transplant research

ScienceDaily (Feb. 26, 2009) — Platelets, tiny and relatively uncharted tenants of the bloodstream known mostly for their role in blood clotting, turn out to also rally sustained immune system inflammatory responses that play a critical role in organ transplant rejection, according to a new report from Johns Hopkins scientists.

“Platelets potentially hold sway over many aspects of transplant biology,” says Craig Morrell, D.V.M., Ph.D., an assistant professor of molecular and comparative pathobiology at the Johns Hopkins University School of Medicine. “Our data, as well as others’, show a surprising interplay of platelets and the immune system, so it’s time for the transplant world at large to have platelets on its radar.”

A self-described “platelet guy” transfixed by the unexplored biology of these circulating bodies, Morrell collaborated with clinicians in the fields of transplant to write a comprehensive review of platelets and transplant biology, published in the January issue of the American Journal of Transplantation.

“It all began with the observation that when transplant tissue is rejected, platelets line up in the interior of blood vessels feeding the tissue,” Morrell says. “It turns out they are not just bystanders, but have a role in driving that rejection.”

As one of the most abundant cell types in the blood — second only to the oxygen-carrying red variety — platelets are ubiquitous but relatively unexplored, Morrell says. “It’s crazy how many potentially active molecules are jam-packed in these small cells and that we’re only just beginning to appreciate their pro-inflammatory qualities.”

In fact, mounting evidence from Morrell and others shows that platelets are part of a sustained and general immune response that can trigger or exacerbate organ rejection. Not only do they rush to the scene of a wound and adhere to local blood vessels, preventing fatal bleeding, they also dump out granules that “talk to” immune system white blood cells, Morrell says, recruiting them from far and wide to stave off potential infections.

These are on the whole very good things for platelets to do, Morrell says, but in the context of organ transplants, their pro-inflammatory function gets out of control, and they do more bad than good after contributing to initial wound healing.

Strategies using drugs or other means to keep platelets quiet and non-inflammatory might benefit transplant patients in the long run because chronic rejection — as contrasted with acute or immediate organ rejection — is a major complication for which there is little current treatment, according to Hamid Rabb, M.D., medical director of kidney transplantation and a professor of medicine at the Johns Hopkins University School of Medicine.

In prior research using mice with skin transplants, Morrell and his team noted that increased platelet interactions led to increased and prolonged white cell interactions with the inner lining of the blood vessels and worsened transplant vessel damage.

“We watched platelets flowing through the blood vessels of transplanted skin in mice with and without platelets and determined tissue-platelet interactions by comparing the speeds of those flows,” says Morrell, whose team ultimately demonstrated that antibodies made in reaction to the transplanted tissue sparked platelet activation and white cell recruitment.

Studies on tissue from platelet-depleted mice helped confirm the importance of platelets in white cell activation and recruitment, strongly suggesting that limiting the inflammatory response might improve transplanted tissue survival.

Mounting evidence suggesting that platelets are activated not only post-transplant, but also during organ harvest, presents new opportunities for attacking organ injury and rejection head-on, says Rabb. The traditional target of current anti-rejection medicine is the so-called T lymphocyte — a white blood cell believed to be the major orchestrator of the immune response against any foreign tissues, including transplants.

“The thought was that if we hit the general that initiates acute rejection, it would put the troops in disarray,” says Rabb. “Traditional therapies therefore inhibit or deplete T lymphocytes and other white blood cell components of the immune system. The newest kid on the block is the platelet and it represents an opportunity to target the effectors of organ injury rather than only the general.”

The authors of the review, who were supported by National Institutes of Health grants, are A.D. Kirk, Emory Transplant Center, Emory University; W.M. Baldwin III, formerly of Johns Hopkins and now at the Lerner Research Institute; and Morrell, of Johns Hopkins.

Transplant Surgery – A Delicate Balance

From HealthNewsDigest.com

Plastic Surgery
Transplant Surgery – A Delicate Balance
By
Feb 8, 2009 – 12:51:34 PM

(HealthNewsDigest.com) – In an incredibly complex 22-hour procedure, the Cleveland Clinic’s microsurgical-research team performed the United States’ first almost-total face transplant last December. The procedure gave a disfigured woman a chance at a normal life, a life that began today when she left the hospital. It’s also another demonstration of the astonishing progress the medical community has made in transplant surgery. For most of us, the awe-inspiring story ends there. But for a transplant patient, finding a donor and then surviving surgery is only half the battle. Next comes a lifelong fight to keep the human body from doing what it is exquisitely designed to do: reject foreign bodies and tissue.

And in this arena, researchers are still struggling with a complex problem. The immunosuppressive drugs that patients need to take to prevent organ rejection are toxic, and the side effects can be debilitating or even deadly in the long term. Medication dosage or quantity can be reduced to limit toxicity, but that also increases the risk of rejection. Alternately, the immune system may be suppressed too much, and infection may overwhelm the body. Finding the right balance is a delicate, sometimes impossible task.

The balancing act can be rough on patients. Laura Ellsworth, 33, of Vancouver, Wash., underwent a living donor kidney transplant 10 years ago with a kidney donated by her father. She takes 17 different pills every day, a mixture of immunosuppressive drugs and medications to control her blood pressure. The regimen increases her risk for heart disease, infection, skin cancer and osteoporosis. She visits a dermatologist regularly for skin-cancer checks, and even though she’s only in her early 30s, she has undergone several bone scans to check for osteopenia, a precursor of osteoporosis.

