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Organ donation - Part 1

What is Organ Donation?

Organ Donation is the gift of an organ to a person with end stage organ disease and who needs a transplant.What are the different types of Organ Donation?

There are two types of organ donation:-

Living Donor Organ Donation: A person during his life can donate one kidney (the other kidney is capable of maintaining the body functions adequately for the donor), a portion of pancreas (half of the pancreas is adequate for sustaining pancreatic functions) and a part of the liver (the segments of liver will regenerate after a period of time in both recipient and donor).
Deceased Donor Organ Donation: A person can donate multiple organ and tissues after (brain-stem/cardiac) death. His/her organcontinues to live in another personӳ body.

A donation is an act of courage and it requires immense determination and dedication to donate one’s organ to suffering relative (the recipient). The donor is the most important person in any living donor transplant program. The donor safety and well-being throughout the entire process of transplant and later in life is of utmost importance to us, as clinicians. The donor undergoes an exhaustive evaluation before being selected for donation. During this evaluation, if anything is found that may harm his well being in the future, the process is stopped. The present article will highlight the key features in the process of donation with emphasis on life after donation.

First let us learn about kidney donation

Which kidney is removed for donation?

Each person has a pair of KIDNEYS located on the posterior abdominal wall below the ribs. Both the kidneys function more or less equally and anyone kidney of a healthy individual can be donated. As a part of donor evaluation, a test called “Renogram” is done to assess the split function of each kidney. Based on this, as a standard of care, the better functioning kidney is always left with a donor.

Does donating a kidney shorten your life?

Living donation does not change life expectancy, and does not appear to increase the risk of kidney failure. In general, most people with a single normal kidney have few or no problems; however, you should always talk to your transplant team about the risks involved in donation.

Is a single kidney able to perform the function of both the kidneys?

After one kidney is removed for donation, the remaining kidney undergoes a process known as “Compensatory Hypertrophy” i.e. it increases in size and takes over the function of the other kidney as well. The donor leads a normal life after donation.

How long is the process of donation?

It usually takes 2-3 weeks in the entire process of donation. This includes complete pre-operative work-up, preparation of legal documents, authorization by the appropriate committee and the surgery.

What is the length of hospital stay and recovery after surgery?

The donor is admitted a day before the surgery. The kidney is removed in a minimally invasive manner i.e. through keyholes. As a result, there is minimal pain, recovery is very fast and there are hardly any problems after the surgery. The donor is usually discharged after 3-4 days. The sutures are self-absorbable and do not require removal. The scars are barely visible after some time. Some medications like antibiotics, antacids, and painkillers are prescribed for a few days at the time of discharge and no long-term medications are required (unlike recipient). The donor can resume his work as early as 7 days, but this is individualized.

How is the follow-up after the surgery?

A regular well-designed follow-up is an integral part of any surgery. It is mandatory for the donor; as living with one kidney may be tricky if that kidney is not properly taken care of. Most of the transplant centers have well-designed follow-up protocols. In our practice, it requires the donor to come back for follow-up at 1-month, 3-month and then annually post-donation. Each visit may require some tests to ensure the donor’s well-being. Studies have shown that with regular follow-ups, the donor population lives longer and have a better quality of life than the age-matched general population.

What should I do in case I develop any medical or surgical illness later in life after donation?

In case the donor develops any problems (unrelated to the donor surgery or the act of donation), which may be as simple as diarrheal illness or as difficult as acute appendicitis requiring emergency surgery. There is no need to panic, as you are as normal as any other individual with the same illnesses. Seek medical advice from your family physician without any delay. Please communicate to your treating doctor about your donation and the fact that you have the only kidney. This will help him in managing your problems in a better way and he will understand the need to avoid certain medications that are harmful to the kidneys.

What precautions do I need to take so that my remaining kidney stays healthy for life?

You need to have regular follow-ups as mentioned previously. Besides, avoid any over-the-counter medications like painkillers. You should take medications for common ailments under medical supervision. Make sure you hydrate yourself well all the time. With these precautions, you are sure to live a healthy life.

Gifting life to someone is NOBLE. Don’t leave this chance to give this greatest gift to the world. Talk to people who are donors or reach them through social media. Know and read as much as possible about living donations. Be an inspiration, be a hero…be a donor!!!

Who should not donate a kidney?

