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Friday , October 5 , 2012
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No more at 18, she lives in five others
- Organ donor milestone

Ajay and Shobna Mathur whose daughter’s organs were donated to five recipients after her death. Picture by Yasir Iqbal

New Delhi, Oct. 4: On their daughter’s 18th birthday, Shobna Mathur and her husband Ajay waited patiently for doctors to harvest the teenager’s organs, and prepared to bid goodbye to her forever.

A week earlier, their daughter had become the victim of a hit-and-run accident — an unidentified vehicle had struck her two-wheeler while she was returning from college, throwing her to the ground.

The girl, a first-year BSc student, lost consciousness and a brain scan later revealed that the third vertebra from the top of her spine, or C3 as doctors call it, had fractured, causing irreversible, lethal damage to her brain stem.

Five days after the accident, she was declared brain dead, a point of no return, and a potential source of organs — the liver, the kidneys, the heart and the corneas — for transplantation into other patients.

The parents’ consent to donate her organs and their wait for five more days while the hospital scrambled with medico-legal formalities, doctors say, provide an inspirational saga amid an acute and nationwide shortage of deceased organ donors.

“They kept hanging with us even after they knew they had lost her — I’ve never seen anyone like them in 22 years of practice,” said Sunil Prakash, a kidney specialist at the BL Kapur Super Speciality Hospital in New Delhi.

The accident occurred in Sahibabad, an Uttar Pradesh suburb bordering Delhi, on August 23. Doctors at BL Kapur certified the girl as brain dead on August 28. Surgeons removed her organs for transplantation only on September 2, two days after the girl would have turned 18.

A 20-year-old girl and a man in his 30s, both on dialysis for kidney failure, received her kidneys, a middle-aged man received her liver, and two other persons got her corneas. There was no patient available for her heart.

India passed a law to facilitate harvesting of organs from brain-dead patients 18 years ago but, doctors say, the number of deceased organ donors is still far too small.

“As this case demonstrates, when a family gets past the emotional trauma of their loss and comes forward, five patients can be helped,” said Aditya Pradhan, a urologist at BL Kapur and a member of the transplant team.

The hospital invited the parents today to a modest felicitation that doctors say was intended to highlight the importance of cadaver donation. “On any day, in a large city like Delhi, I estimate, there would be five brain-dead patients,” Pradhan said.

Transplant coordinator Poonam Tiwari was entrusted by doctors to gently discuss the option of organ donation. It was the first time Tiwari was called to approach the family of a brain dead donor, sometimes called a beating-heart cadaver maintained on a ventilator.

In a brain-dead patient on a ventilator, all the body’s organs receive blood pumped by the heart and are thus suitable for transplantation. In contrast, when blood flow stops following a cardiac arrest, the organs become unviable for transplantation within minutes.

“They agreed when I told them that her organs would continue to live in five other people,” Tiwari said.

The parents recalled today that their daughter was helpful, full of fun and great in studies. She had expressed an interest in specialising in nutrition or teaching, said Shobna Mathur, the mother.

(The parents did not want their daughter’s name to be made public because they wanted to protect her privacy but they gave permission to use their names and photographs.)

“We knew this was a bad brain injury — we prayed she should come back perfectly okay, we didn’t want her to be handicapped, paralysed for life. I guess we prayed to God that ‘if that’s the way she’s going to be, take her’,” Shobna Mathur said.

The sequence of events ahead of the transplantation procedure, doctors say, is an example of how corporate and government hospitals can work together and how slow government and bureaucratic machinery can be stirred for a good cause.

“This was a complex medico-legal procedure,” said Rajesh Pande, director of critical care and emergency medicine at BL Kapur. Any road accident death demands an autopsy and, Pande said, police from two states — Uttar Pradesh and Delhi — were involved.

Hospital administrators lobbied station house officers from Delhi and Uttar Pradesh police for permission to consider organ harvesting.

Hospital chief executive Praneet Kumar telephoned the Delhi health minister — an old school friend — at 11.30pm on August 31, seeking advice on how to overcome medico-legal formalities. The minister set up a three-member panel of experts who sought repeat certification of brain death.

The go-ahead for the procedure arrived at 6.30am on September 2, and the surgeons began the organ harvesting and transplantation surgeries at 8.30am. A government forensic team watched the organs being removed and, independently, conducted the autopsy as required under law.

BL Kapur had resources — surgeon and staff — for only one kidney transplant. So the hospital called a government army hospital in New Delhi, offering them the other kidney, the liver, and the two corneas.

“There’s no reason what happened here should not be replicated elsewhere in other hospitals across the country,” said Pradhan. “There’s a huge gap between supply and demand of organs,” he said.

India’s rate of deceased organ donation is 0.08 per million population, in contrast to more than 12 per million in the UK and 33 per million in Spain. Doctors believe an intensive and sustained public campaign is needed to improve deceased organ donations.

In the southern states, a non-government Multi-Organ Harvesting Aid Network has conducted a campaign and succeeded in raising the deceased organ donation rate in Tamil Nadu to 1.3 per million population.

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