Brain Death and Organ Donation – Common doubts answered
A couple of years back, I happened to see a Malayalam movie, 'Traffic'. It was based on a real life accident that took place in Chennai. When the single child of 18 died due to a bike accident, with broken heart parents donated all his body parts to individual persons who were in need. The movie 'Traffic' was based on this real incident. Vineeth Srinivasan played the role of the dead boy and the whole plot deals with how his body parts were carried successively to different hospitals within the stipulated time through the heart of Ernakulam city, which is always known for traffic blocks. Till then, I have always noted brain deaths and organ donation in magazines and newspapers. Now technology is far advanced and such transplantations are possible even in small cities of our state.
Most common organ transplant nowadays is Kidney transplant. Kidney patients are increasing in number day by day. Kidney is the easiest organ to take from donor. Except kidney and liver, in most cases, organ transplant is being conducted after brain death. Through this article, I would like to briefly explain common doubts related to brain death and organ donation.
What is brain death?
In simple terms, it’s the irreversible end of all brain activities and the patient can never return back to life. Cells of brain are damaged in such a way that brain stops functioning, yet heart and other organs work in slow pace. Brain controls all actions of human body and hence, a block or damage to brain can lead to death soon or later. Though the patient has reached brain death, it’s possible to continue his respiratory functions and blood circulation with the help of modern equipments like ventilator and pacemaker. If ECG is taken it shows heart beats and blood pressure. But it’s not a permanent state; those functions may stop at any moment. In such a situation, organ donation is possible. When pacemaker of heart losses its charge, heart stops beating.
When will brain death occur?
If brain is severely damaged as a result of accident or blow, brain death may occur. In this case, blood circulation to brain may stop resulting in brain death. Cells of brain get permanently damaged when oxygen supply is insufficient.
What’s the difference between brain death and normal death?
In normal cases, heart stops functioning first. Such persons won’t have pulse or bp. It results in permanent stop of blood circulation resulting in the death of cells. Except eye membrane, every organ dies soon after cardiac arrest, as blood circulation is not needed for cornea. That’s the reason why eye transplant is possible soon after death.
How can you confirm that brain death has happened?
Several clinical tests are needed to prove brain death. Such tests are conducted by doctors in two steps. A few of them include – The patient will never breathe again, he never responds to pain, brain losses its response and fails to give reflex action and Iris stops responding (even to torch light). This stage is much different than coma stage. The tests are conducted by doctors only and later they share the results with relatives.
After brain death, is it possible for the patient to return back to life? Is it not possible that doctors have reached a wrong conclusion?
No, it’s not possible. If reports have confirmed after brain death, the person will never return back to life. Though it’s possible to extend the death of the person for a few days, once the heart stops beating, ultimate death will surly happen. Through medicines and with the help of ventilator it’s only possible to keep organs functioning for a few more days. But it’s not an ultimate solution. Chances are nil that doctors have reached a wrong conclusion. A group of 4 doctors consisting of a neurologist, treating doctor, hospital authority and a government representative, conduct two tests in an interval of 6 hours. Then only they reach a final conclusion. 60 years before, brain death has been brought under normal death by America. After that, not even a single person who faced brain death has returned back to life.
Are all deaths brain deaths?
No. In 100 cases, just one or two are brain deaths. Accidents are the main causes of brain deaths. Not only that, any condition that leads a block to blood circulation to brain can result in brain death. For example, stroke, bleeding or tumor.
What is organ donation?
Donating body organs, partially or wholly when alive or soon after death is considered as organ donation. It is of two types – Live donor (if donor is alive) and Cadaver donor (if brain death has happened).
Who can donate their body organs? Is there any age limit?
Patients not suffering from infection, cancer or contagious diseases can donate their organs. Age is not a factor for brain deaths, including children. Though age limit of liver transplant is 55 and kidney transplant is 65, more than age, the functioning of organs is significant.
Which organs can be donated?
For a live person, he can donate one of his kidneys, partially or wholly. If it’s the case of a brain dead person, he can donate both his kidneys, eyes and lungs and liver, small intestine, pancreas, heart, skin, bones, hands and even legs. If it’s a normal death, except eye cornea no transplantation is easily possible. As soon as a death has happened, his organs have to be removed within 10-15 minutes if needed for someone else and it’s very difficult in Indian conditions.
If a person is addicted to bad habits like drinking and smoking, can he become a donor?
Yes, it’s possible. But it’s required to know how much his bad habits have affected his internal organs and its functioning.