People with Long-Term/Medical Risks

Other complications that may occur in the long-term following surgery to donate a kidney include: Developing a disease that could affect the function of the remaining kidney such as: Diabetes. High blood pressure.

Who is not eligible for a kidney transplant?

You may not be eligible to receive a kidney transplant due to: The presence of some other life-threatening disease or condition that would not improve with transplantation. This could include certain cancers, infections that cannot be treated or cured, or severe, uncorrectable heart disease.

What disqualifies you from getting a kidney transplant?

Many factors contribute to whether or not an organ will be offered to you, including, but not limited to: blood type, how long you have had kidney failure, medical urgency, where you live (an organ must be safely transported the distance to the transplant hospital), and in some instances your weight and size .

Can a female donate a male kidney?

The gender of donor and recipient plays a larger role in kidney transplants than previously assumed. Female donor kidneys do not function as well in men -- due to their smaller size. Women have a higher risk of rejecting a male donor kidney.

How painful is donating a kidney?

How much will it hurt? Everyone is different, but you could be in some pain after the surgery. But it will get easier each day, and there are different types of pain relievers to make you feel better.

What is the age limit for donating a kidney?

Is there an age limit to becoming an organ donor?

No: There is no age limit for donation or to sign up. In 2021, one out of every three people who donated organs was over the age of 50. You're never too old to make a difference — as of 2021, the oldest organ donor in the United States was 92.

It can be started at as young as six weeks. The only essential thing is the health and condition of your organs. You can donate all your organs and tissues – heart, kidneys, lungs, corneas, pancreas etc.

However, in India these things are considered :

Age limit for Organ Donation varies, depending upon whether it is living donation or cadaver donation; for example in living donation, person should be above 18 year of age, and for most of the organs deciding factor is the person's physical condition and not the age. Specialist healthcare professionals decide which organs are suitable case to case. Organs and tissue from people in their 70s and 80s have been transplanted successfully all over the world. In the case of tissues and eyes, age usually does not matter.

A deceased donor can generally donate the Organs & Tissues with the age limit of:

Kidneys, liver : up-to 70 years
Heart, lungs : up-to 50 years
Pancreas, Intestine : up-to 60-65 years
Corneas, skin : up-to 100 years
Heart valves : up-to 50 years
Bone : up-to 70 years

Do I need to carry my donor card always?

Yes, it will be helpful for the health professionals and your family.

Do I need to register my pledge with more than one Organisation?

No, if you have already pledged with one Organisation & received a Donor Card, you need not register with any other organisation.

Can a person, without a family, register for pledge?

Yes, you can pledge, but you need to preferably inform the person closest to you in life, a friend of long standing or a close colleague, about your decision of pledging. To fulfill your donation wishes, healthcare professionals will need to speak to someone else at the time of your death for the consent.

If I had pledged before, can I change my mind to un-pledge?

Yes, you can unpledge by making a call to the NOTTO office or write or visit NOTTO website www.notto.gov.in and avail of the un-pledge option by logging into your account. Also, let your family know that you have changed your mind regarding organ donation pledge.

Are donors screened to identify if they have a transmissible disease?

Yes, Blood is taken from all potential donors and tested to rule out transmissible diseases and viruses such as HIV and hepatitis. The family of the potential donor is made aware that this procedure is required.

Can I be a donor if I have an existing medical condition?

Yes, in most circumstances you can be a donor. Having a medical condition does not necessarily prevent a person from becoming an organ or tissue donor. The decision about whether some or all organs or tissue are suitable for transplant is made by a healthcare professional, taking into account your medical history.

In very rare cases, the organs of donors with HIV or hepatitis-C have been used to help others with the same conditions. This is only ever carried out when both parties have the condition. All donors have rigorous checks to guard against infection.

Can I be an organ donor, if I have been rejected to donate blood?

Yes, The decision about whether some or all organs or tissue are suitable for transplant is always made by a specialist, taking into account your medical history. There may be specific reasons why it has not been possible to donate blood, such as having anemia or had a blood transfusion or had hepatitis in the past or there may be reasons why you could not donate blood because of your health at the time - sometimes a simple thing like a cold or medication that you are taking can prevent you from donating blood.

How does whole body donation differ from organ donation?

Organ donation for therapeutic purposes is covered under the Transplantation of Human Organs Act (THOA 1994). Whole body donation is covered by the Anatomy Act 1984.

Organ and Tissue donation is defined as the act of giving life to others after death by donating his/her organs to the needy suffering from end stage organ failure.

