Living donations of dying patients

[okarol]

Living donations of dying patients

Sunday December 27 , 2009

A team of dedicated doctors raced against time to perform a trailblazing multi-organ-and-tissue-donation operation, running between Ratnaprua where a donor was dying and Kandy where two patients waited with hope for new kidneys. Kumudini Hettiarachchi reports

It was by chance that Anaesthetist Dr. Haresh Senaratne took over duty at the Intensive Care Unit of the Ratnapura General Hospital. His colleague who was assigned to the ICU was expecting a baby and would be vulnerable as there had been a suspected H1N1 patient the previous day. So Dr. Senaratne readily agreed to take over.

When he walked into the ICU, he found that two people were brain dead – a soldier and a mother of four daughters. Immediately, the realization dawned that if all procedures could be attended to, some of their organs could be harvested for the desperately ill, to give them a new lease of life.

The soldier’s case history ruled out the possibility of organ donation but the woman turned out to be a potential donor. Tragically, the 54-year-old woman, a worker on a rubber estate, and her youngest daughter had been struck by lightning when they were in the kitchen of their home. The woman had been unconscious when brought to hospital but the girl had been treated and discharged.

The tedious procedure then began, with Dr. Senaratne as the pivot, to coordinate the multi-organ and tissue donation where time is of essence, especially when harvesting the kidneys as the brain-dead patient has to be kept on the ventilator until then.

Although this cadaver donation of kidneys was a first under the National Organ Donor Programme launched last March, for Dr. Senaratne, however, this was nothing new. He had coordinated two others earlier – at Sri Jayewardenepura General Hospital (See box) and Asiri Surgical Hospital in Colombo.
In the latest multi-organ and tissue donation, made possible with the support of Ratnapura Hospital Director Dr. K.M.D. Dharmapriya and many others, Dr. Senaratne speaks of the “difficult task” of breaking the bad news to the woman’s daughters that their mother was dead.

The daughters, ranging in age from 14 to 22 years, from a humble home in Kuruwita, had just become orphans, as their father too had died 10 years before. Gently Dr. Senaratne counselled one daughter and a relative about the mother’s situation while also pointing out the immense service they could render by donating her organs and tissues. But he did not rush them, suggesting that they go back home and discuss the possibility of organ donation, for he did understand that for the daughters it was “an emotional rollercoaster ride”.

Once they mulled over it and came back with a very loud “Yes”, the procedural wheels had to be turned quickly. “When I received a call from Dr. Senaratne about the possibility of harvesting two kidneys and other organs I got in touch with both the Colombo and Kandy Transplant and Dialysis (Nephrology) Units,” says the Chairman of the Kidney Transplant Support Foundation, Ajit F. Perera.

It was this foundation that launched the National Organ Donor Programme in collaboration with the Health Ministry and the National Kidney Foundation and works with the Colombo, Sri Jayewardenepura and Kandy units.

Consultant Transplant Surgeon Dr. P.K. Harischandra and Consultant Nephrologist Dr. Tilak Abeysekera of the Kandy Unit took up the challenge without hesitation and agreed to harvest the kidneys from Ratnapura, while finding two patients in need of donations, the Sunday Times learns.

Dr. Harischandra rushed to Ratnapura with his team on December 4 and hurried back to Kandy, while the two recipients were prepared for the transplant in Kandy. This would have been a test in stamina for Dr. Harischandra, for not only had he to do the journey down to Ratnapura and back to Kandy but also use his skill to harvest the woman’s kidneys and then transplant them back in Kandy, the Sunday Times understands.

The Human Tissue Bank under Manager W.O. Hemaka de Mel, meanwhile, harvested the eyes, long bones including the Patella tendon (at the knee joint), facia lata (the dense tissue on the underside of the thigh) and the Achilles’ tendon.

The bones are used to get bone chips for orthopaedic surgery while the facia lata is used in plastic surgery, it is understood. This was a team effort and we appreciate the contribution of Ratnapura Hospital Director Dr. Dharmapriya, Consultant Anaesthetist Dr. Sriya De Silva, the ICU staff, the JMO, the Coroner and the hospital Police Post officers, said Mr. Perera, adding that the foundation lauds Dr. Senaratne “for his selfless commitment in working late into the night and in the morning, overcoming volumes of red tape and coordinating the whole process. Sri Lanka needs doctors of this calibre”.

Now although the mother is no more, the daughters know that she lives on forever somewhere, someplace in Sri Lanka as her kidneys have given a new lease of life to two women -- a 21-year-old and a 50-year-old.

Helpline

The Kidney Transplant Support Foundation may be contacted at: No. 465/24, Ranasinghe Mawatha, Pepiliyana. Tel: +94-112-824373/+94-115-553890/1; Fax: +94-112-824373 or Mobile:
+94-722-247236.

Pathbreaking operation

The multi-organ and tissue donation at the Sri Jayewardenepura Hospital on June 17, 2006 to my knowledge may have been the first in Sri Lanka, says Dr. Senaratne.

With the support of Consultant Physician Dr. Anula Wijesundera, Prof. Mandika Wijeyaratne of the Faculty of Medicine, University of Colombo had harvested both kidneys. Meanwhile, Human Tissue Bank personnel under Manager de Mel had harvested the eyes, long bones and facia lata while the spleen and liver had also been taken for post-graduate study purposes.