Despite the challenges for patients, it’s clear that transplant medicine is making advances. Doctors are able to keep transplanted organs functioning for longer lengths of time, and most of the approximately 250,000 people living with transplants in the United States, like Ellsworth, are living full, productive lives. Still, a majority of transplanted organs do eventually fail. And patients have to be vigilant about protecting their fragile immune systems to give themselves a fighting chance.

One sign of hope lies in a promising new experimental procedure developed by Dr. David Sachs, head of the Transplant Biology Research Center at Massachusetts General Hospital and a professor of surgery at Harvard Medical School. In a small trial, Sachs was able to achieve immune-system tolerance in several transplant patients completely without using immunosuppressive drugs.

Though the immune system is elegant—distinguishing between the organs, blood, tissues and cells that are part of the “self” and outside invaders such as splinters, dust or germs—it isn’t perfect. Splinters become infected, dust can trigger allergies and germs can get through immune-system defenses. When it comes to organ transplants, the challenge is that the immune system is not making a mistake. Except in the case of identical twins, a transplanted organ is “non-self,” and the immune response to the transplanted organ is all-out war. “What the immune system wants to do is destroy that organ,” says Dr. Sang-Mo Kang, associate professor of surgery at the University of California San Francisco and surgical director of the Intestinal Rehabilitation and Transplantation Program. “Evolution or nature never envisioned the transplant. And therefore, the immune response is absolutely incredible.”

Jennifer Searl, one of Sachs’s patients, knows all about that powerful immune-system response, and how devastating it can be when the immunosuppressive drugs aren’t able to fight it properly. She had her first kidney transplant when she was 13 years old (as in Ellsworth’s case, a kidney donated by her father). Her 10-year stint on the immunosuppressive drugs she needed to keep that kidney functioning was horrific. She was taking 20 pills a day and developed cataracts, high-blood pressure, osteopenia, and painful viral warts on the sole of her right foot.

“It was absolutely the worst time of my life,” says Searl, now 29 and a research librarian in Peabody, Mass. “It was like trading one disease, my kidney disease, for a bunch of other horrible problems caused by these drugs. I hated them.”

Her immune system eventually overcame the drugs and her body rejected the kidney. Things looked bleak, but then she met Sachs. Thanks to the Massachusetts General doctor, Searl is thought to be the first person in the world in whom immune-system tolerance was achieved in a non-matched kidney transplant (where the donor organ is different from the recipient’s tissue type, as is the case in all transplants except those involving identical twins). She has been off immunosuppressive medications for more than six years, an extraordinary accomplishment.

Although there has been some success in weaning patients off immunosuppressive drugs when a donor is closely matched, transplant recipients in Sachs’s protocol received kidneys that were mismatched, like Searl’s. These types of transplants are the most common and, unfortunately, are the most likely to fail, even with an onslaught of anti-rejection drugs: 10 percent will fail within one year, 30 percent within by five years and 45 percent within 10 years.

Sachs’s procedure involves partially destroying the patient’s bone marrow before the transplant to reduce the number of cells involved in organ rejection. Searl went through the protocol in 2002 with a kidney donated by her mother. During transplant surgery, her mother’s bone marrow was injected into one of Searl’s blood vessels, in the hope that Searl’s immune system would achieve “mixed chimerism,” essentially a state in which a patient’s immune system takes on some of the characteristics of the donor’s.

“The results were outstanding,” Sachs says of the procedure, which was successful in 4 of the 5 patients he has used the protocol on. (The results of the trial were published in The New England Journal of Medicine in January 2008.) “We were ecstatic, but everyone has to realize this is just one step.” The next step, according to Sachs, is to see if the regimen works in a larger group of patients. “We need much more patient experience, but the ultimate goal is to help transplant patients live longer and live more normal lives,” he says. If all goes well, Sachs hopes the protocol will eventually be extended to all transplanted organs.

Dr. Maria Siemionow, who heads the microsurgical research team that performed the face-transplant procedure at the Cleveland Clinic, is pursuing another research track. In her animal lab, she’s begun a series of rat experiments designed to trick a host immune system to recognize transplanted tissue as self. She has identified an antibody—a type of protein that links to an invader and repels it—that allows the host immune system to tolerate transplanted tissues without the need for long-term immunosuppression. So far, these rats have achieved immune tolerance for as long as two years.

Siemionow acknowledges that the treatment is not yet ready for human subjects. “We can do a lot with rats and immune tolerance, but humans are so much more complex,” she says. Still, she is hopeful the approach will move forward in human clinical trials in about a year.

Progress is invariably slow in this type of research, and Sachs is feeling the pressure, with the number of patients waiting for organ transplants far exceeding the number of available organs. The hope, he believes, lies in xenotransplantation, essentially a process of growing organs from animals that are compatible with a recipient’s immune system. But that prospect, Sachs says, “is a longer way off,” and would, of course, benefit from just the kinds of advances in preventing organ rejection he’s working on.

For now, even when experimental treatments are successful, as they have been so far for Jennifer Searl, there are still no easy fixes. The procedure she underwent was grueling. The initial effect of having her bone marrow partially destroyed prior to surgery—with low-dose chemotherapy, medication and radiation—was very hard on her, as was spending several weeks in isolation after surgery while her immune system was rebooting. It was “an incredibly lonely time,” Searl says.

But now that time has been supplanted by what she calls “a completely full, normal life.” Searl is a marathon runner and swims on a masters’ team. She likes to read, and admits to a penchant for the television show “Gossip Girl.” “I just feel so normal,” she says. “I don’t know what the future will bring. But today, I can say I’m finally free.”

And if Sachs’s treatment proves to be successful in a larger trial, there’s a good chance that more transplant patients may one day be able to say the same thing.

