Make kidney laws patient friendly
http://www.cityjournal.in/Newspaper/20111224/Metro/Metro_1.htmlArticle by Dhanya Ezhuthachan in city journal
Norms hit organ donation hard
http://www.deccanchronicle.com/channels/cities/chennai/norms-hit-organ-donation-hard-989
September 7, 2011 By Anisha Francis
Article in Deccan Chronicle
Cadaver organ transplants in the state seem to have lost a bit of steam. Even though TN has crossed the 500 donors mark, 217 of them from the government general hospital in Chennai alone, the past few months have been very slow, lament officials.
While the rest of the nation looks up to TN’s programme as a role model and other states have set Tamil Nadu’s record deceased donor rate of 1.3 per million as a target (national average is 10 times lower, at 0.15 per million population), the problems plaguing the entire process in TN are many.
Superstitious beliefs and religious restrictions still put a spoke in the wheel for grief counsellors who approach the families of prospective donors to donate their loved one’s organs. However, the most common reason families refuse to donate organs is the never-ending wait for them to take the body home. Sometimes it takes three days to a week for all the formalities and paper work to be completed before the organs are harvested and the body is released for last rites.
While the entire procedure, including brain death certification and post-mortem, ought to take a maximum of 12-15 hours, as in corporate hospitals, the government set-up suffers unnecessary delays, say the doctors.
In the past two months, there have been cases where the organs have been wasted because of delays in the investigating police officers arriving at the hospital and preparing inquests for the post-mortem.
Says a young grief counsellor, “It is very disheartening when we manage to get the family’s consent to donate organs, but the precious organs are wasted due to procedural delays. Many patients are from the outskirts of Chennai, and the police officers take hours to get here, despite our repeatedly calling them.”
“Many people think that educated families are open to organ donation, but this is not true. Most of our donor families are from very poor backgrounds, often daily wage labourers or farmers from remote villages who have not even heard of brain death or organ transplants,” says Ms Sindhuja, a transplant coordinator at the GH. “Some people believe that their loved ones will be born without eyes and other organs in their ‘next life’ if they donate them to other people.”
Dr Sumana Navin, a coordinator with MOHAN foundation, calls for Islamic religious leaders to get involved with the cause and help spread awareness that organ donation does not go against the principles of Islam.
In Tamil Nadu, 25 per cent of all kidney transplants and 90 per cent of liver transplants are deceased donor transplants – the rest are living, related transplants.
“In India, there are 2.1 lakh people suffering from end-stage kidney disease who need transplants immediately, but we are barely doing 3,000 kidney transplants — both living and deceased donors put together. We really need to step up cadaver organ donation, especially since there are at least 93,000 accident victims who can be declared brain dead every year,” says Dr Sunil Shroff, managing trustee, MOHAN foundation.
THE HINDU
CHENNAI, September 3, 2011
Tamil Nadu’s rate of 1.3 per million people is national target: DGHS chief
The nation’s target will be to attain Tamil Nadu’ s rate of cadaveric organ donation of 1.3 per million people within the next two years, Director General of Health Services, Government of India, R.K. Srivastava, said here on Saturday.
At present the country’s rate is 0.3 per million, and it is essential to bring the country level with Tamil Nadu, which is leading the nation in terms of cadaver organ transplantation, he said. “This is certainly going to require tremendous efforts. However if even one per cent of the patients in hospitals who are brain dead can be declared as such, and the potential for organ donation tapped, we can reach 1.3 per million,” Dr. Srivastava said. The nation would have to go into ‘mission mode’ for achieving this.
He was speaking at Samsaara (Circle of Life), a symposium on Organ Donation Awareness and Brain Death organised jointly by his office, the Tamil Nadu Cadaver Transplant Programme, and Mohan Foundation.
Putting in place systems that will facilitate organ donation is at the core of increasing the number of cadaveric organs available for transplantation, he said. This is evident from Tamil Nadu and even nations that have done much better, having reached a rate of 30/40 per million population. Even in these nations, there continued to be a scarcity of organs, with the number of people requiring life-saving organ transplantations always being higher than the number of organs available, Dr. Srivatsava explained. This made the task of spreading awareness crucial and continuous.
