Organ retrieval at the centre of death, forensic formalities at the time of organ retrieval and incorporation of a clause in the driving licence on organ donation are some of the suggestions made at a conference of MARCH (Medically Aware and Responsible Citizens of Hyderabad) on Cadaver Transplantation - A Roadmap for AP.

Making a presentation on cadaver transplantation, Dr Sanjay Sinha, Consultant Urologist and Transplant Surgeon, Medwin Hospital, Medinova Diagnostics and Mythri Hospitals, said one lakh new kidney patients were added every year in India. Against this, only 3,000 patients, which is about 3 per cent, get transplants. Of the rest, up to 50 patients could benefit from organs and tissues donated by one individual. Cadaver transplantation refers to where a living person receives an organ from a brain dead person.

The maximum number of cadaver transplants are in Europe, especially Spain (88%), followed by USA (65 %). In India cadaver transplants are just 2 %, with Andhra Pradesh registering six cadaver transplants in 20 years.

'Brain dead' is a state where deeply comatose patients do not regain consciousness, although their heart continues to beat and blood circulation is maintained. For all other purposes they are clinically dead. The moment their breathing support machines in the hospital are stopped, they die. Since the patient is under strict controlled environment in the ICU, it is possible to retrieve most organs and transplant them successfully.

Brain death is decided by a team of independent doctors, who are not involved with the patient's treatment and who are from a different hospital and are part of a panel of doctors appointed by the government. The doctors conduct a series of tests to confirm that the patient is truly brain dead. The standards are very strict and are accepted medically and ethically the world over.

According to Dr Sanjay Sinha, brain death is entirely different from coma. In coma, the person is not dead. Though he is unconscious, all his organs are functioning. But in brain death, there is complete cessation of brain activity and the person is already dead.

Though AP has enacted the Transplantation of Human Organs Act in 1995, the major obstacles to cadaver transplants are the unwillingness of the relatives to part with the organs, lack of facilities for retrieval of organs at the centre of death, and the absence of a national network and registry to coordinate organ donation. However, Mohan Foundation, a Chennai-based NGO, is successfully running a regional organ-sharing network. The Foundation had organised a couple of cadaver transplants in Hyderabad recently.

The certification of brain death and forensic tests on time, grief counseling and proper requests to the relatives, handling of medico-legal formalities, the availability of a harvesting team and ready transport were some of the suggestions made by Dr Sanjay Sinha to promote cadaver transplantation. He said the maximum duration for cadaver transplant was 24 hours though the desirous period was six hours. The more the time wasted, the poorer the result.

In Hyderabad six centres had been recognised for cadaver retrieval and transplants. This number should be increased and extended even to districts. Efficient evacuation of accident victims, excellent ICU care, public and physician education, grief counseling and a 'opt in' vs 'opt out' clause in the driving licence could promote cadaver donations and transplants. In addition, an element of humane touch and complete transparency was needed. " Otherwise, we are not going to get this programme going," he said.

Dr P M Bhargava, president, MARCH, presided over the meeting. He cautioned against making organ transplants a commercial business. He also commended the role of NGOs in promoting cadaver transplants.