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The recent disclosure of a kidney sale in Chennai raises fears that there is a widespread racket in Tamil Nadu.

The recent disclosure of a kidney sale in Chennai raises fears that there is a widespread racket in Tamil Nadu.

DOES the kidney trade continue to thrive in Tamil Nadu despite the implementation of the Transplantation of Human Organs Act (THOA), 1994? Has the government taken adequate steps to narrow the gap between the demand and supply of kidneys to help patients with end-stage renal disease (ESRD)? Are the steps initiated by the government to promote cadaver donation yielding results? Is it true that the authorities are trying to find a narrow technical solution to a very complex problem? These and several other questions relating to kidney transplantation have come to the fore again with a resident of Chennai alleging that he sold his kidney to a person who was not related to him. Transplantation of a kidney from an unrelated donor is against the law except when done with an altruistic motive.

M. Sekar, 33, lives in Bharathi Nagar in Villivakkam, which has for long been in the news for kidney trade. The residents here are mostly construction workers, hawkers, vendors or others taking up low-paying jobs and fall in the below poverty line (BPL) category. As pointed out by Dr Sunil Shroff, managing trustee of the Multi Organ Harvesting Aid Network (MOHAN), it seems every other household in the area has a donor.

Sekar’s case appeared in the local media in the end of December 2008 after a non-governmental organisation (NGO), Manitha Urimai Makkal Iyakkam, brought it to light. A kolamaavu (rangoli powder) vendor, Sekar claimed that a kingpin of the illegal trade contacted him a few months earlier and he agreed to part with his kidney for a price the man quoted. The surgery was done in a hospital in the city in October 2008, and he was given only a part of the promised sum, he alleged. Just as most live unrelated donations of kidneys in the past were for monetary considerations, Sekar also said that he had “sold” his kidney to save his family from the debt trap. A major portion of the money was used to repay a loan his father had raised in order to marry off his two sisters. Sekar said the middleman had tutored him to tell the Authorisation Committee – constituted under the THOA – that he was related to the recipient.

T. Santhakumar, president of the Iyakkam, alleged that people who were desperately in need of money in Villivakkam and certain other areas including Ennore and Thiruvottiyur in North Chennai were lured into selling their kidneys. Describing Sekar’s case as the tip of the iceberg, he said the full magnitude of the issue would come to light only if a thorough investigation was done in the areas. The organisation also called for urgent measures to break the hospital-broker nexus and help the hundreds of poor people who had donated kidneys to unrelated recipients.

Official denial

Official sources deny the existence of any fresh racket involving illegal kidney transplantations in the State. According to Secretary (Health) V.K. Subburaj and Director of Medical Education Dr S. Vinayagam, investigations following the media reports of the kidney donation by the Villivakkam resident have revealed that the allegation is baseless. Records available with the Authorisation Committee and the hospital where the surgery was performed also showed that the donor was related to the recipient, Subburaj said.

Dr Vinayagam said the committee had interviewed the donor and the entire proceedings had been videographed. There was no need for any suo motu probe into the commercial dealings in organs in the absence of any evidence, Subburaj said. Officials in the government say that kidney trade in the State is a thing of the past. According to them, things began to change significantly after the government took a string of measures to tighten the procedures relating to organ donation.

However, there are some experts who feel that the racket may be operating at the subterranean level though major hospitals are wary of performing illegal transplantations in view of the law. “This problem arises out of poverty and it takes place in many Third World countries. Law-breakers breach laws and the THOA is not an exception. It is unfortunate that we are trying to find a narrow technical solution to a very complex sociological problem,” said a senior medical expert.

Data provided by the Directorate of Medical Education in Tamil Nadu show that around 75 per cent of the kidneys available for transplants in the State have come from live unrelated donors “by reason of affection or attachment towards the recipient”, as per Clause 9 of Chapter II of the THOA. About 27 per cent of the recipients have been foreigners. Moreover, the Authorisation Committees have rejected only a microscopic percentage of the applications; of 682 cases that appeared before it during 2007 and 2008, only 18 were rejected. Still, official sources claim that the government has taken vigorous steps to curtail the number of live unrelated donations of kidneys. Highlighting the State government’s initiatives, Subburaj said that after illegal kidney transplant cases were reported in 2007, a series of measures were taken to tighten the procedures relating to organ transplantation by issuing seven Government Orders (G.O.s) from January 8 to September 5, 2008. According to him, the government had authorised 58 hospitals in the State to conduct kidney transplantation.

“A system is in place to ensure regular monitoring. Approvals are given only for cases with genuine and correct documents. The Authorisation Committees constituted in Chennai, Madurai and Coimbatore meet every Friday to scrutinise the applications and give their approval,” he said.

Steps have also been taken to strengthen the office of the Director of Medical and Rural Health Service, who is the appropriate authority to deal with any irregularity. A police team has been placed under his/her control exclusively to help him/her in the investigation process if any case of irregularity is reported. Besides, each Authorisation Committee has a police officer as its member. “After taking these steps, we have never come across any case of irregularity,” Subburaj said.

However, even while saying that the Villivakkam incident does not indicate a fresh kidney racket in the State, some experts assert that this kind of kidney sale has been going on all the time. “It ebbs a little when the government brings in some strict measures as a result of a scam, and when things cool down, it becomes normal again. This is primarily because it is a life-and-death issue for the recipient, and the well-off can afford any amount of money to save their lives. On the other side, the very poor and the deeply indebted are in need of money very badly. This is a strong combination and any kind of regulatory framework gets subverted fairly easily,” said C.E. Karunakaran, trustee of the National Network for Organ Sharing (NNOS).