Earlier, he released a ‘brain-death manual’ and inaugurated the one-year PG diploma course in for transplant co-ordinators to be conducted by Mohan Foundation in association with IGNOU.
Mayilvahanan Natarajan, Vice-Chancellor, Tamil Nadu Dr. MGR Medical University, said the programme would have to include bone as an organ that can be harvested and transplanted. Awareness would have to be built on this concept too, he added.
Most people think donating the bone means taking away the hand or leg, but that is not so, the Vice-Chancellor clarified.
V. Kanagasabai, Dean, Madras Medical College, said the momentum had to be accelerated to spread awareness on the importance of cadaver organ donation among all segments of society.
V. Palani, medical superintendent, Rajiv Gandhi Government General Hospital, said organs were still being under-utilised. There were also problems in declaring brain death.
While there was a long way to go before an organ could be found for every person who requires it, using cadaveric organs has bridged the gap to an extent. Tamil Nadu especially has done well in the last 15 years, Sunil Shroff, managing trustee, MOHAN Foundation, said. Today, in the State, 25 per cent of kidneys, and 75 per cent of livers come from deceased donors, he added. The rest of the country could emulate the example set by Tamil Nadu.
The families of donors Babu, Manikandan, Gurulingam, Jegadesh, Shankar, Malliga, Venkatesan and Yuvaraj were honoured on the occasion. In the street play competition held earlier during the day, the team from Madras Medical Mission took the first prize while Loyola College was awarded the second place.
Cadaver_transplant
It is essential to promote cadaver transplants in order to make available organs to suffering patients. After death the organs of the body decompose in a short time and become useless. But if donated they would continue to live in other human bodies giving lives to them and their mitigating pain and suffering.
new anti rejection drug bortezomib
Bortezomib Shows Promise as Antirejection Therapy
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CINCINNATI, Dec. 29 — Kidney transplant recipients experiencing refractory acute rejection saw a quick and durable resolution after a short course of bortezomib (Velcade), investigators here said.
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The treatment effectively quelled eight episodes of antibody-mediated rejection and concomitant acute cellular rejection in six patients, E. Steve Woodle, M.D., of the University of Cincinnati, and colleagues reported in the Dec. 27 issue of Transplantation.The drug achieved marked and prolonged reductions in donor-specific antihuman leukocyte antigen antibody levels and improved allograft function. “Bortezomib represents the first effective antihumoral therapy with activity in humans that targets plasma cells,” the authors concluded. A lack of direct activity against the mature plasma cell — the major antibody-producing cell — limits the effectiveness of current antihumoral therapies, including plasmapheresis, intravenous immune globulin, and polyclonal antilymphocyte antibodies. The proteosome inhibitor bortezomib has pleiotropoic immune modulating effects, including preclinical activity against nontransformed plasma cells. That activity, combined with dissatisfaction with standard therapies for antibody-mediated rejection, led the authors to evaluate bortezomib as treatment or prophylaxis for cell-mediated allograft rejection. The six patients included in the study had episodes of acute rejection as defined by at least a 20% increase from baseline in serum creatinine plus histologic evidence of acute rejection by Banff criteria. Baseline serum creatinine was defined as the mean of five consecutive measurements that immediately preceded acute rejection. Initial rejection episodes occurred from 25 to 2,774 days after transplantation. In all cases, bortezomib was initiated after failure of a trial of one or more standard antirejection therapies. Two patients had a second rejection episode. In one case, the initial episode occurred on posttransplant day 223 and the second on day 452. In the second case, the initial rejection episode occurred on posttransplant day 25 and the second on day 245. Recurrent episodes were treated immediately with bortezomib. Each rejection episode was treated with a single course of bortezomib at labeled dosing. In all cases, the immunodominant donor-specific antihuman antibody declined by more than 50% within 14 days of treatment and remained suppressed for as long as 14 months. Every patient had one or more additional donor-specific antihuman antibodies, which declined with treatment to undetectable levels. Principal bortezomib-related toxicities were gastrointestinal effects, thrombocytopenia, and paresthesias, all of which were transient. The observation of recurrent rejection episodes in two patients “argues for more aggressive therapeutic approaches,” the authors said. “One such approach was used with bortezomib therapy in the third patient in this report, where bortezomib therapy was used concomitantly with additional agents.” Additionally, antihuman antibody levels rebounded in some patients. The observation requires longer follow-up to determine the clinical significance, the authors said. However, they noted, clinical experience with bortezomib in multiple myeloma has suggested that administration of multiple cycles of therapy might be a reasonable approach to enhance the drug’s activity.