Is blood group a significant factor while donating body organs?
Yes, law of blood transfusion is equally applicable to organ donation as well. O group is the universal donor, AB – Universal recipient and RH positive or negative – no problem.
What’s the minimum age required to register as a donor?
18 is the age limit. Any person above 18 can register himself.
Is it possible for doctors to artificially create the condition of brain death?
Never! With any artificial means or medicines, brain death is not possible. It’s the rarest of rarest case that brain death happens to a person (one or two in 100 cases). It’s easy to stop functioning of heart. But it’s not at all possible to stop the brain functions and keep heart continue its regular process.
Though brain death happens to a person, why his other body organs are functioning?
Brain controls all the functions of human body and when brain dies, all functions should come to an end. Functions of respiratory system are made possible with the help of ventilator. As heart owns a battery of its own, it may circulate blood for a few hours or days. As blood circulation is possible the rest organs functions in normal way for a few more hours. If this battery is needed to be charged again, it needs instructions from brain. As brain is dead, recharging never happens.
What are the benefits of organ donation?
Donor or his family will never get direct benefits through organ donation. It’s a mere satisfaction that through organ donation, a person has returned back to life. It’s the best contribution that a person can give to the society. Due to scarcity of organs, numerous persons are dying in our country day by day.
What is organ rejection? Why it happens?
Each and every cell of our body owns an identity. So, when cells of another body reach his body, his body cells feel that those new cells are enemies and they have entered the body to destroy them. Thus the defense mechanism of our body resists the donor’s organ, though it is beneficial to his body. This process is termed as organ rejection. Defense mechanism normally works to protect our body from foreign invaders like virus or bacteria. So, before inserting donor’s organ to patient’s body, immune suppression medicines are to be given.
Can organ donation after brain death give extra cost?
Never! Those expenses are to be taken care of by the recipient and his family.
Can organ donation cause the dead body shapeless?
Never. When eyes are donated, only his eye membrane is taken that is not at all visible externally. If internal organs are donated, his body will be stitched from chest to navel and it will never affect rituals that are to be conducted as a part of religious beliefs.
Who should give consent letter if it’s the case of brain death?
If brain death has happened to a person, his dearest relative (who has the right on his body, as per law) should give consent letter.
In which hospitals organ donation is possible?
As per latest government orders, all hospitals with more than 50 beds and well equipped with an operation theatre can conduct organ donation. But hospital should take consent for this process.
Is any malpractice possible in organ donation in such cases?
Never! Such processes are controlled by government. All processes are visible too. In government websites of different states, lists of those patients are published who are waiting for a donor. Organ donation is to be conducted according to this information.
How much time will it take to conduct organ donation?
If consent is given, the first step is to confirm brain death as per Indian law. It may take up to 8 hours. Then the person will be taken to operation theatre. It may take 4-5 hours. For eye donation only, total time needed is below half an hour and it can be done in homes also.
If heart is transplanted, will his mind and thoughts be changed?
Never. Such ideas are seen only in movies!
Is it possible to sign consent paper even while the person is alive, so that his body organs can be donated after death?
Yes, it’s possible through different organizations. Such forms are available in different websites. But most important fact is that he should let know his family and relatives that he has already signed such a paper. After death, organ donation is possible only with the consent of his family.
If a person is willing to do organ donation, whom should he inform?
Brain death is confirmed only when the doctors let you know the matter. If you are willing to do organ donation, you can tell the doctor or Network of organ sharing of the corresponding state.
What are the main obstacles to organ donation?
Consent of relatives is the first factor. In most cases, they are not willing to give yes nod when someone in their family has met with an unfortunate death.
Very often it’s heard religions never give consent to organ donations. Is it true?
All religions preach lessons to love others and help the need. So, religions will never come in between you and organ donation, as organ donation is one of the best good things that a person can do if we look through religious eyes.
Once organs are taken out, how long will they stay alive? Within which time limit should those organs be transplanted to receiver’s body?
As early as possible! Each organ has a time limit; Heart – 4 hours, Liver – 8 hours, Kidneys – 24 hours and eyes – 4 days.
What’s the life of recipient after an organ transplant? What are the chances of infection and immune suppression?
It may take up to 6 months for the body to adjust with new organ. Though quantity of immune suppression medicines will be reduced as time passes by, the patient may need to take them throughout his life.
Is there any problem if donor and recipient belong to different sex?
No, organ donation is gender free.
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