Though the government’s initiatives have curbed to some extent the transactions that take place on the basis of the altruistic clause (Clause 9 of Chapter II) of the THOA, the sale of kidneys using the near-relative clause goes on. The hospitals also play ball in this because they need the business, he said. He said the government had the power to take action against erring hospitals or individuals involved in the racket and such action would act as a deterrent. Karunakaran also said that though any regulatory measure could be strictly enforced if there was a will, the rich and the powerful and those with political contacts generally got round these measures.

Will the government come forward to rehabilitate live unrelated donors as most of them belong to the BPL category and suffer from tremendous psychological pressure? Dr Shroff referred to a cross-sectional survey conducted among 305 individuals in Chennai in February 2001; the respondents had sold a kidney each around six years before the survey. The study conducted by four experts, including Madhav Goyal, showed that in India, selling a kidney did not lead to a long-term economic benefit for the donor and sometimes it caused a decline in his/her health.

Subburaj said the government had not thought about rehabilitation so far but could extend financial assistance by dovetailing it with existing programmes. He said the donors were being given medical assistance. As a follow-up, the donors were periodically examined even after the surgery and they would not be left high and dry, he added.

But some experts are sceptical about this. “That is unlikely to happen as the rehabilitation of these hapless donors by the government would amount to admitting that the regulation has been subverted,” said Karunakaran.

Referring to a consultation on “Organ Transplant in Tamil Nadu – The Future” held by the State Health Department in association with the NNOS in March 2007, Karunakaran expressed the hope that the government’s cadaver transplantation programme would get off the ground in the next few months and “we can see sustained activity [in this area]”.

It is estimated that around 50 per cent of the nearly 5,000 kidneys transplanted in a year in the country are donated by genuine live relatives, while the remaining 50 per cent are “commercial kidneys”. In Tamil Nadu, Karunakaran said, around 1,000 transplants were performed annually.

Government officials and experts admit that in the prevailing situation, there is no quick-fix solution to the problems arising out of the yawning gap between the demand and supply of human organs in general and kidneys in particular, in view of the ever increasing number of ESRD patients. As many as 1.5 lakh people in the country require dialysis or a kidney transplant every year. According to official sources, one in every 1,000 persons suffers from chronic kidney disease.

Cadaver transplant

Against this backdrop, the government, in consultation with experts, has taken a series of steps to encourage and streamline cadaver transplant. “One of the reasons for the commercialisation of organ transplants was the lack of coordination with regard to cadaver transplantation. Close on the heels of the launching of the cadaver transplant programme, major hospitals in the State have expressed their willingness to be part of the network,” said Dr J. Amalorpavanathan, convener of the Cadaver Transplant Programme. He said the formation of an autonomous organ harvesting and distributing body at the State level was in a nascent stage.

Recalling the role of the MOHAN Foundation in the area, Dr Shroff said that there had been more than 20 cadaver donations in the State in the last three months of 2008 compared with 22 donations in the past three years. He said cadaver donation was catching up with the people after a doctor-couple donated their son’s organs last September; the boy was declared brain dead following an accident.

If the prevailing low rate of cadaver donation in the country – 0.07 per million population – were increased to one per million population, there would be adequate organs available for transplantation and there would be no need for live donations, he said.

Another issue that has been debated is the suggestion of a section of medical personnel and ethicists to declare organ donation by live unrelated donors as “regulated sale” or “rewarded gift”. A regulated market will ensure transparency in the commercial dealing, they feel. But Karunakaran said the experience in Iran where the system is in vogue “shows that those who have sold their kidneys through an open mechanism feel at the end of the day that they are worse off and they would not recommend anybody else to sell their kidneys”.

A discussion on the issue at a meet of experts in Istanbul, Turkey, in the middle of last year concluded that rewarded gifting of organs from live persons should not be allowed. The State government also rejected such an idea because of the THOA and other factors, Karunakaran said.

Experts including Dr Amalorpavanathan and the authorities concerned suggest that the focus should shift to preventive health care as the recipient has to spend Rs.10,000 to Rs.25,000 a month on medicines for the rest of his life to prevent the transplanted organ from getting rejected, and this is not viable for the poor. “The solution lies more in preventive nephrology. The two major causes of renal diseases in adults are diabetes and hypertension. This calls for radical alteration of our lifestyle,” he said. “If you reduce the incidence of these two diseases, the requirement for kidney transplants will come down and the demand can be taken care of by related donors and cadavers.

Tackle organ trafficking by promoting donation

The best way to tackle organ theft and trafficking for organs is by promoting voluntary donation and voluntary sale. The role of government should be to prevent crime, and not to enter into a contract between two parties. Crime includes cheating, trading others organs, and making profit out of it. A person who is willing to offer kidney or organs voluntarily for a price should be allowed to do so, and government should ensure that the contract is honoured. this will thwart the organ traffickers and gory crimes for organs.

Kidney patients on dialysis and post transplant should be treated as physically handicapped

Here is a G.O. of Govt of Kerala regarding reservations to physically handicapped.

