Critical care specialists in India, for the first time have developed concise guidelines for identification and management of identified potential organ donors. The Indian Society of Critical Care Medicine (ISCCM) member doctors, who have developed these guidelines, have also submitted the draft to National Organ and Tissue Transplant Organisation (NOTTO) for its endorsement.
In the recent past, India has witnessed more and more organ transplants. The government has already set up NOTTO for regulating organ transplants in India, but the country does not have any guidelines for identification and management of potential organ donors.
The ISCCM doctors, who have formulated these guidelines, say that there are many misconceptions among doctors on many issues related to organ donation. Doctors are still unaware about many legal procedures on pre and post organ transplants. They have also observed many misconceptions about Apnea test – which is undertaken to certify a patient as brain dead; and about multi-system management of multi-organ donor.
While explaining the purpose of creating such a document, Dr Kapil Zirpe, Director and HoD of Neuro Trauma Unit Ruby Hall, Pune and who was also part of the team who framed these guidelines, said, “The physiology of all available organ donors should be normalized and maintained till organ is retrieved. Often older people are also potential donor candidates; such cases if managed carefully there will be improvement in conversion rate and graft survival after donation.”
“Different doctors from different parts of India, who are associated with ISCCM, have done an extensive research before formulating the documents. Our motive is to make doctors aware about all these issues and to correct misconceptions related to organ donation,” he added.
The document says that brainstem death is usually followed by an expected pattern of complex multiple organ failure, hence an appropriate support to donor before and after brain death can increase the number and quality of organ transplants. It also says that the guidance provided in the statement does not substitute proper clinical decision making in particular case, but will help intensives in management of organs of brain dead patient.
It has explained in detail the medical management of donor through cardiovascular management, hormonal or management of metabolic derangement, management of temperature, respiration, management of hematological parameters and nutritional support. Blood pressure maintenance, body temperature management, urine output and basic nursing care of brain bead patient who can be potential organ donor are also discussed.
The document defines brain death, how it occurs and what medical tests should be carried out to certify a brain dead patient. It also informs about legal aspects like who can certify a brain dead patient and with how many doctors and what many tests the certification takes place etc.
Dr Sushama Kulkarni, Senior consultant at Ruby Hall Clinic, Pune, said, “There are many small hospitals in periphery who are the first to get brain dead patients. It is in the later stage that these brain dead patients come to big multi-specialty hospitals in the city. It is therefore essential that these doctors form periphery should be trained. Also, these guidelines are not final and it will need constant upgradation.”
While the guidelines were released on May 13, the team has recently submitted them to NOTTO for its endorsement. Dr Rahul Pandit, Director of Fortis Hospital Mumbai and also a part of the team, said, “NOTTO is still reviewing these guidelines.”
Dr Abhay Huperikar, Secretary of Zonal Transplant Coordination Centre (ZTCC) said, “Once they are certified by NOTTO, we would circulate them in different hospitals so that uniform guidelines are made available.”
The document provides guidelines on following points:
Potential organ donor, brain death and importance of brain stem death
Declaration of brain death and tests done for confirmation of brain death
Legal aspects of organ donation in India
Physiological changes in brain dead patient and complications
Medical management of potential organ donors