Transplants: A New lease on life

Reba Paul 

Organ transplantation is hailed as one of the greatest advances of modern science in this century, giving millions of people a new chance at life.

Organ transplantation was a confusing, even horrific prospect for people living a few centuries ago to ponder.  All of the ethical, moral issues that the concept brings up in many communities have been allayed over the past few decades, and transplants are now widely considered by doctors and the public alike to be the best medical option for many diseases. In cases involving end stage kidney failure, this is the only solution that can ensure the patient a good quality of life. Organ transplantation is hailed as one of the greatest advances of modern science in this century, giving millions of people a new chance at life.

Based on human physiology, the heart, kidneys, eyes, liver, lungs, pancreas, intestine and the thymus can be transplanted. Tissues can also be transplanted – like bones, the cornea, skin, heart valves. In fact, musculoskeletal and corneal transplants are ten times more prevalent than organ transplants. In the organ transplant area, the kidneys are the most transplanted organs, followed by the liver and then the heart.

What does it entail?

Moving an organ from one body to another for the purpose of replacing the recipient’s damaged or absent organ, is a complicated endeavor. Previously it was a prerequisite that the donor and the recipient have matching or compatible blood groups. This is becoming increasingly flexible now, due to the new drugs in the market. Higher degrees of tissue compatibility are thought to help the success rate of the transplant. The first successful organ transplant happened when a kidney was transplanted between twin brothers in 1954. The main problem faced after a transplant is that the recipients’ body tries to get rid of the foreign organ.  Every body’s immune system clearly knows what belongs in the body and what is a foreign object. So after a new organ is transplanted, the immune system sees it as ‘foreign’ and keeps trying to get rid of it. This is what causes organ rejection. This problem is tackled by giving the recipient medicines that suppress this instinctive response of his immune system – these are called immunosuppressants.

Organ Donation

Any healthy adult who wishes to donate his organ is free to do so. Also, any healthy adult who wishes to bequeath his organs for transplantation after death can also do so. This is one way to positively impact the life of a fellow being even after your time on the planet is done. In case of a natural death, only a few organs can be ‘harvested’ – like the cornea, bone, skin and blood vessels. However, if a person is ‘brain dead’, then many more organs can be successfully harvested to benefit the life of other people – technically almost 37 different organs and tissues can be put to this worthy use.

The Indian Scenario

Generally speaking, chronic organ failure is still not being seen as the serious problem it really is. In India, thanks to improving mortality rates and disease management, most of the attention in the medical scenario is primarily focused on heart disease, diabetes and other such diseases. What we are failing to understand is that a huge chunk of the present population is going down the road that will inevitably lead to organ failure.

The rise in the incidence of organ failure globally has impacted India in many ways. At the time when transplants began to be commercially executed and were becoming popular, India had the rare combination of having trained transplant personnel, good medical facilities, a large impoverished population and lack of legal governance on organ transplantation. This made the country a quagmire of organ transplant activity from the late 1980s onwards. India got a lot of attention globally due to a multitude of reports regarding large-scale transplants being done with kidneys sourced from poor, illiterate donors under questionable circumstances. Following all the media criticism, the Government of India enacted the Transplantation of Human Organs Act (THOA) banning payment for human organ donation.

The Loophole

Despite this, most of the transplants happening in the country are from live donors who get paid for giving their organs. This is due to a loophole in the Act, which says that a donor can give his organs ‘for the reason of affection or attachment towards the recipient or for any other special reason’.  It is estimated that India has approximately 3500–4000 kidney transplants and 150–200 liver transplants happening every year. The main source is live or unrelated donors.

