Postmortem Organ Donation: A Great Initiative That Can Save Many Lives

Beginning:

Recently, the news of a young woman named Sarah Islam appeared in the newspaper. Suffering from incurable tuberous sclerosis, Sarah died at the age of twenty, but is remembered for her work. With the permission of her and her family, Sarah's two kidney transplants after her death have given two patients back a somewhat normal life. His cornea showed light to two others. But the kidney transplantation is more prominent, because in Bangladesh, kidney transplantation from the dead to the living person was started with Sarah Islam.

When a human organ cannot function properly, it sometimes needs to be replaced. Although some organs can be taken from animal bodies, it is best if the organ can be transplanted from another human. For many patients with chronic or long-term diseases, the only way to live a normal life is to transplant the diseased organ.

History Of the First organ transplant:

The first attempted human deceased-donor transplant was performed by the Ukrainian surgeon Yurii Voronoy in the 1930s; but failed due to ischemia.

In 1905, Alexis Carrel (1873–1944) and C C Guthrie (1880–1963) in New York City did the first heart transplantation in a dog. In 1906, Mathieu Jaboulay (1860–1913) in Lyon used kidneys from pigs and goats to attempt xenotransplantation in a human patient.

First Successful Organ Transplant, Image Source: Samoa Global News

In 1954, the kidney was the first human organ to be transplanted successfully. Liver, heart and pancreas transplants were successfully performed by the late 1960s, while lung and intestinal organ transplant procedures were begun in the 1980s.

Variations in organ transplantation:

Organ transplantation, in medical terms organ transplant can be from animal to human or human to human. Human-to-human transplantation is again of two types. A living person can donate a kidney, lung, pancreas, liver or part of the digestive system. This is called a living donor transplant.

Both kidneys, both lungs, the heart, the pancreas and the entire digestive tract, and the cornea can be taken from a deceased person. Heart valves, skin, tendons, etc. can also be transplanted from a dead person to a living patient. Transplantation of organs from a dead person to a living person is called a cadaveric transplant. 80-90% of transplanted organs in developed countries come this way.

Organs that can be transplanted; Image Source: medlineplus.gov

In 1968, a Japanese surgeon performed a heart transplant, killing both the living donor and the recipient. That is why he has to stand in court on charges of murder. Since then, the dead donor appears to be the most convenient for transplanting vital organs, or organs essential for life, which is called the 'Dead donor rule'. As a result, it becomes important to doctors and legislators when a person can be pronounced dead.

Criteria for death in medicine

In general, people mistake the heart for death, called cardiac death. As a result of which blood circulation in the body stops, it is also called circulatory death. Cardiac death is also recognized in medicine. But vital organs die quickly when circulation is cut off, so removing these organs for transplantation while the circulation is still on, that is, while the heart is still pumping, increases the success rate.

Cardiac death is declared when the heart stops permanently; Image Source: hackensackmeridianhealth.org

 

It is mainly for this reason that in the 1970s and '80s the concept of brain death was introduced, by which the permanent cessation of brain activity is understood. With the help of modern equipment in the ICU, the heart and lungs of such patients are kept alive, but in fact their chances of survival are almost zero. Therefore, brain death is considered legally dead in various countries. To declare brain death, doctors examine certain nerves that originate in the brain stem, which connects the cerebrum, cerebellum, and spinal cord of the nervous system. Brain death is considered to occur when the brain stem is permanently immobilized.

brain stem; Image Source: verywellhealth.com

In many Western countries, clinical death refers to brain death. With the consent of the patient and family, the process of removing the donated organs begins. The heart and lungs are kept artificially alive till the end of the operation. So the patient did not die of cardiac death. Only certain organs can be harvested from patients who have died of cardiac death, such as kidneys, liver and pancreas.

A History of Organ Transplantation in Bangladesh:

The first living donor-to-patient kidney transplant was successfully performed at the current BSMMU in 1982. Since 1988 kidney transplants have become widespread, but all of them have been living donor transplants. Only corneas were taken from deceased donors, which became popular in 1984. Besides, no other organs were taken. As a result, despite the large number of patients in need of organ transplantation, the required organs could not be procured. Moreover, the whole issue gets somewhat muddled in the social and religious discipline debate.

The first successful kidney transplant was performed at the current BSMMU in 1982; Image Source: bsmmu.edu.bd

On April 13, 1999, the Bangladesh government enacted The Human Organ Transplant, which specified that any living person can donate an organ to a patient. However, as this list is very limited, illegal trade is rampant. As a result, the law was updated in 2018.

Back to Sarah Islam's words again. Despite the availability of necessary equipment and skills, postmortem organ donation has not gained momentum so far due to lack of donors. It is hoped that his contribution will create a new awareness of this issue among us, encouraging individuals and families to think about it. It must be remembered that once there were social barriers to donating blood, donating corneas, etc., but with increasing awareness, now we know about its benefits. There is also a need for social movements around cadaveric transplants, which could benefit many people in need.

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