Organ transplantation is the only curative option available for many
diseases resulting in irreversible organ-failure. Advanced
surgical-techniques, peri-operative care and immunosuppressive therapy
have tremendously improved survival rates in patients undergoing
transplantation. However, the primary impediment in the progress of
transplantation in our country is the lack of donor organs. Ever since the
Transplantation of Human Organs Act was passed in India in 1994, making it
possible to retrieve organs from brain-dead donors, there have been about
1000 adult cadaver donations, but only 6 (3 boys and 3 girls) pediatric
cadaver donations. Their age range was 16 months to 16 years. Four of them
had sustained brain death (BD) from head trauma and the others from brain
tumor and ventriculitis.
Pediatric cadaver organs are satisfactory for children
awaiting organ transplantation. The transplantation of the pediatric
cadaver kidneys and liver into adult recipients yields graft survival
rates similar to adult cadaver organs(1,2). Thus, the promotion of
pediatric cadaver organ donation (PCOD) programme would help to overcome
the existing paucity of organs.
Several factors including unforeseen death, religious
and cultural beliefs, fear of mutilation and families not being asked
about organ donation (OD) lead to denial of PCOD(3). Illiteracy and lack
of information are other contributors in India. In addition, the lack of
appropriate identification of BD, shortage of trained transplant co-ordinators
and organ procurement organizations are important hindrances.
We share our experience of the first PCOD at our
centre. A 16 month-old-girl with biliary atresia and end-stage liver
failure was referred to us for a liver transplant. She had coexistent
hydrocephalus and suffered BD from ventriculitis. After declaration of BD
by the pediatric neurology team, her parents were counseled for OD by
transplant coordinator. They agreed to donate her eyes and kidneys making
her India’s youngest cadaver donor.
PCOD should be a part of comprehensive organ retrieval
program. Pediatric cadaver donors include children with severe head
trauma, road-traffic accidents, spontaneous massive intracranial
hemorrhage, primary brain tumor, neurometabolic disorders, cerebral anoxia
or drug intoxication(4). Creating a positive attitude, providing emotional
support, giving time to comprehend death before discussing OD and offering
the option of donation to all families are the main steps which should be
practiced while promoting OD(4). Involvement of media and nongovernmental
organizations along with governmental support are needed. There is a need
to educate people regarding the pivotal importance of PCOD to overcome the
hurdles in the success of cadaver donation program.
References
1. Csapo Z, Knight RJ, Podder H, Kerman RH, Schoenberg
L, Katz SM, et al. Long-term outcomes of single paediatric vs.
ideal adult renal allograft transplants in adult recipients. Clin
Transplant 2006; 20: 423–426.
2. Hideaki T, Deborah V, Albert S, Stuart D, Michael S,
Jodi F, et al. Liver transplantation utilizing pediatric cadaver
donor livers. Pediatr Transplant 2005; 9: 47-51.
3. Weiss AH, Fortinsky RH, Laughlin BL, Lo B, Adler NE,
Mudge C, et al. Parental consent for pediatric cadaveric organ
donation. Transplant Proc 1997; 29: 1896-1901.
4. Warren J, Gill B. Guidelines for Hospital Administrators for
Implementing Required Request. Alexandria, VA: American Council on
Transplantation; 1987. p. 1-36.