The 27th Annual Conference of the Indian Society of Critical Care Medicine - CRITICARE 2021 was held virtually from 26th to 28th February 2021. Dr. Sunil Shroff, Managing Trustee, Mrs. Lalitha Raghuram, Country Director and Dr. Sumana Navin, Course Director, MOHAN Foundation were invited as faculty members for the conference.
A panel discussion on ‘Issues with organ donation in India’ was moderated by Mrs. Lalitha Raghuram. The panelists were Dr. Vivek Kute, Nephrologist, IKDRC, Ahmedabad, Dr. Apar Jindal, Pulmonologist, MGM Healthcare, Chennai, Dr. RMPL Ramanathan, Pulmonologist, KMCH, Coimbatore and Dr. Sumana Navin. Mrs. Raghuram gave an overview of deceased organ donation in India and spoke about the abysmal organ donation rate in the country which was less than 1 per million population. She said that MOHAN Foundation has been promoting organ donation awareness among doctors and conducting training programmes for intensivists and ICU staff. Mrs. Raghuram posed various questions to the panelists ranging from the key roadblocks to deceased organ donation in India and the role of intensivists to the impact of COVID-19 on transplantation and lung transplantation in particular.
Dr. Vivek Kute said that the Spanish model of Transplant Procurement Management (TPM) would be helpful in improving the deceased donation rate in India and that ISCCM, ISOT and TTS working together could aid in overcoming the barriers. Dr. Sumana Navin spoke about the need for national guidelines for disconnecting cardio-respiratory support in a brain death situation. Even though Kerala and Gujarat had issued Government Orders in this regard, it was evident that doctors needed further reassurance. There was a need for education and training of practitioners in certifying brain death and this was one of the recommendations of the World Brain Death Project. Dr. Apar Jindal said that lung transplantation was an option in a specific group of patients with COVID-induced lung injury with no foreseeable lung recovery. Dr. Ramanathan and Dr. Kute emphasised the key role intensivists played in declaring brain death and Dr. Jindal said that they also needed to be trained in donor optimisation. Mrs. Lalitha Raghuram wrapped up the panel discussion with a call for all stakeholders to work together and for intensivists to lead the way.
Dr. Sunil Shroff spoke on ‘Donation after Circulatory Death (DCD) - Procedures’. He said that DCD was definitely possible in India and that the law permitted it. DCD category IV (cardiac arrest in a patient who is brain dead) could be easily done if family consent for organ donation was already in place. With regard to DCD category III (cardiac arrest following planned withdrawal of life sustaining treatment), it was imperative that there be consensus in the team about withdrawal of treatment and the decision be delinked from organ donation. It was necessary to define ‘no touch time’ after asystole and formulate guidelines for withdrawal of treatment.
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