I request that kidney patients on dialysis and those who have undergone transplant should be treated as physically handicapped

Sreeekumar

GOVERNMENT OF KERALA Abstract Public Services – Reservation for physically handicapped persons – 3% reservation to class III and class IV posts – orders issued. PERSONNEL AND ADMINISTRATIVE REFORMS (ADVICE-C) DEPARTMENT G..O.(P) No. 20/98/P&ARO, Dated, Thiruvananthapuram, 14th July 1998. Read: – 1. G.O. (MS) No. 146/85/GAD, dated 24-04-85. 2. G.O. (P) No. 215/85/GAD, dated 12-06-85. 3. G.O. (P) No. 367/85/GAD, dated 03-09-85. 4. G.O. (P) No. 30/95/P&ARD, dated 29-11-95. O R D E R In the G.O. read as Ist paper above, orders were issued for a maximum of 50 appointments each in the categories of subordinate Service, Last Grade – Service and Part time Contingent service being set apart every year for appointment of the Physically Handicapped persons to the Public Service Commission (consultation) Regulations, 1957 were amended to exclude the above appointments from the purview of the Public Service Commission. In the G.O. read as 4th paper above, the scheme was revised as the scheme for the direct recruitment of Physically Handicapped Persons in Public Service. As per the scheme 51 appointments each would be made every year in subordinate Service, Last Grade Service and Part time contingent service. The vacancies should be chosen in such a manner that the three broad categories of physically Handicapped get equal opportunities to be appointment under the scheme, ie, a ratio of 1:1:1 should be maintained among orthopaedically handicapped, deaf, deaf and dumb and blind in appointment. Section 33 of the Persons with Disabilities (Equal Opportunities, protection of rights and full participation) Act, 1995, provides that Every appropriate Government shall appoint in every establishment such percentage of vacancies not less than 3% of persons or class of persons with disability of which one percent each shall be reserved for persons suffering from (i) blindness or low vision (ii) bearing impairment and (iii) locomotor disability or cerebral palsy, in the posts identified for each disability. Based on this Government of India has decided that 3% reservation for the physically handicapped in group C and Group D posts shall be allowed on the basis of total number of Vacancies occurring in all group C and group D posts respectively under each Head of Department. Government, after examining the matter in details, are pleased to order that 3% vacancies in class III and Class IV Posts in Public Services will be reserved for appointment from physically handicapped persons as done by the Government of India in accordance with the provisions in the Persons with Disabilities (Equal opportunities, Protection of Rights and full participation) Act 1995. The existing scheme for appointment of physically handicapped persons to 153 posts in Public services every year issued in the G.O. read as 4th paper above is suitably modified and the revised scheme for appointment of physically handicapped persons in Public Services as approved by Government is Appended to this order (Appendix) By order of the Governor DHARAM VEER Secretary to Government. To All Heads of Departments The Chief Executives of Public Sector Undertakings, Companies and Corporations. All District Collectors. All Departments (all sections) of the Secretariat including Law, Finance and Legislature. The Secretary, Kerala Public Service Commission (with C.L) The Registrar, High Court of Kerala, Ernakulam (with C.L) The Registrar Mahatma Gandhi University, Kottayam (with C.L) The Registrar, University of Kerala/Kochi/Kozhikode/Kannur (with C.L) The Registrar, Kerala Agricultural University, Thrissur (with C.L) The General Manager, Kerala State Road Transport Corporation, Thiruvananthapuram (with C.L.) The Secretary, Kerala State Electricity Board, Thiruvananthapuram (with C.L) The Advocate General Ernakulam. The Private Secretary to the Chief Minister and other Ministers. The Private Secretary to the Leader of Opposition, Cantonment House, Thiruvananthapuram. The Private Secretary to the Governor, Raj Bhavan, Thiruvananthapuram. The Deputy Secretary to the Chief Secretary. The Director of Public Relations. The Stock File. Forwarded/by order Section officer APPENDIX Scheme for Direct recruitment of Physically Handicapped persons in Public Service 1. This scheme shall be called “Scheme for Direct recruitment of Physically Handicapped Persons in Public service. 2. Only Physically handicapped persons satisfying the criteria laid down in the explanation under Rule 9 (e) in part II of Kerala State & subordinate Service Rules, 1958 Shall be eligible for appointment under the scheme. 3. Three percent of the vacancies arising in Class III and Class IV categories shall be reserved for appointment from Physically handicapped persons. The posts to which appointment will be made are enumerated in Annexure –I. The number of appointments to be made each year in various categories will be fixed annually by Government in the Personnel and Administrative Reforms Department on the basis of the number of appointments made the Class III and Class IV posts (except N.J.D. Vacancies) during the previous year. The Government will collect in January each year from the office of the Kerala Public Service Commission details of the vacancies in Class III & Class IV posts to which advice has been made by the Public Service Commission excluding N.J.D. vacancies. The list should contain the number of advices made by each district office and the head office separately. Three percentage of the total number of vacancies will be allocated among various districts taking into account the number of appointments made in each district. The posts suitable for appointment of the different categories of Physically Handicapped are given in Annexure – II. 4. The selection shall be made on a district – wise basis for appointment to posts coming under the scheme of District wise recruitment and on a state –wise basis for appointments to other posts. 5. The selection shall be made by a selection committee consisting of the District Collector as the Chairman, the District Employment Officer and another District Officer of a Major department in the District co-opeted by the District Collector as members. The sub-Regional Employment Officer of the Special Employment Exchange for physically handicapped will be the member of the selection Committee in the place of District / Divisional Employment officer in Districts where special employment exchanges for physically handicapped are functioning. The Committee may utilize the services of experts to assist them in the conduct of test and /or interview. The District Collector shall be the co-ordinating authority in the matter of as curtaining the vacancies, selection and allotment for appointment. 