he euphoria over the State deploying an air ambulance for the first time ever, to aid organ donation is yet to subside. The keen public interest apart, the availability of air ambulances are the least of the worries of doctors involved in cadaver organ harvesting and transplantation in Government hospitals in Kerala.Unknown to many, they are up against innumerable system challenges, inadequacies of infrastructure and staff in the daily business of saving lives.
At least one brain death occurs every day in the intensive care units (ICUs) of Government Medical College Hospital (MCH), Thiruvananthapuram. Yet, in the past seven months, not a single deceased donor organ donation took place.
“Six cases of brain deaths were reported at the MCH in these seven months and all families had agreed for organ donation too. But not even one case reached the organ donation stage because the brain-dead patients could not be maintained properly in the ICUs, making their organs unviable,” a senior surgeon said.
Even as hundreds of patients with chronic end-stage kidney and liver diseases are awaiting a new lease of life through new organs in various hospitals in the State, just one-third of actual brain deaths occurring in the ICUs are reported. Even lesser number of cases get converted as actual organ donations. A staggering 75 per cent of patients on the transplant waiting list die while waiting for new organs.
The protocol guiding deceased organ donation begins with the early identification of brain-dead patients in ICUs, mandatory certification of brain deaths by neurosurgeons and rigorous maintenance of brain-dead individuals in the ICUs to manage the wide range of physiological changes that occur following brain death, so that quality of organs are maintained till retrieval.
“The issue is not just the late reporting of brain death. With the huge load of road accident trauma cases that swamp the neurosurgery ICUs, shortage of nursing staff and other system inadequacies, the focus is invariably only on serious patients who can be saved through intensive care,” he pointed out.
Maintaining the haemo-dynamic stability of potential organ donors is a time-consuming and intense activity in ICUs and very crucial to maintaining the quality of donor organs. The Medical Colleges just do not have adequate nursing staff or anaesthesiologists to manage this, along with the regular workload.
Aggressive management of neuro trauma cases, with an accent on immediate resuscitation of the patient and prevention and treatment of intracranial hypertension and secondary brain insults can work both ways – save lives while providing care till the end to those whose organs might be salvageable. Yet, this is where the Medical Colleges seem to lag.
Unless the government invests in proper trauma care facilities and develops organ transplantation as a separate entity with dedicated transplant teams, the public sector hospitals will have little to contribute to the organ transplantation process in the State, which is going well because of the huge involvement of private sector hospitals.
