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Kidneys aren’t for burning; nor are eyes, hearts & livers

Who among us has not experienced death at first hand? All of us lose our elders; some more tragically, a younger relative. Our reaction varies, and we may feel intense grief, despair, anxiety, or just numbness. Whatever the emotion, the hour of death is not the time to make serious decisions, and that is one reason why most doctors hesitate to broach the subject of organ donation with the family at that time. Every day in every hospital in the world, a number of people die, many of them with healthy eyes and kidneys and livers, many too with healthy hearts. Many times that number die at home with healthy eyes. The tragedy of death is compounded by the failure to donate these organs. Not only does someone die, the opportunity to save the lives and sight of so many others is lost. How can we prevent this waste of lives? We must begin with ourselves. Who is better qualified than you to decide whether to donate your organs? Make the decision today, and make it known. That will make the task of your family easy. All of them will know exactly what they should do at that sad moment. You will feel, with Sydney Carton in Dickens’ A Tale of Two Cities: “It is a far, far better thing that I do, than I have ever done…..”

I hope you have read my earlier articles on this subject, “Spare a thought for the donor” and “Saving lives after death” in The Hindu of April 15 and May 15. They are available from the archives on The Hindu’s website at http://www.hindu.com/2008/04/15/stories/2008041554940900.htm and at http://www.hindu.com/2008/05/15/stories/2008051554821100.htm

The most commonly used organs are the eyes, which are best removed within six hours of death. It is not necessary for death to occur in hospital, and teams from the eye banks will retrieve the eyes from the deceased even at home. Once removed, the eyes may be preserved for two weeks and used at any time during that period, though more often they are used within three days. Age is no bar, and eyes may be removed from people of all ages, from infants to centenarians. It is not necessary that the donor should have had good eyesight. The need for spectacles in life does not preclude eye donation. Even blind patients with eye damage due to diabetes can donate their eyes. People who should not donate eyes are those with infections of the eyes, the brain or the blood, and people with leukaemias (those dying of other cancers were rejected some years ago, but ophthalmic thinking has changed, and they are accepted nowadays). You need not worry about the face being disfigured. The eye socket is filled with gauze and stitched shut, so that there is no distortion of the features.

What should you do when someone else, to whom you are the closest relative, dies suddenly at home, or anywhere away from a hospital? Please ring up any eye bank, and give them the information, and their team will come and collect the eyes. I do not have the telephone numbers of eye banks in every city, but a few you can use in Chennai are Sankara Nethralaya: 28226694, 28281919, Dr. Agarwal’s Eye Hospital: 28116233, Government Ophthalmic Hospital: 28553840, 28555281. Remember, the eye must be removed within six hours of death, so don’t leave it too late. Inform the eye bank as soon as death occurs, to give the team time to get to your house.

The eye is the only organ that can be retrieved from the home of the deceased. All other organs can be used only if the donor dies in a hospital. While the ideal donor would be one who is brain dead but has his organs sustained by his being on a ventilator (a heart beating donor) the kidneys can be taken even after the heart stops beating (a non-heart beating donor), provided they are taken within an hour of death. That allows the kidneys to be second only to the eyes in the number of organs used. Patients with cancers of any organ except the brain (cancers of the brain do not ordinarily spread outside the cranium) and those with active blood stream infections cannot be used as donors.

The liver and the heart are the other organs commonly used. These organs can be taken only from a heart beating donor. Donations of livers and hearts can only be taken if the donor is in a hospital that has an intensive care unit, though kidneys can be removed after death in any hospital that has an operation theatre. Once the organs are harvested, the kidneys must be transplanted into the recipients within 24 hours, though it is possible to extend this time to three days if an appropriate perfusing machine is available. The heart and liver are preferably put into the recipient within six hours, though again longer preservation is possible with special machines.

Getting all this organised takes time. There will be a delay in your receiving the body of your loved one if you consent to organ donation. I appeal to all who are ready to donate organs not to withdraw the permission just because of a delay of a few hours in obtaining the body. A few hours of inconvenience to you could give a fresh lease of life to a few dying people. The artificial kidney can keep patients with kidney failure alive and well for years, but people with failing hearts and livers have no such life support. Only those on the verge of death are chosen to receive these organs, and your donation may be their only chance of survival. Would you begrudge a few hours of your time to save someone’s life?

There will be no mutilation of the body. The chest has a rigid cage, and will not collapse because of removal of the heart or even the lungs. Only the liver and the kidneys, and perhaps the pancreas, will be removed from the abdomen in most instances, and the bulk of the contents of the abdomen are the intestines, which will be replaced. A long incision will be visible on the front of the chest and abdomen, but it will be neatly stitched and dressed and will not be unsightly.

Which organs can be used? The medical team that has been looking after your patient knows the condition of the different organs of the deceased, and can make that decision. Please leave it to the doctors to use whichever organs can be used.

I have just been invited to attend the wedding of the son of one of my patients, who received a deceased donor’s kidney 12 years ago, and is now living a full life. He tells me the guest of honour at the wedding will be the father of his donor, a young man who died an untimely death. Through his grief, the father thought of doing this supreme act of benevolence. He sees his son living on in the person who bears his kidney, and has always been deeply interested in his welfare and that of his family, and gets some consolation through him for the loss of his own son.

We often institute orations or scholarships in the name of someone we have loved and lost, to commemorate them. Is not this endowment, the gift of life and sight, so much better a memorial? This is truly the path to immortality.

I am indebted to Dr. Prema Padmanabhan of Sankara Nethralaya, who taught me much about eye donation.

(Dr. M.K. Mani, Chief Nephrologist at Apollo Hospitals, Chennai, is a pioneer of renal transplantation in India.)

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