6. As soon as Government fix the quota for each District the District Collector shall ascertain from the District offices of the Departments in the District concerned the vacancies in the posts enumerated in annexure –I likely to arise during the year which can be apart for appointment of physically handicapped persons. The vacancies should be chosen in such a manner that the three broad categories of physically handicapped get equal opportunities to get appointed under the scheme, i.e., a ratio of I:I:I shall be maintained among (1) orthopaedically handicapped (2) deaf, deaf and dumb and (3) blind in appointment. 7. The vacancies of District – wise recruitment shall be reported to the District Employment Exchanges and the vacancies of State-wise recruitment to the Director of Employment asking for a panel of names. 8. On getting the panel of names from the District Employment Exchange/Director of Employment, the candidates shall be directed to the District Medical Board for Medical Examination to ascertain whether they satisfy the criteria laid down in the Explanation under 9 (e) Part II of Kerala State & Subordinate Service rules, 1958. 9. The candidates certified by the Medical Board as Physically handicapped satisfying the criteria laid down in the Explanation under rule 9 (e) will be called for test and / for interview by the Selection committee. Definite norms shall be laid down by the Selection Committee for the Selection. 10. The Selected candidates in each category of posts shall be arrange in the order of merit and the candidates allotted in the order of their ranks to the District officers/ appointing authorities of the concerned Departments for issuing the appointment orders. 11. The Rules regarding age probation etc., as provided in the General Rules in Part II of Kerala State & Subordinated Service Rules, shall apply to the recruitments under the scheme. The rules regarding communal rotation shall also apply. 12. The Rules regarding verification of character and antecedents shall apply . The candidates allotted for appointment shall be initially appointed on a temporary basis under General Rule 9 (a) (i) and regularized after his/her character and antecedents are verified by the Police Department and found to be satisfactory. 13. The rules regarding inter-district transfers shall apply to the cases of candidates appointed under the scheme on district –wise basis. 14. The year for the purpose of the scheme shall be reckoned as the calendar year. In such exigencies where the reservation could not be utilized during year the same shall be carried forward in the subsequent three recruitment years at the and of which the reservation shall be deemed to have lapsed. 15. The District Collectors shall after the year’s selection is over submit to Government by 31st December, every year, in the personnel and Administrative Reforms (Advice- C) Department a comprehensive report on the selections made under the schemes during the year for information and record. ANNEXURE – I Posts Suitable for Appointment of the Physically Handicapped Subordinate Service. 1. Clerk (LD) 2. Typist (LD) 3. Confidential Assistants. 4. Teachers (Primary) 5. Compositors 6. Proof Reader 7. Book Binder 8. Accounts Clerk. 9. Lab Assistant 10. Compiler 11. Store Keeper 12. Accountant 13. Librarian 14. Musician 15. Tracer 16. Draft man 17. Tutor Grade II (Mridangam, Violin, Veena, Vocal Music) 18. Clerk Typist 19. H.S.A. (Languages and social studies) 20. Assistant Teachers (School for Blind) 21. Braillist 22. Oraft Teacher 23. Weaving Instructor 24. Occupational Therapist 25. Booth Attender 26. Massieur 27. Assistant Instructor in Basket Making 28. Craft Instructor 29. Dark Room Assistant 30. Photo copier Operator 31. Telephone Operator 32. Music Teacher 33. Part-Time Instrumental Music Teacher Last Grade Service. 1. Peon 2. Chowkidar 3. Telephone Attendant 4. Lift Operators 5. Roneo Operators 6. Dark Room Attender 7. Duster 8. Map Binder 9. Packer Counter/Packer 10. Ice man 11. Female Attendant 12. Waiting Room Attendant 13. Messenger 14. Pump Operator 15. Packer 16. Xerox Operator 17. X’ray Attender 18. Gardner APPENDIXE – II Post Suitable for appointment of different categories of the Physically Handicapped Category of Handicap. Post in the subordinate Service (Entry Grade) Post in the Last Grade Service A. Orthopaedically Handicapped (a) Upper Extremities. (i) Major Defects (ii) Minor Defects (b) Lower Extremities: (i) Major Defects (ii) Minor Defects C. Partially Deaf Clerks Accounts Clerk Lab Assistants (Chemical/Clinical) Proof readers store Reapers Compilers Teachers (Primary) Typist, Clerks Accounts Clerks Clerk Typist Tutor in Music Clerks Account Clerks Compositors Confidential Assistants Proof Readers Typists Clerk Typist Librarians Musicians Tracers Confidential Assistants Typists Draftsman Proof Readers Clerk Typist Compositors Tracer Clerk-Typist Clerks, Draftmsman Compositors, Lab- Assistants, (Chemical/Clinical) Librarians Confidential Assistants, Typists Book Binders Tracer, Clerk-Typist. Peon Peons Chowkidars Attender Telephone operator Life Operator Roneo Operators Chowkidars Peons Roneo Operators. D. Blind E. Partially Blind Musicians, Primary School Teachers Tutor Grade – II in Mridangam, Violin and veena, H.S.A (Languages & Socials studies) Asst. Teacher (School for Blind) Braillist, Draft Teacher, weaving Instructor, Dark Room Assistant Masseur, Booth Attender, Occupational Therapist Telephone Operator Asst. Instructor in Basket Making Craft Instructor Photocopier operator Music Teacher, Part – Time Instrumental Music Teacher. Musicians, Teacher (Primary) Tutor Grade-II in Mridangam, Violin & Veena H.S.A (Languages & Social Studies) Asst. Teacher (School for Blind) Braillist, craft Teacher, Weaving Instructor, Dark room Assistant, Masseur Booth Attender Occupational Therapist, Telephone Operator Asst. Instructor in Basket making Craft Instructor Photocopier operator Music Teacher Part-Time Instrumental Music Teacher. Chowkidars Peons Roneo Operators. Peon Lift Operators, Duplicator operators Female – Attendant Dark Room Attender, X-ray Attender Duster, Gardner, Map Binder Waiting Room Attendant Pump operator Radio Operator packer counter Ice man, Xerox Operator

