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JMA Bruno Mascarenhas M.Ch., (Neuro)Asst Professor of Neurosurgery, Madras Medical College&Technical Associate, Cadaver rgan Trans!lantProgra""e

#overn"ent of Ta"il Nadu

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$our %oring #rou!s'

Cadaver organ donation

Cadaver organ trans!lantation Coordinating rganiation for organ

sharing

ive donation and trans!lantation33 recommendations for follo* u!

action.

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The !artici!ants felt that there *eremany grey areas in theTrans!lantation of +u"an rgans Act. n !articular, no guidelines on who

will get the donated cadaver organThe #overn"ent follo*ed u! *ith a

series of consultative "eetings held*ith grou!s of doctors -yMr.P.%.C.avidar A/

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eclaration of -rain death "ade"andatory

Procedure for declaration of Brain eath

Authoriation Co""ittee ProceduresProcedure to -e ado!ted for Cadaver

trans!lant -y the #overn"ent and Private+os!itals

0es!onsi-ilities of Trans!lant centers inhos!italConvenor, Cadaver Trans!lant Progra"Post1"orte" e2a"ination in "edico legal

cases 3 Procedure !rescri-ed

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Prof r J A"alor!avanathan, Professorof 4ascular /urgery, MMC & 0###+a!!ointed as Convenor, Cadaver

Trans!lant Progra""e in honoraryca!acity5ce s!ace !rovided at the

#overn"ent #eneral +os!italAdvisory Co""ittee headed -y +ealth

/ecretary, #oTN Mr avidar, M/, M6, TNM/C, Police e!t, 7 N#s, 8 Medical 6thicist, 9 #overn"ent +os!itals, : Private +os!itals

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nitiatives for for"ing ;Ta"il NaduNet*or for rgan /haring< and"aintaining a co""on online*aitlist for all !otential reci!ients inall hos!itals *ho choose to co"eunder this net*or in Ta"il Nadu and

allot"ent of organs -y the Net*orCo""on %aiting ist (-ased Blood#rou!) visi-le to all staeholders

Allocation -ased on *aiting ist

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denti=ed ey cha"!ions#ot the /tate #overn"ent involved

#ot the Ma>or +os!ital Manage"entsinvolved#ot the Media involved

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T+A ;alone< is not enough forCadaver Trans!lant

t regulates only *ho can donate,*here and ho*

No say on who will get the organs -a crucial issue

No !rogress !ossi-le *ithout this =rstste!

Maharashtra did it =rst. ?arnataa, TNand AP follo*ed ne2t

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Because organs donatedaltruistically do not -elong to the

donor hos!ital or to anyone elseThey are donated to society at large.

ts re!resentative, the govern"ent,has to decide *ho gets it.%orld*ide, this is the !ractice.

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/hould -e -ased on sociallyacce!ted nor"s of fairness,

accounta-ility and trans!arency%ithout such authentic fra"e*or,hos!itals *ill not feel con=dent orsecure to "ove for*ard and *ill

al*ays @uarrel *ith each other

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TN regulation is -etter than of otherstates 1 "ore !ractica-le

Because it evolved through awide

process of consultation withstakeholders

All trans!lant hos!itals called for aone day consultation, follo*ed -y

doens of "eetings *ith s"allgrou!s of s!ecialistsThe $ra"e*or is evolving still

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+ard nfrastructure e2isted to so"ee2tent, even if inade@uate

/oft nfrastructure 3 no*ledge andsills in -rain death certi=cation,cadaver "aintenance, regulatoryco"!liance etc., develo!ed

rganised training !rogra""es and!re!ared detailed !rotocols for allactivities

/ensitised Police e!art"ent

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That Neuro1s!ecialists do notcoo!erate in -rain death declaration isa Tro>an +orse

f to! "anage"ents of hos!itals getinvolved, all issues get sorted out

Botto" ine is *hat drives !rivate

hos!itals n TN, iver Trans!lant +os!itals are

"ore "otivated than ?idney Trans!lant+os!itals

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+ard infrastructure !rovided in eygovern"ent hos!itals

evelo!ed ?idney, iver and +eart

trans!lant ca!a-ilities there6dge in organ allocationTop down pressure until inertial

barrier is crossedBecause "ost !otential donors arise

hereAlso -ecause society loos to see *ho

gets the organs

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""unology a- Accessi-ility 3 7:hrs

C Beds, 4entilators in ey !u-lic charita-le hos!italsA"-ulancese-ate ethical issues in

infrastructure allocation 3 i""ediatevs. distant, visi-le vs. invisi-le lifesaving

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Costs very little ti"e and eort tohighlight hu"an interest stories in

organ donationThe +ithendran eect in TNMedia -rings !ressure on hos!itals,

doctors

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A!!ro!riate Authority "ore friendlyand eective

a*s inter!reted in s!irit, not *ordTi"e delays avoided in a!!rovinghos!itals and !anel of na"es for Bcerti=cation

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Cri--ing on T+A de=cienciesCo"!laining a-out Neurologist non1

coo!eration%aiting for Central #overn"ent toact

%aiting for /tate #overn"ent

fundingoing a*areness generation

!rogra"s3 (DEF consent rate in TN)

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Convenor runs the CTPverseen and su!!orted -y the

Advisory Co""ittee *hich ee!s*atch and a"ends #uidelines asneeded

Partici!ating hos!itals to ee!