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Tagbilaran City, Bohol, Philippines
Renal malfunction, now ranks tenth in the list of the country’s fatal diseases kills about 7,000 Filipinos annually, statistics from the Philippine Renal Disease Registry of the Department of Health. A team from the country’s Renal Disease Control and Prevention Program (REDCOP) of the National Kidney Transplant Institute sat down to train trainers for renal disease prevention during a three-day activity at the Cebu Grand Hotel January 28-30. The graduates from the REDCOP Trainor’s Training for the Visayan regions are the new campaign advocates. They come from the Department of Health, Education, Philippine Information Agency provincial offices, the academe and well advocacy meaning groups. Stepping up on the fight, the country’s program manager on renal disease control stressed that the best move against it is information and getting the right diagnosis at its early stage. Renal or kidney diseases include kidney diabetic kidney disease, chronic glumerulonephritis, hypertensive kidney disease and chronic and repeated kidney infection or pyelonephritis. When not treated, these could lead to end stage renal disease which is fatal, according to a REDCOP brochure. Dr. Remedios de Belen-Uriarte said if left unattended, the disease may degenerate into an irreversible end stage renal disease that does not come cheap. Dr. Uriarte is the program manager for the country’s REDCOP based at the NKTI where the country’s kidney transplants are performed. A kidney transplant, the only remedy to prolong the life of a patient now ranges between P500T to a million, and another remedy is hemodialysis which comes out thrice a week and costs P3,500 to P6T per session. She added that maintenance drugs may also be a big drain in the pocket as a patient may need at least P20T a month. In poverty plagued areas, renal specialists have shifted the campaign to the preventive side of the disease control while called for a healthy diet and early detection by regular check-ups with doctors and urine analysis. It is in this aspect that the campaign needs to get down to the grassroots, Dr. Uriarte said. (rachiu/PIA)
Tagbilaran City, Bohol, Philippines
Renal malfunction, now ranks tenth in the list of the country’s fatal diseases kills about 7,000 Filipinos annually, statistics from the Philippine Renal Disease Registry of the Department of Health. A team from the country’s Renal Disease Control and Prevention Program (REDCOP) of the National Kidney Transplant Institute sat down to train trainers for renal disease prevention during a three-day activity at the Cebu Grand Hotel January 28-30. The graduates from the REDCOP Trainor’s Training for the Visayan regions are the new campaign advocates. They come from the Department of Health, Education, Philippine Information Agency provincial offices, the academe and well advocacy meaning groups. Stepping up on the fight, the country’s program manager on renal disease control stressed that the best move against it is information and getting the right diagnosis at its early stage. Renal or kidney diseases include kidney diabetic kidney disease, chronic glumerulonephritis, hypertensive kidney disease and chronic and repeated kidney infection or pyelonephritis. When not treated, these could lead to end stage renal disease which is fatal, according to a REDCOP brochure. Dr. Remedios de Belen-Uriarte said if left unattended, the disease may degenerate into an irreversible end stage renal disease that does not come cheap. Dr. Uriarte is the program manager for the country’s REDCOP based at the NKTI where the country’s kidney transplants are performed. A kidney transplant, the only remedy to prolong the life of a patient now ranges between P500T to a million, and another remedy is hemodialysis which comes out thrice a week and costs P3,500 to P6T per session. She added that maintenance drugs may also be a big drain in the pocket as a patient may need at least P20T a month. In poverty plagued areas, renal specialists have shifted the campaign to the preventive side of the disease control while called for a healthy diet and early detection by regular check-ups with doctors and urine analysis. It is in this aspect that the campaign needs to get down to the grassroots, Dr. Uriarte said. (rachiu/PIA)
