December 2012 | Jai Wadia

Life after death

Supported by the Navajbai Ratan Tata Trust, the Mohan Foundation is doing sterling work to save lives by facilitating organ donations and training transplant coordinators

S Ravichandran, a 47-year-old marketing executive in Chennai, met with a motorbike accident and suffered severe head injuries. When he was declared brain dead, doctors at the Rajiv Gandhi Government General Hospital (RGGGH) and the transplant coordinator from the Mohan (Multi Organ Harvesting Aid Network) Foundation counselled the family to consider donating Mr Ravichandran’s vital organs.

The victim’s family had to decide quickly because once the heart comes to a stop the organs cannot be used. Their agreeing to donate his organs saved the lives of five people — a patient dying of lung failure, another in desperate need of a heart transplant, a third who required a liver transplant and two others who needed kidney transplants.

Mr Ravichandran’s father, KM Sabarathnam, would say later that support and help from the transplant coordinator (TC), trained and placed at the hospital by the Mohan Foundation, helped him to take the painful yet ultimately gratifying decision.

Started in November 1996, the Mohan Foundation is a public charitable trust that facilitates organ donation from cadavers or brain-dead patients. The Foundation, headquartered in Chennai, works closely with RGGGH, government officials from the Tamil Nadu Cadaver Transplant Programme and other public and private hospitals in Chennai.

The need
Organ transplants are crucial to people suffering from kidney, liver and heart failure; about 210,000 people in India are diagnosed with kidney failure every year, but only about 3,000 kidney transplants are undertaken annually.

In 1994, the Government of India passed the Transplantation of Human Organs Act to broaden the concept of organ donation and stop commercial transactions in them, especially kidneys. The Act also recognised brain-dead individuals as dead and allowed the transplantation of kidneys, heart, liver, and lungs. Later, it was mandated that all transplant centres in the country must have a TC (proper and timely coordination is a crucial aspect of any successful organ donation and transplantation programme).

Dr K Deiveegan, professor of neurosurgery at Madras Medical College, explains the process: “A brain-dead person has a beating heart but there is complete loss of all brain stem reflexes.” Keeping the person’s heart and other organs functioning artificially with the help of a ventilator can only be done for a short period of time. Consequently, TCs have a small window of time in which to complete all the formalities. When the case of a brain-dead patient is reported, they immediately contact the family. Once the decision is made to donate the organs, they work to ensure that the process moves smoothly.

So far, the Mohan Foundation has trained 334 TCs and these professionals are attached to hospitals with transplant centres. The TCs are trained to handle cases of brain-dead patients in order to facilitate organ donation and transplantation in a positive environment. It’s part of their function to provide much-needed support to the donor family.

Along with knowledge of basic human anatomy, the TCs are taught counselling skills and kept abreast of legal and ethical issues concerning organ donation and transplantation. Training programmes typically last a week; more in-depth teaching involves month-long courses. The foundation also conducts public education programmes, networks with other organ procurement organisations and liaises with the government for favourable legislation in this sphere.

One of the big hurdles in organ donation is lack of awareness and inadequate infrastructure in hospitals. The conversion rate of organ donations from potential donors is low in India (less than one percent as compared to 25-30 percent in developed countries). Tamil Nadu, with 65 percent conversion rate, has the largest number of organ donors in the country.

The Mohan Foundation works to increase awareness through public rallies, brochures, newsletters, etc. It runs a toll-free helpline in English, Hindi, Telugu, Tamil and Kannada. As a result, in the past three years, close to 90,000 donor cards have been taken by potential donors.

The rapport factor
“It is difficult to motivate donor families but in most cases we have been successful,” says Sindhuja KR, who has been working as a TC for more than a year. Adds Dr Sumana Navin, a course director for the training programme: “What helps is that over the years the foundation has developed a good rapport with hospital staff and government officials.”

Says Prof J Amalorpavanathan, convener of the state-run Cadaver Transplantation Programme: “The Foundation serves as the key resource in the advisory committee formed by the Tamil Nadu government; it provides trained transplant coordinators and also helps maintain the organ allocation and waiting lists.”

The Mohan Foundation gets financial support from several corporate houses, but the TC training programmes conducted in Chennai and Hyderabad are supported by the Navajbai Ratan Tata Trust (NRTT). “The grant was given for a three-year period starting December 2009 and we have received a proposal to expand and extend the programme for another three years,” says Aneka Paul, senior development officer at NRTT and the Sir Ratan Tata Trust. “To the best of our knowledge, there is no other such training programme”.

Thanks to the foundation and the generosity of donor families, more people are getting a new lease of life — such as Sushma Shinde of Mumbai, who had a successful kidney transplant in August 2012. “I can look forward to having children,” she says.