Organ donation after brain death in India: A trained intensivist is the key to success

Tele-ICU enabled management of an organ donor in an under-resourced setting

A man in his 30s was involved in a road traffic crash in a small town in India, not equipped to deal with cases of brainstem death. He was declared brain-dead after a few hours. The patient's information was forwarded to organ specialists across the country, with the goal of preserving the patient's organs for donation via a tele-ICU model. The team comprising bedside doctors and remote intensivists communicating via an indigenously developed tele-ICU platform managed the patient for 24 hours, following treatment protocols and providing critical care to ensure that the patient's vital organs were optimally perfused. The following morning, specialist teams from a nearby city arrived at the local hospital to retrieve the patient's organs. This fast-tracked organ retrieval and transplant process were made possible through advances in technology and the involvement of specialists from other parts of the country through this tele-ICU model.

Assessment of Awareness Level Regarding Organ Donation among Healthcare Professionals and Students in India

Introduction

Organ donation can be a life-saving opportunity for patients with severe organ failure. In India, the rate of organ donation of the deceased Indian population is exceptionally low. This necessitates enhancing awareness regarding organ donation among health care professionals and students, which can motivate the general population.

Aim

To assess and analyze the awareness level of healthcare professionals and students on organ donation in order to suggest potential strategies regarding improvement of awareness and willingness towards organ donation.

Materials and methods

A cross-sectional online and offline survey was conducted at the national level between July 2022 and September 2022. Indian healthcare professionals as well as students of various fraternities were included. The Snowball sampling technique was used for data collection. Statistical analysis was undertaken using the statistical package for the social sciences (SPSS) software, version 25.

Results

A total of 1,303 respondents were enrolled in this study. The majority of the participants were students (66.5%) residing in southern India (89.6%) pursuing medical profession (88.9%). The predominant age group was 18-24 years (73.9%). The awareness level regarding organ donation among healthcare professionals and students was 69%. Healthcare professionals and respondents aged 40 years and above had better awareness levels regarding organ donation which was reported as statistically significant (p < 0.001).

Conclusion

Healthcare professionals and students awareness about organ donation need to be improved. Strategies including but not limited to prioritizing employment and education to the first relatives of the deceased organ donor should be implemented by the government to legally improve organ donation willingness.

How to cite this article

Chandrasekaran S, Chandrasekaran VP, Nandi D, Setty RS, Srinivasan O, Kaur KN. Assessment of Awareness Level Regarding Organ Donation among Healthcare Professionals and Students in India. Indian J Crit Care Med 2023;27(1):57-63.

Assessing comfort level of organ donation competencies among pediatric intensivists in Saudi Arabia: a national survey

BACKGROUND

As increasing the number of organ donations presents a global challenge, Saudi Arabia is no different. Intensivists can play a major role in maximizing the organ donation process and minimize the challenges. The purpose of this study was to investigate Saudi pediatric intensivists' comfort and importance levels of organ donation competencies.

METHODS

We conducted a cross-sectional survey whose sampling frame included 100 pediatric intensivists. The pediatrician intensivists were identified through an updated list provided by the Saudi Critical Care Society. We assessed 14 competencies categorized into four domains: the general donation, donation after brain death (DBD), neurological determination of death, and medicolegal, religious, and ethical domains. Then we investigated the association between these competencies and physicians' characteristics.

RESULTS

With a response rate of 76%, we found that 40-60% of the surveyed pediatric intensivists rated their comfort in 6 out of 14 competencies as high or very high. There was a statistically significant gap in the intensivists' rating of 10 competencies (i.e., high importance but low comfort levels). Ordinal regression showed that comfort levels with the general donation, neurological determination of death, and medicolegal, religious, and ethical domains were higher in intensivists who were frequently involved with DBD than those who had never been exposed.

CONCLUSIONS

Pediatric intensivists expressed low comfort levels to organ donation competencies that are essential for maximizing donation rates. Adapting mandatory comprehensive donation education programs and dedicated physician specialists may be beneficial in critical care units aiming to increase donation rates.

