Death and Transplantation

Diagnosis of Brainstem Death  

◦ Exclusions  ◦ Under effect of drugs  ◦ Cold temperature (< 35 °C )  ◦ Severe metabolic or endocrine disturbance  . Preconditions  ◦ Deeply comatose  ◦ On ventilator  ◦ Known cause of coma  

. Personnel who should perform tests 

 ◦ Two medical practitioners  

◦ Expert in the field (not transplant surgeons) (Anaesthetist)  

◦ One should be consultant status (Anaesthesia earlier Neuro)  

○ Each should perform tests separately, twice  

MOLECULAR DEATH  

. Death of cells and tissues individually which takes place usually one to two hours after the stoppage of vital functions  

◦ Depends on residual oxygen and metabolic activity of cells  

What are vitals?

Resp, Circulatory and 

Somatic vs. Molecular Death  

◦ Fear from disposal of body before actual death (spontaneous movements at funeral)  

◦ Transplantation fails due to loss of vitality of organ (loss of revitalisation)  

Death Certificate  

>Who can issue..? 

Registered Medical practitioner who is treating at the time of terminal event and assure about no foul play.  

◦ When the person suffering from an incurable disease, any physician who attended the terminal events can issue even if he had not treated him.  

> Medical practitioner can not refuse/delay(except in suspicious/sudden death) or charge for issuing Death certificate  

> Medical practitioner should forward it to registering authority (usually sent through relatives)  

Clinics should be registered at?

Form 4 for hospital deaths and 4A for non-hospital deaths.

Cardiorespiratory Arrest and Cardiac arrest never be the cause of death...

Septemb

◦ September, 2004 - Review Committee set up to examine provisions of THO Act and the Rules.  

◦ The Transplantation of Huran Organs (Arnendrnent) Bill, 2011 - Drafted by Ministry of Health  

THO Act to cover both organs & tissues  

e Regulation of removal, storage and transplantation of human organs and tissues for therapeutic purposes.  

◦ Prevention of commercial dealings of human organs and tissues  

Definitions  

Expansion of the term Near Relative  

◦ 'Near Relative' - To include grandparents and grandchildren, in addition to spouse, son, daughter, father, mother, brother or sister (Section 2)  

Definitions  

Human Organ Retrieval Centre  - Hospital with adequate ICU facilities, but not  registered under the THO Act  

- Hospital registered under the THO Act  

Definitions  

. Transplant Coordinator

 A person appointed by a hospital to coordinate all matters relating to removal or transplantation of human Organs/tissues  

Required Request ◦ Mandatory for ICU doctor, in consultation with transplant cordinator to request relatives of brain dead patients for organ donation.  

◦ Record of all brain dead patients and that of the next of kin who are approached to be kept.  

Special Provision for Removal of Corneas  

◦ Technician possessing such qualifications and experience, as may be prescribed, may enucleate an eye.  

Certification of Brain Death  

◦ Expansion of certifying panel of experts  

◦ In addition to neurosurgeon / neurologist, surgeon _/physician and an anesthetist/ intensivist nominated from a panel already approved by the Appropriate Authority.  

Swap Donations e Two different willing but incompatible 'near relative' donors (vis-à-vis their intended related recipient) permitted to donate their organs,  

◦ Authorisation committee will evaluate on a case- to-case basis.  

ON  

NOTO

ROTO

SOTO

Powers of the Appropriate Authority  

◦ To grant registration to a hospital for the removal,  storage and transplantation of any human organ  ◦ To suspend or cancel such registration  ◦ To enforce standards for hospitals engaged in the  removal/ storage or transplantation of human  organs.  

Advisory Committee  

◦ To assist Appropriate Authority in the discharge of  its functions  

◦ Constituted for a period of two years  

◦ Representation from an NGO working in the field  of organ or tissue donation  

Authorisation Committees  

. Hospital level Authorisation Committees  

◦ State or District level Authorisation Committees  

◦ Central Government to prescribe composition of Authorisation  Committees to ensure uniformity  

◦ Actual appointments made by respective State Governments/  Union Territories.  

Hospital Authorisation Committee  ◦ Hospital does more than 25 transplants annually  

e Medical director/superintendent  

◦ Two doctors not part of transplant team  

◦ Two members from society  

◦ Director/secretary of health services  

National Registry  ◦ Central Govt. to development and maintain  national registry of recipients.  

◦ Evaluation of scientific and clinical status of  organ transplantation.  

Offences & Penalties  

Enhancement of Penalties  ◦ Removal of human organ without authority  ◦ Imprisonment - Up to 10 years  ◦ Fine - Up to Rs.20 lakh  ◦ Removal of human tissue without authority  ◦ Imprisonment - Up to 3 years  ◦ Fine - Up to Rs.5 lakh  

Offences & Penalties  

◦ Live unrelated organ donation - false documents ◦ Imprisonment-5 to 10 years ◦ Fine -Rs.20 lakh to Rs.l crore  

Offences & Penalties  

Supplying tissues for payment ◦ Imprisonment 1-2 years ◦ Fine: Rs. 5-20 lakh  

Offences & Penalties  

◦ Penalties for doctors  ◦ First offence -name struck off from State Medical Council for  three years  ◦ Second offence -name struck off permanently  

Survival of organs  

◦ Cornea-6 hours 

 ◦ Skin - 24 hours 

 ◦ Bone -48 hours 

 ◦ Blood vessels -72 hours 

 ◦ Kidney, heart, lungs, pancreas and liver must be obtained soon after circulation has stopped 

 ◦ Cornea transplanted is not rejected