Organ Donation after Circulatory Determination of Death in India: A Joint Position Paper

Avnish K Seth; Ravi Mohanka; Sumana Navin; Alla Gk Gokhale; Ashish Sharma; Anil Kumar; Bala Ramachandran; K R Balakrishnan; Darius Mirza; Dhvani Mehta; Kapil G Zirpe; Kumud Dhital; Manisha Sahay; Srinagesh Simha; Radha Sundaram; Rahul Pandit; Raj K Mani; Roop Gursahani; Subash Gupta; Vivek B Kute; Sunil Shroff

doi:10.5005/jp-journals-10071-24198

Organ Donation after Circulatory Determination of Death in India: A Joint Position Paper

Indian J Crit Care Med. 2022 Summer;26(4):421-438. doi: 10.5005/jp-journals-10071-24198.

Authors

Avnish K Seth¹, Ravi Mohanka², Sumana Navin³, Alla Gk Gokhale⁴, Ashish Sharma⁵, Anil Kumar⁶, Bala Ramachandran⁷, K R Balakrishnan⁸, Darius Mirza⁹, Dhvani Mehta¹⁰, Kapil G Zirpe¹¹, Kumud Dhital¹², Manisha Sahay¹³, Srinagesh Simha¹⁴, Radha Sundaram¹⁵, Rahul Pandit¹⁶, Raj K Mani¹⁷, Roop Gursahani¹⁸, Subash Gupta¹⁹, Vivek B Kute²⁰, Sunil Shroff²¹

Affiliations

¹ Manipal Organ Sharing and Transplant (MOST), Manipal Hospital, New Delhi, India.
² Department of Liver Transplant and HPB Surgery, Reliance Foundation Hospital, Mumbai, Maharashtra, India.
³ Independant Consultant.
⁴ Apollo Hospitals, Hyderabad, Telangana, India.
⁵ Department of Renal Transplant Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
⁶ Ministry of Health and Family Welfare, Government of India, New Delhi, India.
⁷ Department of Pediatric Intensive Care, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India.
⁸ MGM Healthcare, Chennai, Tamil Nadu, India.
⁹ University of Birmingham, United Kingdom and Apollo Hospitals, Navi Mumbai, Maharashtra, India.
¹⁰ Vidhi Centre for Legal Policy, New Delhi, India.
¹¹ Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India.
¹² Department of Heart and Lung Transplantation, SS Sparsh Hospital, Bengaluru, Karnataka, India.
¹³ Osmania Medical College and Hospital, Hyderabad, Telangana, India.
¹⁴ Department of Palliative Care, Karunashraya, Bengaluru, Karnataka, India.
¹⁵ NHS Blood and Transplant, Scotland, United Kingdom.
¹⁶ Fortis Hospital, Mumbai, Maharashtra, India.
¹⁷ Department of Critical Care and Pulmonology, Yashoda Super Specialty Hospital, Ghaziabad, Uttar Pradesh, India.
¹⁸ Department of Neurology, PD Hinduja National Hospital, Mumbai, Maharashtra, India.
¹⁹ Max Centre for Liver and Biliary Sciences, New Delhi, India.
²⁰ Department of Nephrology, Institute of Kidney Diseases and Research Center, Dr HL Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, Gujarat, India.
²¹ Madras Medical Mission, Chennai, Tamil Nadu, India.

Abstract

Organ donation following circulatory determination of death (DCDD) has contributed significantly to the donor pool in several countries. In India, majority of deceased donations happen following brain death (BD). While existing legislation allows for DCDD, there have been only few reports of kidney transplantation following DCDD from India. This document, prepared by a multidisciplinary group of experts, reviews international best practices in DCDD and outlines the path for DCDD in India. Ethical, medical, legal, economic, procedural, and logistic challenges unique to India have been addressed. The practice of withdrawal of life-sustaining treatment (WLST) in India, laid down by the Supreme Court of India, is time-consuming, possible only in patients in a permanent vegetative state, and too cumbersome for day-to-day practice. In patients where continued medical care is futile, the procedure for WLST is described. In controlled DCDD (category-III), decision for WLST is independent of and delinked from the subsequent possibility of organ donation. Families that are inclined toward organ donation are explained the procedure including the timing and location of WLST, consent for antemortem measures, no-touch period, and the possibility of stand-down and return to the intensive care unit (ICU) without donation. In donation following neurologic determination of death (DNDD), if cardiac arrest occurs during the process of BD declaration, the protocol for DCDD category-IV has been described in detail. In DCDD category-V, organ donation may be possible following unsuccessful cardiopulmonary resuscitation of cardiac arrest in the ICU. An outline of organ-specific requisites for kidney, liver, heart, and lung transplantation following DCDD and techniques, such as normothermic regional perfusion (nRP) and ex vivo machine perfusion, has been provided. The outcomes of transplantation following DCDD are comparable to those following DBDD or living donor transplantation. Documents and checklists necessary for successful execution of DCDD in India are described.

How to cite this article: Seth AK, Mohanka R, Navin S, Gokhale AGK, Sharma A, Kumar A, et al. Organ Donation after Circulatory Determination of Death in India: A Joint Position Paper. Indian J Crit Care Med 2022;26(4):421-438.

Keywords: Circulatory death; Donation; Organ donation.