In November last, when the State government decided to follow the Spanish model in organ donation and to have the entire process coordinated in the intensive care units through dedicated transplant procurement managers (TPMs), it was a pro-active measure to breathe life into Mrithasanjeevani, the government’s deceased donor organ donation programme, which had been flagging since 2016.
Mrithasanjeevani is run with the involvement of private hospitals designated as transplant centres across the State. Though the GO on appointing TPMs had been sent to all registered transplant centres in the State, both public and private, only one private hospital chose to implement it. None of the government MCHs did.
The lone private hospital, a prominent transplant centre in the south, which appointed a TPM, is now leading the way in organ donation and demonstrating how a committed medical team and a supportive hospital administration can change the system.
“KIMS Hospital appointed a TPM in November last. His team has already done six deceased donations under Mrithasanjeevani — three in the last 10 days — by promptly identifying potential organ donors in their ICUs, counselling families and systematically moving the processes,” said Noble Gracious, Nodal Officer, Kerala Network for Organ Sharing. “It puts immense strain on the hospital but they have shown how a dedicated team to coordinate activities, right from maintaining the potential donor in the ICU to counselling the grieving families, can win the trust of the public and smoothen the donation process. We need to implement the system in our MCHs soon so that more lives can be saved,” he added.
Spain, the global leader
KNOS had recommended the TPM model to the government following interactions with its Spanish counterpart. Spain has been the world leader in deceased organ donation and it has been training several developing nations to emulate the model.
A TPM, essentially a neurosurgeon/intensivist working in ICUs, is expected to “provide clinical leadership within the hospital and to raise the value of organ donation”. His main task is to identify potential donors in ICUs, help conduct tests as required under law to confirm brain death and to ensure that the rest of the processes, including approaching families, is carried out in a professional manner.
“Earlier, the treating doctor used to be burdened with the task of conveying the sad news to the family and then presenting the option of organ donation. Brain death used to be under-reported in the ICUs as surgeons were under tremendous stress. Now, as soon as a potential donor alert is received from the ICU, my team takes over. It has been an intense yet rewarding experience,”said R. Muraleedharan, the intensivist and TPM at KIMS Hospital.
Counselling families
“We had counselled the families of 26 potential organ donors and six resulted in organ donations. Most families were willing but a lot of factors have to come together for a successful conversion,” he added.
It is a voluntary job, which a doctor is expected to do as part of his other ICU responsibilities and only a medical professional with some amount of social commitment can be a successful TPM. KNOS is now planning to organise training programmes for ICU staff with Spanish collaboration, so that more doctors would be encouraged to take on the role. “The public has no negative perceptions about deceased donations.
The right attitude of the medical professionals can bring down the trust deficit and help many families find the joy of giving, even in their grief,” said Dr. Gracious.