Deceased Donor Organ Donation in a Developing Country; An Early Experience in a Tertiary Care Center in Sri Lanka

Abstract

Introduction The demand for organ transplantation in Sri Lanka, is limited to transplantation of kidneys and liver at present. Supply of organs is mainly met by live donors. However, there is a shortage of organs for transplantation while there is a significant wastage of potentially transplantable deceased donor organs. Deceased donor organ transplantation programs, although well established in some countries, is in its early stage in Sri Lanka. Present abstract shares the initial experiences on retrieval of deceased donor organs for transplantation received by the National Hospital, Sri Lanka (NHSL). Methods Records of all deceased organ donation offers from June 2016 to March 2017 were analyzed. Results For the stipulated 9-month period we have received 53 deceased donor offers. Of which, 36 (67.9%) were from tertiary care health institutions, 16 (30.1%) from secondary care institutions and 01 (2%) from a private institution. Majority of the deceased donors were males 32 (60.4%) with age ranging from 17 to 70 years (median 48 years). Of the donor offers received, 10 (18.8%) offers were rejected prior to consenting due to medical conditions of the deceased donor. Relations of 33 (76.7%) out of 43 potential deceased donors granted consent. Of them, 16 (48.4%) underwent organ retrieval. From the total of 16 retrievals, both liver and kidneys were retrieved from 2 (12.5%) donors, kidneys only from 13 (81.25%) donors and liver only from 1 (6.25%) donor. Organ retrieval was abandoned in 17 (51.6%) of the consented mainly due to sepsis (8, 46.9%). The rest of the donor offers (9) were rejected due to hypotension, low oxygen saturation and old age. Conclusion Even though the deceased donor organ donation and transplantation program is at its early stage in Sri Lanka, the attitude of the guardians seems to be appealing, as depicted by the consent rate. As per the present study findings, the maximum utilization of deceased donor offers was hindered due to issues in donor management, sepsis of the potential donors, lack of resources. Improving the awareness and attitudes among the public and the health care staff may improve the present status. Expanding the initiative as a multi-centric network with a central coordinating mechanism based in NHSL may improve the outcome and maximum utilization of deceased organ donation.