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Cadaver organ donor transplants: Procedure
Cadaver organ donors are victims of severe head or brain injuries, accidents or brain haemorrhage due to severe hypertension or malformations of blood vessels in the brain, who have been declared brain-dead by a panel of doctors other than transplant specialists.

Such patients are found only in the Intensive Care Units of hospitals. They are comatose, artificially kept alive by a respirator and are unresponsive to both pain and stimuli. “Brain function is nil,” says Dr. Harischandra. “Their condition is irreversible and brain damage is permanent. Although their heart is beating, they are dead.”

The functions of transplantable organs are maintained temporarily and if the brain-dead person’s next-of-kin, be it the father, mother, brother, sister or wife after an intensive session of counselling consents, the organs (in Sri Lanka only the kidneys so far), are harvested and transplanted in those in need.

Do we get brain-dead people often? Such brain dead people are not rare, according to Dr. Harischandra. “Every month, one or two people are found like this in a hospital. But, of course, all cannot be used for the transplant programme.”

When neurologists declare a person brain dead, the transplant team will evaluate whether the patient is suitable for organ harvesting, checking out whether he/she is reasonably young and has no infections such as hepatitis and HIV. “The time factor is extremely important because the brain-dead patient’s heart will stop within 24-48 hours and we have to act within this time. Ventilation needs to be maintained as the organs may begin to perish,” he says.

“Then we bring the patient from the ICU to our theatre and in a routine operation, remove the kidneys and place them in a preservative solution that is 40C cold. In some cases the doctors have only a few minutes to work because the heart stops and we have to massage it to keep the circulation going until we can harvest the kidney. If the blood to the kidney stops, it will pack up,” he explains.

Referring to the law, Dr. Harischandra says they are governed by the Transplant Act of 1987 under which permission has been given to perform cadaver organ donor transplants. “I also get permission in writing from the Ministry of Health.”

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