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Friday, 2 February 2018 00:00 - - {{hitsCtrl.values.hits}}
Deterioration in the functioning of vital organs of the body – the heart, lung, kidney, liver, pancreas and bowel – eventually results in organ failure by which time the patient knows he is facing death. The only step that can save the patient at this juncture is a transplant. However, the lack of donor organs in Sri Lanka is an obstacle to this solution.
Live donors and deceased donors play a crucial role in saving lives. While live donors can donate only certain organs, like a kidney, deceased donors can donate up to eight organs. In Sri Lanka over 5,000 patients suffer from organ failure and anxiously await organ transplants but only 17% receive transplants.
The exponential rise in the need for organs and the lack of available deceased donors necessitate increased awareness among the public so that more people would come forward to become donors.
Organ Donor Day
With this in mind, plans are underway to launch ‘Organ Donor Day’, a collaborative effort by the Organ Transplant Unit of Sri Jayewardenepura General Hospital and the Ministry of Health, Nutrition and Indigenous Medicine. It will be held for the first time in Sri Lanka on 18 February.
The day will be marked by a walk which will commence at the Diyawanna Food Court and end at the Sri Jayewardenepura General Hospital (SJGH). The walk will be flagged off by President Maithripala Sirisena along with Minister of Health, Nutrition and Indigenous Medicine Dr. Rajitha Senaratne. Further, a commemorative monument will be unveiled at the hospital to acknowledge the many deceased donors who had given other people the gift of life.
In a press conference that was held at the hospital premises on Thursday (25), members of the SJGH Organ Transplant Unit steering committee spoke about the noble contribution of deceased organ donors and the need for a greater understanding on the importance of deceased organ donations.
“Many people are dying today, globally as well as nationally, due to end-organ failure. If an organ fails, we need to substitute that with another organ; if not, that patient will die. Take kidney failure for example; the ultimate way to save a patient with kidney failure is transplantation; with dialysis we can only buy time until transplantation,” said Consultant Urologist and Transplant Surgeon Dr. Niroshan Seneviratne.
“Fortunately, since we have two kidneys, we can get one kidney from a living donor and do the transplant though it’s a very difficult task sometimes to find a live donor. But if you consider the other organs, for instance the heart or lung, if they have severe heart or lung failure these patients, irrespective of age, will die if there is no transplantation.”
Golden opportunity:
8 lives can be saved
“In the West there is a concept called ‘deceased organ donation’. Deceased donor means the patient is basically dead but by dead we mean their brain is dead; when brain-dead patients are in an ICU set-up, they are under a ventilator and with certain drugs, the other organs can be made to function for a few hours. With these life-support methods we can keep the organs working until the transplant takes place. This is a golden opportunity for such patients; if they become organ donors, we can take these organs and perform transplants and save lives of eight other individuals!” he said.
Organs that can be donated include lungs, heart, liver, pancreas, kidneys and bowel; while tissues that can be donated are eye tissue, skin, heart valves, bone, tendons and ligaments.
A team of specialists work together to ensure that the whole process takes place efficiently and the organs are transplanted safely so another person can live. This coordinated team consists of transplant surgeons, anaesthetists and intensivists, nephrologists, hepatologists, cardiologists, endocrinologists, neurosurgeons, neurologists, transfusion medicine specialists, psychologists and counsellors.
Consultant Anaesthetist and Intensivist Dr. Chamila Pilimatalawwe who works at the ICU unit of SJGH said, “When patients are brought to the ICU with a severe damage to the brain, which could be due to a blood clot, stroke, bleed or traumatic accident, sometimes we can’t save them because the damage is too severe – the brain cells begin to die, there is no circulation to the brain, and the entire brain, including the brain stem dies.
“As an Intensivist I must tell you that our prime aim is to make the patient live in some way – so we try our best to treat them and reverse damage if possible. It is when there is no way that person can live any longer and the brain ceases to function completely, and certain tests are carried out independently and confirmed by two clinicians, that we pronounce the patient brain-dead – that is legal death – and that is the time that person dies.”
“If this person was at home or on the road, we would say that person died at that place and we can’t take their organs – not every person who dies whether on the road or in the hospital can donate their organs – they have to be in an ICU and confirmed brain-dead before organs can be donated. If they are in an ICU and connected to a ventilator and given drugs to keep the blood pressure controlled and the other organs working; when the brain dies the rest of the organs, like the heart will continue to work, for a small period. During this time, we can take these organs that are still functioning, and make the transplantation to patients who are in need,” she explained.
Advance directive
“Death is common to all of us – some of us might die in tragic circumstances and some of us at old age and some may be confirmed brain dead. When your loved one is in an accident (and most of these are sudden deaths), it is probably not the best time to talk to the relatives about organ donation. This is a problem that we face daily. When a patient is confirmed brain dead in the ICU, how do we approach the relatives? It is a traumatic experience for everyone – family, relatives and friends; they might think we are inhumane to even ask that question.
“If they have already heard about this earlier, perhaps from a national program like this, it would be at the back of their minds and would therefore be helpful when a situation like this arises,” Dr. Pilimatalawwe noted.
She further noted that it would be easier for relatives to make that decision to donate the organs if the donors have given an advance directive stating that if they are to die and are brain dead they would like to donate their organs. If they let their family know that they are organ donors, it would be easier for this whole process to take place very rapidly and it does need to happen rapidly because the organs will only continue to function for a very short time.
“This is an important concept that needs to be understood – these patients are dead and don’t need the organs anymore. We can give the organs to someone who does. This is a golden opportunity to save someone else’s life when you die. The country is badly in need of deceased organ donors and more people need to know about its value and come forward to help,” added Dr. Seneviratne.