India’s Human Organ Transplantation Act says that a father, mother, brother, or sister can donate organs to the patient. Other live donors go through a screening process by a state transplantation authorization committee to make sure that they are donating organs purely due to emotional attachment to the patient and not for monetary or material gain. The fact that there are so many live, unrelated donors providing organs for the majority of the transplants seem to point to the fact that there is collusion between the agents who source the donors and the authorization committee. Several ‘kidney rackets’ have been busted which have had doctors working with kidney agents to get donors. These donors would have documents fabricated regarding their relationship with the patient, and would be eventually sanctioned by the screening committee. The worst part is that since the whole process is illegal, after the various cuts are taken by the agents and others involved, the donor actually gets only a fraction the amount that the patient pays for the organ. But the question is, when such a huge need for organs exists, should we not have a better solution?

The Multi Organ Harvesting Aid Network Foundation (MOHAN)is a non-governmental organization that has, among many others, been campaigning for more cadaveric transplants. Doctors connected to this organization say that less than 600 cadaveric transplants have been performed in India since the THOA came into being. But the annual number of kidney transplants is over 2000. They point out that ‘there doesn’t have to be a shortage of cadaver organs in India- most relatives of brain dead persons are willing to donate, but there is no system in place in most hospitals to counsel relatives and harvest organs.’

The foundation has written to the health ministry requesting that the government take steps to promote cadaveric transplantation and also enforce stricter scrutiny of live, unrelated donors. They are still waiting for a response. Meanwhile, kidney and other organ rackets flourish in the country. Stray reports surface in the media regarding these from almost all major Indian cities, but no long term official solution seems to be in sight.

The cadaver donation solution

The urgency of the situation is due to the fact that the number of people who need a transplant to save their lives far outnumbers the number of live donors. The only viable solution we are left with is to promote cadaver transplants – which can be done only through people agreeing to donate their organs after death. Oddly enough, most public surveys show that organ donation has high support from the general public. The fact that this is not becoming a reality, is most probably due to the fact that after a patient dies, their relatives are either not aware of this, or are against it, and so the individual’s wishes are not carried out. Statistics say that as many as half of all families decline to donate the organs of their recently deceased loved ones.

In a country populated by more than 1 billion people, the pool for cadaver harvest is understandably high. But in India, the number of cadaver transplants is miniscule in comparison to live donation. Every year, almost 100,000 Indians suffer from kidney failure. Of these about 3,000 actually get a donor kidney, with a very small percentage being from cadavers. In the eight year span between 1995 and 2003, only 524 cadaver transplants were done. The critical shortage of available organs is only getting worse as more people succumb to kidney and liver failure.

The issue gets even more important as we consider that India has an ever increasing number of end stage liver failure patients. Patients who have kidney failure can be helped with therapies like dialysis. But liver failure has no such therapy, and transplant is the only solution. Of the majority of liver failure patients, only a handful get timely transplants that save their lives. The same is the issue with heart-lung transplants. Unlike the kidney, which a donor could give one and still survive well on the functioning of the remaining one, no one except a cadaver can donate his heart and lungs.

Cadaver Donor Program

It would not be an exaggeration to say that unless India develops a good cadaver donation program, we will remain right where we are now, with many of our citizens dying for lack of organs. This problem has to be addressed from the side of the government and policy makers, if any significant change is to take place.

Awareness has to be created about the existing problem, and the public has to be encouraged to be cadaver donors. The family unit has to be informed, and there has to be a way of ensuring that the individual who wishes to donate will have his wishes honored after his death. There should also be a practical and efficient organ retrieval mechanism that is implemented on a national level.

Well trained staff should be present in hospitals to educate and inform families about cadaver donation – in a way that this sensitive issue is handled impeccably without compromising on the optimum time for organ retrieval. One brain dead patient can help seven patients in critical stages, to lead normal lives. Another option to consider is that a national policy could be created whereby every patient in a hospital who becomes brain dead will have his organs harvested, unless otherwise clearly specified to hospital authorities. This way more organs can be made available for the living. Infrastructure should be created for harvesting, storing, biochemical work that will facilitate the best organ-recipient match. Organ donation is possibly the last and most noble act that any human being could undertake; don’t make it so hard to do.

Paid Donation – No good for Donor?