Study of Knowledge, Attitude, and Practice of Organ Donation Among Medical Students in a Tertiary Care Centre in South India

Introduction The deceased donor renal transplantation (DDRT) program in India has seen its ups and downs. The Indian state of Tamilnadu runs a successful DDRT program. Future doctors play an important role in continuing with this success and hence educating them on organ donation is of paramount importance. Methods We conducted a cross-sectional questionnaire-based study from June 2015 to December 2017 among 480 medical students to analyse their knowledge, attitude and practice regarding organ donation. The validated questionnaire sheets were distributed during lecture hours and completed sheets were analysed. Results Of the 480 participants, 425 completed the questionnaire which is a response rate of 88.5%. Knowledge scores were uniformly low among all four batches of students (p=0.001). The first and third-year students scored better in practice (p=0.001) and attitude (p=0.001) domains. Females outnumbered males by scoring high in all three domains. Conclusion The poor knowledge score among all the batches of medical students is alarming. This implies the need for urgent changes in the medical curriculum to better educate future doctors of the country. Durable changes in practice can be brought about by changing the attitude of medical students.

Brain Death and Organ Donation Rates in a City Hospital: A Retrospective Study

Introduction

Although organ donation rates have been increasing over the years, the lack of organ donation remains the most important problem in transplantation. By changing strategies, the Cekirge City Hospital in Bursa/Osmangazi has achieved a cadaveric donor rate of 24.9 per one million individuals in 2016; this rate is 21.5 in England, 20.9 in Norway, 14.7 in the Netherlands, and 10.6 in Germany.

Methods

Brain death cases were retrospectively evaluated between January 1, 2011, and December 31, 2016.

Results

There were a total of 137 brain death cases. Three of eight cases, five of 12 cases, three of 13 cases, 13 of 25 cases, 16 of 29 cases, and 21 of 50 cases became a donor in 2011, 2012, 2013, 2014, 2015, and 2016, respectively.

Conclusion

Deceased organ donation rates have increased over the years; however, the number of brain dead patients and the acceptance of organ donation by families have been increasing, but the percentage of brain death donations did not increase. We suggest that the reason for this situation is that well-trained and educated physicians diagnose more brain death cases and have a greater desire to treat end-stage organ failure patients, but the tendency of the public to donate has not increased as hoped. Donation and transplantation rates may be increased with a combination of well-trained, educated, and dedicated physicians with public education.

Irreversible Total Loss of Brain Function and Organ Donation in Patients with Aneurysmal Subarachnoid Hemorrhage

OBJECTIVE

Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening disease with an often fatal clinical course leading to irreversible loss of brain function (ILBF) (i.e., brain death). The purpose of this study was to assess the prevalence and characteristics of patients with aSAH who became organ donors after diagnosis of ILBF.

METHODS

Anonymized clinical data sets of 395 patients treated for aSAH at a university medical center from January 2011 to December 2016 were retrospectively analyzed. Prevalence of consent for organ donation and clinical characteristics, including parameters for diagnosis of irreversible loss of brain function, were assessed.

RESULTS

After initial admission to the intensive care unit, 18.0% of patients (n = 71) died (Glasgow Outcome Scale score 1). Intracerebral hemorrhage occurred in 42.3% of patients who died, aneurysmal rebleeding occurred in 19.7%, and intraventricular hemorrhage occurred in 87.3%. In 50.7% of patients who died (n = 36), ILBF was diagnosed, and 32.4% (n = 23) of these patients became organ donors. In 55.6%, additional diagnostic electroencephalography was performed. Male patients significantly more often became organ donors than female patients (P = 0.008). ILBF with subsequent organ donation was predominantly seen in patients <60 years old. A total 85 of organs were explanted for donation, including 42 kidneys, 21 livers, 3 pancreas, 11 hearts and 8 lungs.

CONCLUSIONS

ILBF in the setting of fatal aSAH is a prevalent diagnosis with complex demands for neurointensive care physicians. We demonstrated the clinical characteristics and epidemiologic factors of patients with aSAH converting to organ donors.