Wednesday, May 12News That Matters

Editorial- February

Death is inevitable and it is certain. It becomes powerful gift, once anyone is able to save others’ life by donating organs after death. Manusmriti clearly mentions donations as sacred approach and among donations, donation of own body as infinitely worthwhile. Donation of organs is need of time as many people die due to organ failures or, many of organs face decline in quality after death before transplantation. The process of transplantation of organs is needed to be very quick after death. Declaration of death becomes important as waiting too long brings decline in quality of organs. Recently on January 28, in issue of The New England Journal of Medicine, Dhanani et al. collected data of 631 patients from 20 intensive care units from three countries for an observational study to ascertain the death. They observed resumption of cardiac activity after withdrawal of life-sustaining measures through a computer program to capture and review heart rate, blood pressure, blood oxygenation level and respiratory patterns. ‘Flatline’ signals were reviewed in 480 patients. 67 patients exhibited stop and start patterns of heart. The longest stop was 4 minutes and 20 seconds before restarting and the longest duration of heart activity was noted 27 minutes. Most of cases showed duration for few seconds only after restarting of heart activity. Heart rate and pulse ceased together in 91 patients. None of these patients survived. Authors detail about the intermittent signals as expected one without cardiopulmonary resuscitation, but there was no returning of life.
They support the current practices of organ donation after 5 minutes of death declaration in case of circulatory death and respiratory cessation. Donation of organs becomes easier after declaration of brain death for patients, still having functioning heart. Even in case of circulatory death, new methods are applied to recondition the organs viz., in-situ normothermic recirculation or ex-situ normothermic regional perfusion to restore the flow of oxygenated blood. Such study is beneficial for organ donation points of view.