A group of independent American researchers, who tracked down over 300 individuals who had sold a kidney in Chennai, India, found that:

•         The donors received far less money than what had been promised to them during the process of initial bargaining

•         Instead of improving, their family income declined by about one-third after donation, and the number of participants living below the poverty line increased by about 20%

•         75% of the participants who chose to sell their kidney to get out of debt, continued to be in debt

•         More than 95% of the sellers admitted that the desire to help a gravely ill patient with kidney disease was not a factor in their decision

•         Almost 90% of them reported significant decline in their health status

•         In many cases, women had been forced to donate against their wishes because the husbands needed money.

When asked what advice they would give to others thinking of selling a kidney, more than 80% said that they would not recommend such a step. The authors concluded that the Authorization Committee failed in its duty, shattering the myth that the money earned by selling an organ helps the donor to improve their financial standard and get a fresh start in life.

Iranian Model of Organ Donation

The Iranian model of transplants is seen as the one that is the most fair to the recipient as well as the donor. It is a state supported program – the compensation and regulation are done by the state. This program started functioning in 1988, and gives financial incentives to living donors who volunteer their organs. These living unrelated donors get a sum of money, without having to go through any middlemen. Anyone who needs a kidney gets it. However, there are regulations in place that ensure that transplant tourism does not get the benefit of this. So foreigners cannot have a renal transplant from an Iranian national in Iran, nor can they be a donor.

After this system was in place, renal transplants increased so much that by 1999, the waiting list was eliminated. Right now, there is no renal transplant waiting list in Iran. The advantage of this model is that many of the ethical issues surrounding live, unrelated donation are eliminated, since the donor is directly connecting to the government for his compensation. Also, he will not know who is going to get his kidney, since it going to an organ pool and given to the patient who is the best match for it.

All hospital expenses are also paid for by the government, so even poorer patients can afford to have a transplant. The transplants are only performed in government hospitals that are affiliated to universities. The transplantation teams, including the doctors, have no connection with identifying possible donors and no middlemen are involved.  More than 50% of Iranians who had end stage kidney failure are living with a functioning transplanted kidney. It is the only country that has successfully eliminated a transplant waiting list in this manner.

mail to rebekaah.paul@gmail.com the author of this article published in the Novemebr 2011 Issue of THE HEALTH CAFE'. Sign in for the health cafe newsletter for a complimentary annual e-subscription. 

Appendix : Cut it or Keep it....

Is the appendix just a useless evolutionary vestige, or does it have a role to play in our health. New evidence suggests that it may be persisting in our systems for a purpose!

Case 1: My 40-year-old friend collapsed with a sudden abdominal pain one morning. With no prior warning, she came close to an absolute blackout. In minutes, the pain was gone completely. Nevertheless, she went to a hospital to get it checked out. Routine scans were done to check if her appendix was to blame, but the technician saw no problems with her ‘evolutionary vestige’. All through the morning, one thought kept coming back to mind. Her IUD was long past removal date – maybe that was to blame. The doctor she met later, however, insisted that she be admitted immediately for an appendectomy. She ventured that she felt totally fine, and that she would check with a gynecologist about the IUD first…the doctor immediately proposed that she could be admitted, have an appendectomy and also have the IUD removed by his wife, who was a gynecologist. Deeply troubled by that option, my friend insisted on going back home, despite dire predictions of doom by the doctor. The next day, she got the IUD removed, and has had no ailments since. She says, “I understand that the appendix is considered unnecessary…but it’s something that’s inside my body that wasn’t giving me any trouble! Why should he insist on removing it even when it is fine? I was being pushed to do a surgery that was totally unnecessary!”

Case 2: A patient comes into the hospital complaining of acute abdominal pain. The doctor diagnoses acute appendicitis and surgery is immediately scheduled. Later, the patient finds out that his appendix was on the verge of rupturing and that the timeliness of the operation had saved his life. “It was such unbelievable pain! I am so relieved that it could be solved by such a simple procedure – and thankfully we don’t need the appendix, so it’s not going to affect my life!”

