Doctor remembers a family's sacrifice in donating organs

To ensure a husband's ultimate sacrifice was not made in vain, a team of specialists swung into action

PUBLISHED : Monday, 06 May, 2013, 12:00am
UPDATED : Monday, 06 May, 2013, 10:50am

The night of December 22, 1995 is so long ago, but it stands out in my memory. I got a call from the ICU that a 30-year-old man, involved in an accident, was deeply comatose.

A CT scan later revealed a badly damaged brain, but his heart was beating strongly, his blood pressure was stable and his kidneys were functioning.

The victim's relatives were aware of the critical condition, and 24 hours later, the situation was reviewed with the family: the patient was brain dead.

The topic of organ donation was broached with them and it was crucial not to say or do anything that could be remotely construed as an act of coercion. No deadlines were given.

It was vital for the family to know that it was the patient, not the organ recipients, who mattered to the doctor.

At midnight, 30 hours after the accident, I was informed that the patient's blood pressure was falling, suggesting imminent, irreversible cardiac arrest. If we wanted to save his beating heart and other working organs, they had to be removed immediately.

But consent for organ donation had still not been given. We were racing against time. What transpired in the next six hours would have done any international crisis committee proud.

Scores of telephone calls were made and vehicles dispatched. Surgeons, anaesthetists, the blood bank, laboratories, operation theatres, nurses and paramedical support services were placed on red alert. Doctors authorised by the government to declare brain death were contacted.

Legal experts reviewed the 1995 Transplantation of Human Organs Rules. Two secretaries appeared at 3am to record the events. The atmosphere was palpably tense.

The task of getting the family's approval involved tact and diplomacy ... discretion and consideration

The lift operators, ward boys, electricians and security guards - anyone who was anyone in the hospital - did their bit. A chain is only as strong as its weakest link and, in those few hours, every single link was crucial. A few hours into the crisis, consent had still not been obtained and the clock was ticking.

The task of getting the family's approval involved tact and diplomacy, supplemented with discretion, consideration, poise and thoughtfulness. Doing things quickly, without appearing to be impatient - knowing when to push and when to hold back - was the order of the day.

It was pointed out that the five specialists who had confirmed brain death had between them a century of experience. The ICU had state-of-the-art equipment and personnel. Everything humanly possible had been done.

Would the family accept this and save four other people's lives and give eyesight to two more? Can we expect the wife of a brain-dead patient to take a calm, calculated decision in such an emergency?

I knew I would have to strike a chord that would resonate with the wife. Any decision is influenced by one's education, cultural and social background.

Pregnant, she had been married for three years and the next day would have been her husband's birthday, followed a week later by their wedding anniversary.

At this stage I unashamedly broke down. The years of professional training, the knowledge that the end justifies the means, all this gave way. Tears rolled down my cheeks and I made no attempt to wipe them off. Here I was at 5am, asking a young woman for permission to remove the beating heart of her husband!

Seeing her look at the monitor displaying her husband's strong pulse broke my heart. With one last look at her loved one, she asked for the forms and signed them.

However, as the teams were being mobilised, I was told she had changed her mind. All activity was put on hold (by now it was on autopilot and no one really knew where the dozens of instructions were coming from).

Another counselling session ensued. If she had the slightest of misgivings, she was assured that we would destroy the consent forms and call off the whole exercise. In the end, she assented.

The patient's heart, liver, kidneys and corneas were removed. Teams of anaesthetists and surgeons swung into action. For the liver transplant, in particular, 160 units of blood and blood products were made available - which could save lives.

The extraordinary display of co-operation was all the more dramatic because it was done by ordinary people who had only one mission that Sunday: to ensure that the ultimate sacrifice made by a remarkable father and wife would not be in vain.

Eighteen years have passed since that incident. Awareness of organ donation has increased exponentially. We have about 900 individuals in India enjoying a good quality of life with kidneys, hearts and livers from donors.

Worldwide, about 500,000 kidneys, 20,000 livers and 3,500 hearts have been transplanted. One donor can potentially donate seven solid organs - heart, lungs, liver, pancreas, small intestine and two kidneys - in addition to the cornea, skin, blood, bone, cartilage and veins. Kidneys are the most needed.

Last year in India, about 600 organs and 400 tissues were obtained from 200 donors, a donation rate of only 0.16 per million of the population. This is far below Hong Kong with three per million, and the world leader, Spain, with 32. In the West, 85 per cent of 25,000 annual transplants are from brain-dead patients.

If properly taken care of, a transplanted kidney can last an average of 15 years. For other organs such as hearts, lungs and livers, the 10-year survival rate is about 70 per cent.

Dr Krishnan Ganapathy is a neurosurgeon and telemedicine specialist