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Indian Pediatr 2010;47: 197

Creating Awareness about Pediatric Cadaver Organ Donation in India

Anupam Sibal and Satvinder Kaur,

Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi 110 076, India.
Email: [email protected]
 


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.
 

 

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