Yes, it’s true that the appendix is considered a remnant of an evolutionary process by evolutionists. But is it a ‘useless’ mass of tissue in our body? The human body is a super-intelligent mechanism that harmoniously conducts millions of processes in every second. If something was really useless, why would the body still have it inside? Is it right of us to see the appendix and the tonsils so lightly – and choose to throw them out at the slightest provocation? Does it all come down to a comparative decision? Or does the appendix only function as a source of financial support for surgeons? Let’s find out.

The Unwanted Appendix

Till some time ago, science on the whole considered that the appendix was a part of us that the body missed out or forgot to discard when we evolved into homo sapiens. However, it has always been the focus of a lot of discussion and debate. It is understood that the appendix may have had a big role to play in the past, but after our bodies evolved to what they are now, their role diminished.

It has been widely considered that the appendix is a shrunken remainder of a large intestinal tube, from which our intestines evolved to their current state. Inside the body, the appendix is a small, finger-sized projection attached to the large intestine in the lower right area of the abdomen. It is usually between two to eight inches long. The appendix is longest in childhood and gradually shrinks through adult life.

Scientists’ view of the appendix is changing from what they believed in the past. A growing consensus is that the most likely function of the human appendix is as a part of the gastrointestinal immune system. Some opine that reasonable arguments exist for suspecting that the appendix may have a function in immunity as the appendix is highly vascular, is lymphoid-rich, and produces immune cells normally involved with the gut-associated lymphoid tissue. It’s also known to be a storehouse for the ‘good’ bacteria also.

Appendicitis

Appendicitis is a painful inflammation of the appendix. The condition starts as a pain in the centre of the abdomen. It then travels to the lower right-hand side and gradually gets worse.

Appendicitis is a medical emergency that usually requires urgent surgery to remove the appendix. If left untreated, the appendix can burst and cause potentially life-threatening infections. It’s not exactly clear what the causes of appendicitis are, although it’s thought to occur when something, usually a small piece of faeces, blocks the entrance of the appendix, causing it to swell.

Symptoms

Appendicitis typically starts with a pain in the middle of your abdomen that may come and go. Within hours the pain travels to the lower right-hand side, where the appendix lies, and becomes constant and severe.

Pressing the appendix area, coughing or walking, may make the pain worse. You may lose your appetite, feel sick and suffer from constipation, diarrhoea, vomiting and high fever.

Go for Surgery

An inflamed appendix will most probably rupture if not removed. Rupturing spreads the infection throughout the abdomen, creating a potentially fatal situation.  In most cases, the appendix will have to be surgically removed. This is one of the most common operations and its success rate is excellent.

Surgery is most commonly performed as keyhole surgery (consisting of three small cuts). Open surgery (a single large cut over the appendix area) is usually carried out if the appendix has burst.

Are there any other ‘spare parts’ in the human body?

Male nipples

Men have nipples and mammary tissue which can be stimulated to produce milk. They can also get breast cancer.

Wisdom teeth

Early humans had an extra row of molars to help with the vast quantity of vegetable fibre they had to chew. Now, about 35% of the population does not develop wisdom teeth at all.

Coccyx

The remains of a tail lost long before man began to walk upright six million years ago.

Spare ribs

Humans have 12 ribs but about 8% of humans have an extra pair, as do chimps and gorillas. They live with that extra pair of ribs!

The appendix does have a use: Re-booting the gut

For generations medical orthodoxy has maintained that the appendix is useless, warranting attention only for its tendency to becomepainfully inflamed and requiring swift removal. But now the reputation of this unwanted little sac in the human gut has beenrehabilitated by a theory from a team of immunologists.

Scientists have found that the appendix acts as a “good safe house” for bacteria that are essential for healthy digestion. In effect, theappendix ‘re-boots’ the digestive system after a bout of amoebic dysentery or cholera or any case of extreme diarrhea that purges thegut.