Body donation is defined as the act of giving oneӳ body after death for medical research and education. Those donated cadavers remain a principal teaching tool for anatomists and medical educators teaching gross anatomy.

Can a dead body be left for medical education or research after the organs have been retrieved for donation?

No, Bodies are not accepted for teaching purposes if organs have been donated or if there has been a post-mortem examination. However, if only the corneas are to be donated, a body can be left for research.

Can we get our kidney back once we donated it?

The usual answer is NO! From a medical perspective, the act of returning an organ that has once been donated (hereafter, organ restitution) is not permissible if serious safety issues arise due to returning the organ. Accumulating cases have reported on the reuse of transplanted kidneys.

Infections and other health issues make things complicated.

One person asked me this Q which made me give the above information:

Q: My father needs a kidney and my mother wants me to donate my kidney, but I am only 20 years old. What should I do?

Krishna : I will tell a similar story that is real. One of my senior colleagues donated her kidney to her father when she was 27. Nobody asked her to do this. She did this on her own as she loved her dad very much and he had end stage renal disease or ESRD. But just six months after she had donated her kidney her dad died.

Not because the kidney didn’t work, but because her dad developed fungal infection and it spread to the brain (causing fatal meningoencephalitis) because of the immunosuppressant drugs he took. The kidney worked well till the end.

My colleague is doing well, she didn’t develop any complications because of her operation or losing one of her kidneys. Her only complaint is her sacrifice went in vain.

I told you this story to make you think more clearly.

In the end it is you who should decide what to do after considering all the pros and cons.

Q: Do donated organs last a life time?

Krishna: Usually they don't!

While transplanted organs can last the rest of your life, many don't. Some of the reasons may be beyond your control: low-grade inflammation from the transplant could wear on the organ, or a persisting disease or condition could do to the new organ what it did to the previous one.

If If you’re a young recipient, odds are good you’ll outlive the transplanted organ!

Other factors that could affect the life of a transplanted organ include how long the organ was outside of a human body from the time the organ was procured from the donor and implanted into the recipient (longer is usually worse), whether the donor was living or deceased (living is better) and the health of the recipient. And some organs are simply more vulnerable than others—lungs are more prone to infection because they’re in constant contact with the outside world.

But you don’t have to give up when your organ does. Re-transplantation—that is, another transplant following a previous one—is possible and depends on the condition of the patient and how long it’s been since their last transplant. Re-transplants are much more common with kidneys than organs such as the heart or lungs.

Q: When one donates one of his/her kidney, is there a chance that the other one could be affected in time to come?

KS: There are some risks in donating a kidney, but they’re reportedly small.[1] As in any surgery, there are risks of intraoperative death. About 7 out of 100,000 donors die in surgery. Some donors have post-operative bleeding or other complications, but they can generally be resolved. Kidney donors have less lifetime risk of kidney failure than average, and longer life expectancy than average, but this is not because of the procedure itself. The statistics are thought to be due to selection bias—kidney donors are generally healthier, and more health-conscious, than the average person, and take better care of themselves.

I did find one relevant thing on the plus side. When one has donated a kidney, the other kidney grows to compensate for it,[2] at least in donors up to 74 years old. One study found an average 22.4% increase in the size of the remaining kidney.[3] Donors under 40 show the greatest compensatory growth. Total renal function dropped 77% (in one study[4]) in donors who have given up one kidney, but that’s within normal limits for healthy kidney function.

Footnotes

[1] https://www.donorcarenet.org/education/kidney-donation-risks/?gclid...

[2] https://onlinelibrary.wiley.com/doi/abs/10.1111/nep.13578

[3] Compensatory Hypertrophy After Living Donor Nephrectomy

[4] Kidney Function and Compensatory Growth of the Kidney in Living Kid...

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If you want to donate organs, you will find more information Here:

You can be a donor by expressing your wish in the authorized organ and tissue donation form (Form-7 As per THOA) and send signed copy to NOTTO at below mentioned address:
NATIONAL ORGAN AND TISSUE TRANSPLANT ORGANISATION,
4th Floor, NIOP Building, Safdarjung Hospital Campus,
New Delhi-110029.

You may fill up an online pledge to donate your organs. To sign up and register yourself as donor, click here.

https://www.organindia.org/ngos-in-organ-donation/

You can fill a form and get a donor card here:

https://www.organindia.org/claim-your-donor-card/

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