New Way to Increase Supply of Organs

Transplant Surgeon Pioneers

New Way to Increase Supply of

Organs

http://www.newswise.com/articles/view/540154/

Newswise — Transplant surgeons such as Dr. Robert Love of Loyola University Hospital are pioneering a new way to increase the supply of organs from deceased donors.

Today, most organs are obtained from donors on life support who have been declared brain dead. The organs are in good condition because the heart is still beating.

But more surgeons are beginning to use organs from patients who have been declared dead after their hearts have stopped beating. Last year, there were 793 donations after cardiac death in the United States. That’s up from 117 cases in 2000.

Kidneys and livers are the most commonly used organs from cardiac-death donors, but surgeons also are using lungs and pancreases. Love has done about 30 lung transplants from cardiac-death donors.

Nearly 100,000 people are waiting for organ transplants in the U.S. Some people wait for years. And many die while still on the list.

“We must do everything we can to encourage people to become organ donors,” Love said. “And we also have to make sure that every usable organ is used.” Love is a professor of thoracic and cardiovascular surgery at Loyola University Chicago Stritch School of Medicine.

Steve Schumann of Palatine is among the patients of Love who have benefited from a cardiac-death donation. The 60-year-old pharmacist had pulmonary fibrosis, a progressive and incurable lung disease. Schumann had uncontrollable coughing fits, and needed oxygen 24 hours a day, even in the shower.

Without a lung transplant, Schumann did not have long to live. If his only option had been a transplant from a brain-dead donor, an organ might not have become available soon enough to save his life, Love said. Fortunately, Schumann’s time on the waiting list was shortened when a pair of lungs became available from a cardiac-death donor.

Last July, Love and Loyola surgeon Dr. Michael Eng traveled to the donor’s hospital in Joliet to recover the lungs. Love brought the organs back to Loyola in an ambulance, and performed the transplant along with Dr. Mamdouh Bakhos.

Shortly after waking up from surgery, Schumann’s new lungs filled with air. For the first time in more than two years, he could breathe without an oxygen tank.

“The feeling was indescribable,” Schumann said. “It was such a relief.”

Schumann can walk again, without gasping for breath or being tethered to an oxygen tank. He has just joined an over-fifty softball league, and plans to play as much golf as possible this summer.

“It was a miracle,” he said.

Obtaining organs from cardiac-death donors can be technically challenging. Organs begin to deteriorate as soon as the heart stops beating. Surgeons generally have only a 30-minute to 60-minute window to remove organs.

A typical case involves a patient who has suffered severe and irreversible brain damage from, for example, a car accident, gunshot wound or brain hemorrhage. The patient still has minimal brain function so is not considered brain dead. But the patient is near death, and further treatment is considered futile. The family agrees to withdraw the patient from life support and donate the organs.

The patient usually dies shortly after being taken off the ventilator and other life support, such as medications to maintain blood pressure. Five minutes after the patient’s heart stops beating, the body is taken to an operating room, where the organs are recovered.

Donation after cardiac death leaves the family little time to say goodbye. “But families are usually very understanding about this,” said Joyce Maly, Loyola’s in-house coordinator for organ and tissue donation. Maly’s position is a partnership between Loyola and Gift of Hope Organ and Tissue Donor Network.

Families take solace from knowing that their loved-ones’ organs will enable other people to live. “They are living on in someone else,” Maly said.

India ranks 2nd in kidney transplants from live donors

India ranks 2nd in kidney transplants from live donors
A ‘Kidney International’ report said India has no reliable national data to show how many kidney transplants occur
Seema Singh

Bangalore: Fifteen years after India passed the Transplantation of Human Organs Act, allowing organ retrieval from the brain-dead patients, kidney donations by live donors remain very much in vogue and, according to a recent study, the country sees more such transplants than any other country in the world barring the US.
Also See Top 10 Countries by Transplants (Graphic)
India, however, slips to the 40th rank in the study of 69 countries in terms of number of transplants per million population, with only three in a million getting the kidney in case of a renal failure.
According to a new report in Thursday’s issue of the Kidney International—the journal of the International Society of Nephrology—about 27,000 related and unrelated living kidney donor (LKD) transplants occur worldwide every year, of which 6,435 take place in the US and 1,768 in Brazil with India figuring in between with about 3,200 transplants, a number which the authors said, doesn’t represent “reliable national data”.
“It’s true, we don’t have any national registry and nobody knows how many kidney transplants occur in India,” said Sunil Shroff, managing trustee of the support group Multi Organ Harvesting Aid Network Foundation in Chennai. He estimates the number of transplants per year to be in the range of 3,000-3,500, with barely 5% coming from the brain-dead. The annual requirement is about 150,000.
The LKD rates in two-thirds of the 69 nations surveyed have been growing at 50% over the last decade, but India remains stuck at the same level, which Shroff attributes to lack of health insurance, and institutional and financial support. A kidney transplant costs about Rs3-4 lakh, with a lifetime monthly post-operative care costing at least Rs10,000.
Tracking the rate of LKD is important as the worldwide prevalence of end-stage renal disease is increasing and a global trend can help countries evaluate their performance, said authors Lucy Diane Horvat, Amit Garg and colleagues from the University of Western Ontario in Canada.
India is in an unenviable position when it comes to the disease burden, implementation of the organs Act and preventing kidney rackets that frequently rock the nation.
At present, brain-dead transplant, also called disease donation, amounts to 0.7 per million population, but if this is increased to one, then there would be 1,100 donors and 2,200 kidneys for transplants, said Shroff. If pushed further, to two per million population, then 4,400 kidneys could be retrieved, dramatically reducing the burden on living donors.
“We (surgeons) have a problem in LKD…operating on healthy people, who in many cases die or develop complications,” said Sandeep Guleria, a transplant surgeon at All India Institute of Medical Sciences. He said unlike the West, which started with cadaver transplants and took to living donors to bridge the gap, India started with living donors and even 15 years after the Act, has failed to adopt cadaver transplants in earnest.
Some of the ambiguities in the Act that led the kidney donor-broker-hospital nexus to thrive have now been cleared. The Act was amended with effect from 4 August, to make the procedure more transparent , said Harsh Jauhari, head of renal transplantation at Sir Ganga Ram Hospital in New Delhi.
But several problems remain and experts believe they can be addressed when the national organ transplant programme—ambitious but apparently hurriedly announced in November—on the lines of the National AIDS Control Organization will eventually be launched. “It will bear fruit only four-five years down the road,” said Jauhari.

