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NARRATIVE REVIEW
Year : 2022  |  Volume : 16  |  Issue : 1  |  Page : 26-41

Organ donation after circulatory determination of death in India: A joint position paper


1 Manipal Organ Sharing and Transplant (MOST), Manipal Hospital, New Delhi, India
2 HN Reliance Foundation Hospital, Mumbai; Liver Transplant Society of India, India
3 Division of Training and Education, MOHAN Foundation, Chennai, Tamil Nadu, India
4 Department of Intensive Care and Emergency Medicine, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India
5 Department of Renal Transplant Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
6 Ministry of Health and Family Welfare, Government of India, Delhi, India
7 Department of Cardio-thoracic Surgery, Apollo Hospitals, Chennai, Tamil Nadu, India
8 Department of Cardio-thoracic Surgery, MGM Healthcare, Chennai, Tamil Nadu, India
9 Department of Hepato-biliary Surgery, Apollo Hospital, Navi Mumbai, Maharashtra, India
10 Vidhi Centre for Legal Policy, Delhi, India
11 Department of Neuro Trauma Unit, Grant Medical Foundation, Ruby Hall Clinic, Pune, Maharashtra, India
12 Department Heart and Lung Transplantation, SPARSH Hospitals, Bengaluru, Karnataka, India
13 Department of Nephrology, Osmania Medical College and General Hospital, Hyderabad, Telangana, India
14 Karunashraya Hospice, Bengaluru, Karnataka, India
15 NHS Blood and Transplant, Scotland, UK
16 Department of Intensive Care, Fortis Hospital, Mumbai, Maharashtra, India
17 Department of Critical Care and Pulmonology, Yashoda Super Specialty Hospital, Kaushambi, Ghaziabad, Uttar Pradesh, India
18 Department of Neurology, P.D. Hinduja National Hospital, Mumbai, Maharashtra, India
19 Max Centre for Liver and Biliary Sciences, Max Saket Hospital, New Delhi, India
20 Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr H.L. Trivedi Institute of Transplantation Sciences (IKDRCITS), Ahmedabad, Gujarat, India
21 MOHAN Foundation, Chennai, Tamil Nadu; Indian Society of Organ Transplantation, India

Correspondence Address:
Sunil Shroff
MOHAN Foundation, 3rd Floor, Toshniwal Building, 267, Kilpauk Garden Road, Chennai - 600 010, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijot.ijot_61_21

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Organ donation following circulatory determination of death (DCDD) has contributed significantly to the donor pool in several countries, without compromising the outcomes of transplantation or the number of donations following brain death (BD). In India, majority of deceased donations happen following BD. While existing legislation allows for DCDD, there have been only a few reports of kidney transplantation following DCDD from the country. This document, prepared by a multi-disciplinary group of experts, reviews the international best practices in DCDD and outlines the path for furthering the same in India. The ethical, medical, legal, economic, procedural, and logistic challenges unique to India for all types of DCDD based on the Modified Maastricht Criteria have been addressed. India follows an opt-in system for organ donation that does not allow much scope for uncontrolled DCDD categories I and II. The practice of withdrawal of life-sustaining treatment (WLST) in India is in its infancy. The process of WLST, laid down by the Supreme Court of India, is considered time-consuming, possible only in patients in a permanent vegetative state, and considered too cumbersome for day-to-day practice. In patients where continued medical care is determined to be futile following detailed and repeated assessment, the procedure for WLST, as laid down and published by Vidhi Centre for Legal Policy in conjunction with leading medical experts is described. In controlled DCDD (category-III), the decision for WLST is independent of and delinked from the subsequent possibility of organ donation. Once families are inclined toward organ donation, they are explained the procedure including the timing and location of WLST, consent for antemortem measures, no-touch period, and the possibility of stand down and return to the intensive care unit without donation. While donation following neurologic determination of death (DNDD) is being increasingly practiced in the country, there are instances where the cardiac arrest occurs during the process of declaration of BD, before organ retrieval has been done. Protocol for DCDD category-IV deals with such situations and is described in detail. In DCDD category V, organ donation may be possible following unsuccessful cardiopulmonary resuscitation of cardiac arrest in the intensive care. An outline of organ-specific requisites for kidney, liver, heart, and lung transplantation following DCDD and the use of techniques such as normothermic regional perfusion and ex vivo machine perfusion has been provided. With increasing experience, the outcomes of transplantation following DCDD are comparable to those following DBDD or living donor transplantation. Documents and checklists necessary for the successful execution of DCDD in India are described.


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