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India – Change mind-set on cadaver donation 

Ten people, including the 12-year-old pictured here, are on an increasingly grim-looking waiting list for a heart transplant. But does Mumbai know? And does it care? City’s high rate of road, rail deaths yields at least 12 potential donors every day. But their families are not even approached by counsellors for a cadaver donation 
In the Intensive Care Unit of Mulund’s Fortis Hospital, 35-year-old Abhishek Dalvi is fighting for life ­ every day, every minute. A digital marketing professional, Abhishek battled cancer as a teenager, but the treatment took toll on his heart. His heart’s pumping capacity is down to a mere 5 per cent now ­ just getting out of the bed can leave him panting and trigger a seizure. Abhishek’s last hope is a heart transplant, for which doctors would need a live, ticking heart in a brain dead body.And that is where the hitch is.A complete lack of awareness about cadaver donations and a shamelessly callous attitude of hospitals authorised to harvest organs from brain dead patients has left Abhishek and nine others in Mumbai desperately hanging on to life as time fast runs out. Abhishek and the other nine, including two 14-year-old boys and a seventeenyear-old girl, are registered with Fortis and Asian Heart Institute, two of the four hospitals in Mumbai with a licence to carry out heart transplants. Some of them have been waiting for a donor for over six months.When every day counts, that’s a lifetime.

If Mumbai could get its act together, all 10 of them could be off that list and off to a new life in less than a week’s time. Consider these numbers: At least one person loses his life in a road accident and another nine in train accidents in Mumbai every day. While it may sound macabre, the World over accident victims are considered potential organ donors. It is so because in many accidents the victim’s brain is affected but organs remain intact and functional.

Add to this, at least a couple brainstem deaths every day in hospitals across Mumbai and you have 12 potential donors every single day. But because our hospitals’ mechanism for reporting brain dead patients to the Zonal Transplant Coordination Center is so poor and because there is such low awareness about how in death one can give somebody a new life, not one of the families of these 12 potential donors are even approached. And so, the 10 critically ill heart patients in Fortis and Asian Heart Hospital, and hundreds of other like them in need for other organs, continue to wait.

Dr Sujata Patwardhan, chairperson, Zonal Transplant Coordination Center, believes it is time to make it mandatory for all hospitals to report brain deaths. “It is time for the government to step in. Only when there is a mandate, will we get a decent response,“ she said, adding that active participation of public hospitals in identifying brain deaths can turn around the organ transplant programme given their huge footfalls.

As many as 32 city hospitals, three of them run by the government, are registered for organ transplantation and at least ten other hospitals have the license to harvest organs if they have a cadaver donor. However, barely 10 hospitals report brainstem deaths to the Zonal Transplant Coordination Center. The city has not had a cadaver donation for the past three weeks.

“The mindset about organ donation needs to be changed,“ said S Narayani, zonal director for Fortis Hospital. She said that after a patient is declared brain dead, it is obvious that the family will find it difficult to discuss organ donation. “But our job is to try.There are trained counsellors for this job. And of course, greater awareness will lead to greater acceptance,“ she said.

So far this year, 40 cadavers have been donated for organ retrieval, which is a miniscule number if one also considers the waiting list of 2600 for kidneys and 160 for liver.

According to Patwardhan, 10 per cent of all ICU deaths are brainstem deaths. While all of them cannot be fit for organ donations, a considerable number can be managed if the hospital’s social workers and counsellors pitch in time.

Maharashtra can take a cue from Tamil Nadu, a pioneer in organ transplant in India. It got 155 cadaver donors in 2014 and holds a record of 19 cadaver donations in a single day.

Mumbai so far has had five heart transplants , all of them this year and all at Fortis Hospital.

According to paediatric cardiac surgeon Dr Vijay Agarwal, the rejection rate of a heart is much lower than other organs like kidney and liver. Of the nine patients on Fortis’ waiting list, three are minors. “Technically, the procedure for a paediatric heart transplant is the same as that for an adult. However, the sensitivity involved much more when it comes to convincing a family to donate,“ he said. For a paediatric patient, the organ has to be taken from a donor of similar height and weight.

Twelve-year-old Pranav Gaikwad is one of the nine on Fortis’s waiting list.Having been diagnosed with dilated cardiomyopathy, brought upon by a nasty viral infection when he was just 18 months Pranav’s heart currently operates at 40 per cent of its capacity and is rapidly losing steam. He is forbidden from playing outdoors and is bedridden with high fever at least twice a month. “His life is limited to being in class and at home,“ said Pranav’s father. A Mumbai with a little more heart can give Pranav his childhood back.And yes, every day counts.


When Mumbai Mirror started working on this report, there were 11 on the heart transplant waiting list. However, on Saturday, Rajan Desai, a 58-year-old resident of Kandivali, received a donor heart from Surat.

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