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Request for helping kidney patients sent to ministers

dear friend

I have sent  email to finance minister, Kerala State and forwarded the request to the Chief Minister and health minister to kindly do something for kidney patients and those who have transplants done.

The letter copy is given below

Regards

Sreekumar

To the finance minister, Kerala State

Dear Sri.Thomas Isacc,

It is great to see that you have been sensitive to many social issues, as reflected in your budget and I appreciate you for the same.
However there are areas where I feel your attention has not yet reached. One such area is that of the suffering patients afflicted with chronic diseases in Kerala.
May I bring your kind attention to the pathetic situation of kidney patients who are in dialysis and in need of kidney transplant.

As a person of social sensitivity, you might not have missed the advertisements that appear almost everyday in newspapers, requesting financial help for kidney transplant operations. Any person can suddenly find himself/herself a patient with organ failure. It is devastating to the patient and his/her close ones. I request you to kindly visit my blog site

http://sree1010.wordpress.com/government_assistance/

ASSISTANCE SOUGHT BY KIDNEY PATIENTS

There is crying need for Government Assistance for the welfare of kidney patients and those who have undergone organ transplant.

Patients with organ failure and those who have undergone transplant, both need help of the government for their survival.

Following urgent actions are suggested :

Ensure job security and income security to patients and/or families so that they can meet the medical and other expenses associated with the the miserable situation arisen as a result of the disease.

Ensure Job Security

Measures to ensure that kidney patients are not laid off or dismissed from the institutions they work, particularly from the private sector institutions.

Kinder approach to patients with organ failure with generous working conditions allowed in government and non government institution so as to help them adjust job commitments along with their treatment for health.

Ensure job reservations for patients who are in dialysis and also those who have undergone kidney transplant so that they make some money to meet their treatment expenses and reduce dependency on others.

Ensure job reservations at least on contract basis  to aclose relative of a person afflicted with organ failure so as to enable him/her to support the patient. This may be limited to the period the patient suvive

Provide Insurance Coverage

Measures to ensure that kidney patients gets quality medical insurance coverage

Make Employees State Insurance (ESI) compulsory in all private institutions including educational institutions
Medical Infrastructure

Establish government dialysis centers in all districts where dialysis is given at subsidised /affordable rates.

Subsidise medicines and medical accessories used by kidney patients to reduce their financial burden

Increase the supply of dialysis units available in hospitals and make available affordable dialysis to all patients and make dialysis equipments tax free.

Welfare schemes

Rehabilitation schemes shall be introduced for kidney patients

Introduce concessions in all sectors for kidney patients and their supporting relatives including private and KSRTC buses.

Introduce concessions in both private and state transport corporation buses at par with railway concession for kidney patients

Reservations for children of kidney patients in private and government schools and provide educational supports including fee concessions

Introduce employment schemes tailor made for patients suffering kidney diseases or have undergone transplant operation.

Increase organ availibility

Appoint a task force to remove hurdles for facilitating organ transplant.

Encourage willing donors to donate kidney /organs. Make willing living donors symbols of human love and kindess and sacrifice and reward them with job reservations/ governmental assistance

Promote cadaver transplant for increasing organ availability by introducing generous incentives for relatives for the dead person, advertisements in media, compulsory retrieval of cadavers as done in developed nations, removing hurdles for retrieving organs from cadavers etc.

Promote living donor transplant and encourage willing donors by providing introducing incentive schemes and reservations for the living donor. Unfair kidney trade must be stopped by government stepping in to provide fair deal to the willing donors for their sacrifice.

Promote donor organ swapping by facilitating mass transplant operations where a group of patients and willing donors come together and donors with matching kidneys are swapped

Increase organ transplant infrastructure in government hospitals to highest standards

Other Measures

Promote medical research in the field of kidney diseases and introduce mechanisms to share information

Introduce a national directory for organ transplant

National policy for organ transplant and monitoring machinery to ensure better availibility of donor organs

Promote private sector and NGO involvement in supporting kidney patients
Anyone can be a patient. Losing health is devastating for the poor people and the middle class. They lose job and income source, they become dependent on others, The families are shattered due to loss of income and the miseries associated by having a chronic patient among them. Many families have become bankrupt and have even committed suicide due to unsurmountable problems due to a member falling ill.

A government aimed at people’s welfare cannot ignore the diseased and their families. Loss of health and associated problems is the cause of insecurity in the minds of most people and a progressive minded society do not leave the sick members to fend for themselves without helping.

I request you to read the above suggestions and take appropriate actions to ensure that patients are given kinder treatment.

Yours faithfully,

Sreekumar B
KSEB colony, 110 kv substation, Chevayur, Kozhikode-17
Phone: 9946554580
email: sree1010@gmail.com
website: http://sree1010.wordpress.com/