This function has been made obsolete by modern, industrialised society; in dense populations, people pick up essential bacteria fromeach other, allowing gut organisms to re-grow without help from the appendix, the researchers said.

But in earlier times, when land were more sparsely populated and whole regions could be wiped out by an epidemic of cholera, theappendix provided survivors with a vital individual stockpile of suitable bacteria.

“The function of the appendix seems related to the massive amount of bacteria that populates the human digestive system,” said BillParker, a professor of surgery and one of the scientists responsible for establishing its status as a useful organ. “The location of theappendix, just below the normal one-way flow of food and germs in the large intestine, helps support the theory.”

New Ways To Battle The bulge

Thanks to changing lifestyles, poor eating habits and sedentary jobs, an increasing number of people are hitting the overweight mark. As a result, they are busy lightening their pockets in an effort to lighten their bodies and get rid of those unsightly bulges and flab. Plastic surgery is steadily becoming a way of life to a certain section of urban upper middle class individuals.

One of the most popular procedures for fat reduction is liposuction. However, its main drawback is that it is mostly done on patients who are only within five to ten pounds in excess of their ideal weight. This is where people start to look for a backup plan for getting rid of that unsightly fat! Would topical creams effectively remove or lessen specific fatty areas? Many non-prescription creams, lotions and pills declare that they will be absorbed into the layer of fat and make it vanish. You wish!

Getting rid of unwanted fat is a booming business, and naturally has numerous bogus solutions that ‘desperately seeking to lose weight’ people flock to. So, what is the world to do? Is there no other answer in sight? Something that’s non-invasive, nonsurgical, and less expensive, which would help to improve our thighs, abs and hips…

People looking for a safe procedure for liposuction…rejoice! You can now get rid of your fat without anesthesia risks, without invasive surgery! It’s called Ultrasound assisted Laser Fat Reduction, and is now available in India. The process has been developed and utilized in several countries all over the world as an alternative to conventional liposuction.

Like most plastic surgeries, the technique is continually changing, expanding, and improving each year.

The basic challenge of any fat reduction procedure is:

To remove the right amount of fat

To cause the least disturbance of neighboring tissue, such as blood vessels and connective tissue

To leave the person’s fluid balance undisturbed

To cause the least discomfort to both patient and  surgeon

As techniques have been refined, many ideas have emerged that have brought conventional liposuction closer to being safer, easier, less uncomfortable, and more effective. The marketing that goes on however, makes it harder for the consumer to distinguish truth from exaggeration.

The good news about Ultrasound Assisted Laser Liposuction is that such complications can be avoided. It causes less discomfort for the patient, both during the procedure and afterwards; decreases blood loss and can access larger areas. This new technology focuses on only the target fat cells in the body and essentially melts away the fat. The broken down fat cells are moved through the body through the body’s metabolic system and discarded naturally.

How it works:

The reason this is preferred by many is that there is more precision to the removal of fat, and it is non-invasive. Carefully calibrated energy is directed into the skin. The fat cells in our body absorb the ultrasound energy, whereas the other tissue around the fat deposits will reflect the ultrasound. This helps the surgeon to target the fat cells clearly, without posing a risk to the other tissue surrounding it. The fat is liquefied, and can be naturally expelled by the body, or is sometimes suctioned out with a small suctioning cannula.

This procedure works best in removing small to medium fat buildup – like behind the knees, around the neck or chin or arm fat. When larger areas are targeted, you will need to have some device invading your skin to suction out the larger amounts of fat being liquefied. This kind of a procedure can also be effectively used to remove deep seated tumors, which may be under many fat layers. The cost of the procedure will depend on how many sessions are required, how much fat has accumulated, you age etc.

So, thanks to advances in technology, you can lay your fears to rest. There are several back up plans available to get rid of the hideous results of our dietary indulgences. Of course, all this is possible only if we are ready to dig deep into our pockets, so weigh your options and decide what’s best for you!