

So far, 5,000 soldiers and officers have registered to donate internal organs in case of brain-death. "The declaration of brain-death of a patient is decided by a panel of specialists," said Nandi. "Relatives of potential donors get emotional and convincing them is not an easy task."

For this purpose special training is done by lady officer and transplant coordinator Lieutenant Colonel Pradhi Nambiar. "For family members of the dead person, donation of organs is a very difficult task, but some do agree to it believing it to be a noble cause. The donors' family is rewarded by the defence minister every year so that others get inspired to do the same."

The truth is, India's social environment is still far from ready on organ transplantation which is not just about surgery, or medical science and technology. It touches a host of other issues - legal, social, emotional and religious - all of which have to be addressed with sensitivity and thoroughness. 

Transplantation depends on the availability of human organs which in turn depends on voluntary donation of organs by relatives of persons who have met with sudden brain-death. "We have the technology and the expertise needed for the transplants, but the main problem is of shortage of organ and tissue donors," notes Lieutenant General Naresh Kumar VSM, AVSM, R&R. 

People must be prepared to do something meaningful which makes the loss of near and dear ones easier to bear. Many western countries have the Required Request Law, which makes it mandatory for the hospital to ask the relatives of a person, who has suffered brain-death, whether they are willing to consider organ donation. "The thought may not have even occurred to many people, so the first step is to bring it within public consciousness," said Colonel Anupam Saha, consultant, Surgery and Gastrointestinal Surgery. 

"One of the fundamental problems with cadaveric organ donation lies in our understanding of death. A 'cadaver' refers to a human body that has been declared brain-dead -- that is, the brain has stopped functioning but the heart continues to beat on an artificial support system, like a ventilator. Many people confuse brain-death with a state of coma," clarified Nandi. 

A person who is in a coma is actually in a state of deep unconsciousness with the heart beating on its own while natural breathing continues. The person may emerge from a comatose state and regain most normal organ functions. Brain-death, however, is irreversible, when the person is clinically and legally deceased. "People find it very hard to accept this as death, because the body is still warm, and the heart is still beating," he explained.  

It is estimated that nearly 60,000 brain-deaths occur every year in this country representing a potential pool of thousands of organs that can be donated. "We have to understand that death can occur when either the heart or the brain stops working," said Nambhiar.  This is important for organ donation because organs can be harvested only from cadavers that are being maintained on ventilators, that is, when the organs are still being pumped with blood, and are in a state where they can continue to function in another body. "The family must decide to donate when their dear one still appears to be breathing and their body is still warm." 

Organs cannot be harvested in the case of death at home because even the slightest time lag between the end of circulation and the removal of the organ can make it unusable. Another area of concern is the delay in bringing the dead body back home from the hospital, as the organ-retrieval process takes six to eight hours after consent has been obtained. 

"We have found that once people have decided to donate the organs, they also have the strength to deal with these logistics," said Nandi. "It helps tremendously if the concerned person indicates a wish to donate his organs to his family before his/her death. It makes them want to respect the dying person's last wish," he added.

This story is from the print issue of Hardnews: MAY 2010