!roviding in!uts to i"!rove the#uidelines

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0egister *illing trans!lant hos!italsin the organ sharing net*or

?ee! the" !osted of the regulatoryfra"e*orConvene "eetings of the Advisory

Co""ittee and tae follo* u! action

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Tae calls 7:GD fro" donor hos!itals,allocate organs and co1ordinate tilltrans!lants tae !lace

/end !eriodic re!ortsMaintain data-ase of cadaveric and

live donor trans!lants

Maintain *e-site ***.d"rhs.orgConvene "eetings of hos!itals forideas on i"!roving the fra"e*or

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+os!itals treating !atients *ith 6nd/tage rgan $ailure (?idney failure

or liver failure or heart failure)register those *illing for trans!lantat the online data-ase ***.tnos.org

%aiting ist is "aintained online and

is *atched -y all hos!itals in the!rogra""e

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6ach hos!italAll #overn"ent hos!itals co"-ined

All !rivate hos!itals co"-ined andAll +os!itals Co"-ined

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8st !riority 1 ist of the #overn"ent+os!ital *here the deceased donor islocated, for liver, heart and one idney.

The other idney *orld -e allocated to'7nd !riority 1 co"-ined #overn"ent

+os!itals list9rd !riority 1 co"-ined Private

+os!itals list:th !riority 1 #overn"ent +os!itals

outside the /tate

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Eth !riority 1 Private +os!italsoutside the /tate

$inally, if the organ(s) re"ainsunutilied -y the a-ove criteria, it"ay -e oered to a foreign nationalregistered in a #overn"ent or

Private hos!ital *ithin and thenoutside state. (This is to ensure thatthere is no *astage of organsdonated)

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8st !riority 1 the list *ithin thePrivate +os!ital *here thedeceased donor is located, for

liver, heart and one idney. Theother idney *orld -e allocated to'

7nd !riority 1 the co"-ined list of#overn"ent and Private +os!itals

9rd !riority 1 #overn"ent !rivatehos!itals outside the state

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$inally, if the organ(s) re"ainsunutilied -y the a-ove criteria, it"ay -e oered to a foreign

national registered in #overn"entor !rivate hos!ital *ithin and thenoutside the state, !rovided earlierinfor"ation and such a re@uest has

-een registered *ith the Advisoryco""ittee Convenor, CadaverTrans!lant Progra", Ta"il Nadu.

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E9H onors $ro" Ta"il Nadu I +eart

:7 ung

:KK iver

I:K ?idney8EDD Ma>or organs

E9: +eart 4alve DI: Cornea

8H /in7I8E Total rgans

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I:K Patients *ith Chronic 0enal$ailure have -een -ene=tted

LI:K +ealthy !atients *ere noto!erated

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/tate #overn"ent +os!ital to do+eart Trans!lants

And Totally $ree of Cost

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/tate #overn"ent +os!ital to doiver Trans!lants

And Totally $ree of Cost

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eceased onation (ie onationfro" Braid /te" ead !atients) 0ate

in TN is 8.9"illionyear *hich is 8Hti"es the national average

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n July 7H8H, a 8: nation %+ "eetin #eneva to esta-lish a -lue !rint to

i"!rove organ donation in NCountries, !ut in TN 62!erience as aey !oint in the -lue !rint !re!ared

Many states have follo*ed TN Model

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New lives out of deaths V.K. Subburaj, P.W.C. Davidar, J.Amalorpavanathan and C.E. Karunakaran TamilNadu ho! th" !a# in or$an tranplantation.

f your liver has failed and you need afunctioning organ to -e trans!lanted foryou to survive then go to Chennai' thisis the -u a"ong liver1failure !atients

across ndia The /tate has done 88Hdeceased donor liver trans!lantations ina !eriod of less than t*o years. All other/tates !ut together have not done evenhalf this nu"-er.

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+% 6C6A/6 N0T0AN/PANTATN / MPACTN# A6CN6 N CMM60CA

T0AN/PANTATN 1 T+6 TAMNA 6GP606NC6 3

%uvaram N V &"dd#'(), *ill#

*atth"!'(), Saravanan S'(),Amalorpavanathan'+), "or$iAbraham'(,-), Sunil Shro'/)

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Cadaver rgans Trans!lantProgra""e isneither too trivial to ignore anddo nothing

nor too co"!licated to des!airof.

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eceased onor Trans!lant *illeradicate women slavery

*here "ore than IHF of livingrelated ?idney onors are *o"enThis is a social responsibility of

the octors for the /ociety fro"*hich they should not shy a*ay

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62tre"ely dedicated Neuroconsultants

ntensivists *ho are *illing to"anage the !atients *ith severeBrain /te" ysfunction

Anaesthesiologists *ho are *illing to

do A!nea testingAd"inistration *ho are *illing tosu!!ort this !rogra""e

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The contri-utions "ade -y all the!atients

The relatives *ho too the no-le,valiant, gallant decision of donatingthe organs of the deceased

Trans!lant Tea"

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5cials in #overn"ent

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r./hro Mr.C6?arunaaran

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/!lit iver ' /ingle iver for an Adultand one "ore child

tilie More +earts/tudy the utco"e of Trans!lant

0eci!ients ncreasing a*areness of *hole -ody

donation

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