 Well, health is a very important part of our aspect and we have between us Dr. Rinaun, Dr. Rajay and Shridhara Shetty. I would like to give a small introduction about him. He has a lot in his kitty. I hope I can do justice here. He is a senior consultant, urologist from the robotic surgeon and a specialist in renal transportation. With more than 15 years of experience he is working currently as a lead consultant in the head of department in urology in multiple hospitals. His main area of expertise is in the field of renal transplantation. He has been performing life donor and disease donor renal transplantation since the last 15 years. He is also passionate about laparoscopic and robotic surgery. Furthermore he has a lot of publications to his credit in national and international journals. He is a master trainer in healthcare communications and has also conducted several workshops for healthcare professionals at national levels. I now welcome Dr. Rajay Shetty to please share his thoughts. Thank you. Good afternoon to you all. Thank you Ganesh for this opportunity to talk to all of you about this life-saving, life-transforming endeavor that is very poorly understood and very poorly adopted in our country. I decided on this occasion I will give you a perspective on organ donation and how dismal the situation is for patients and their families who are waiting for organ donation. I am Dr. Rajay Shetty, lead consultant urologist and a robotic surgeon. I have been doing kidney transplants for the last 15 years and currently I work out of Manipal hospitals, Yashvanpur and Hebal. Let me just get this going by giving you an index case of what usually happens. We had a 35-year-old gentleman who came to us, who was referred to as in the hospital. Working in a startup the last one month he has been having severe headaches. When he came to us his blood pressure was 220 by 150, attributed the headaches to that. Further evaluation we found his kidney functions were completely in disarray. His electrolytes were all over the place he was diagnosed at that point to have stage 5 chronic kidney disease which is an equivalent of end-stage kidney failure. Completely unsuspecting out of the blue he gets this message and he is being counseled that the only way to proceed is to go on dialysis and now start looking for donors for organ transplantation to get back to normalcy. That's when all the trials and tribulations begin because the first thing is the parents stepped forward as donors and both parents had medical illnesses that precluded them from organ donation. He had only one sibling who was abroad and not very keen on donation. He was in a relationship but all that relationship status changes once the diagnosis was made so he was alone. So the first thing people like this do is register themselves on the waiting list for organ transplantation and to improve your chances you don't do it in one state, you go to the adjacent state whether donation rates are better, that's Tamil Nadu, put your name in there too and wait. He started with dialysis twice a week. Two years, three years down the line he was still waiting list number four. Dialysis had gone on to three times a week and one day bodily complications grew and he succumbed to the disease with a full-blown infection following dialysis. Now stories like this are not uncommon. You see similar stories in patients with liver failure, kidney failure and heart failure. Look at the numbers. Five lakh patients register themselves for organ transplantation every year in our country. Six to seven thousand people die waiting for organs to come their way and you can see kidney, heart, livers, how many are required and how many are actually available. So seven thousand deaths is an equivalent of 15 A380 air buses, double-decker air buses filled to capacity and crashing with no survivors all for the want of a single signature. It's downright depressing for us every day to see our patients wither away in front of us just because families refuse to donate organs. Now let's look at statistics. What are the organ donation rates all over the world? And when you say organ donation we talk about per million population. Spain is one of the highest all over. 46 or 47 per million population. Belgium stands at 38. The United States stands at about 32 per million population. Where do we stand? We are a population of one and a half billion right now and our donation rates are 0.86 per million population. Our current national policy is what is referred to as opt-in. In our country we are in the opt-in policy. US is in the opt-in policy. What does opt-in mean? Now if and when you decide that you want to be an organ donor you can go take that step and register yourselves as an organ donor and opt into the donation program. Spain on the other hand is opt-out. There are many countries like that including UK right now who follow this opt-out. Opt-out means that by default you are considered an organ donor and if you decide that you don't want to donate then you opt-out of the process. Now there are pros and cons for both. This is probably not the forum for that but this is where we stand right now. How many people die every year in our country? How many brain dead patients in our country? The statistics today is about one and a half lakhs. The vast majority of them come from road traffic accidents. Brain dead, brain dead while in the hospital or even at arrival. One and a half lakh patients die of brain death. Now if you look at how many of these patients have or families have agreed to donations. As for the latest statistics, this was about last year. We took the statistics from 2020. Out of the one and a half lakh patients we got only 1,100 donations. That's about 0.5 to 0.6%. Donation rates and this is the reason why patients die waiting for organs to come their way because the average waiting time to get a deceased organ is about 3 years. Now kidney failure guys can manage with dialysis. What about guys with liver failure, heart failure, heart lung failure? These guys, the clock is ticking and they don't know whether they will go on to the next day. Imagine the waiting list of 3 years, what they and their families are going through. Now let me just quickly define what organ donation is. Organ donation is a practice where we retrieve a human organ from either a living or a deceased donor and that is called as the donor and transplant it into another person who's suffering from organ failure, could be liver, kidney, pancreas, anything. And this person will not survive unless he or she receives that organ and that is the recipient. Now you know that there's a huge demand and there is barely any supply. What would that lead to? That's when you come into the realm of illegal trafficking of human organs, you must have heard of it. That's when you come into the realm of commercial dealings in transplantation whereby somebody pays somebody an X amount of money and takes an organ. So to regulate this whole process, the government of India in 1994 passed the transplantation of human organs and issues act. What they were trying to do was make this process a lot more regulated and transparent. They allowed, this is the main provisions of the act, they allowed transplantation of organs from both living and deceased donors. They recognized that brain stem death which is head injury, post-head injury, brain stem death is a form of death because previously one would say only if the heart stops you will be considered dead. But now to promote the whole philosophy of organ donation, they recognized that without brain activity and brain stem death you could consider it as a form of death and encourage people to donate. Obviously they made protocols and guidelines in place to certify brain death. And lastly set up a group of regulatory and advisory bodies to make this more transparent. For example, the appropriate authority. These guys go to hospitals and inspect the hospitals and see the infrastructure and grant their licenses. The advisory body is a group of domain experts who guide the appropriate authority. The authorization committee, for example, if I want to donate to somebody I take my papers with the recipients papers and we go to the authorization committee. They screen all the paperwork and make sure that I am who I said I am. Because a lot of times you can bring anybody and say this is my brother. So these guys are the people who actually go through all the paperwork and make sure that the process is transferred. Now when they said who can donate according to the Transplantation of Human Organs and Tissues Act we can take organs from a living donor or a deceased donor. Now who can donate in the living donor? The near related donors are one the wife, parents, siblings, children, grandchildren and grandparents. These are considered as near related and there the process is not too complicated. But can a friend donate? Can my neighbor donate? Can somebody who has been working with me for 20 years and has an emotional connect donate? Yes, even that is possible. But obviously that is after an intense scrutiny by the authorization committee. And as far as deceased donors go, we have two categories. The vast majority are people who have brainstem death, which I will give you to later. And cardiovascular death, which doesn't form a significant component. Because once the heart dies, it's a bit difficult to maintain circulation to all the critical organs. So those organs become suboptim. But with brain death, you can keep patients alive on artificial support and maintain circulation to all these critical organs. And how is that? Now, what organs can be donated? All of you I'm sure have heard of eye donation. That's something that most people are aware of. But these are the organs that can be donated. First, we have two kidneys. They can be donated. The liver, the heart, a pair of lungs, pancreas and intestine. So these are the organs that are critical that can be harvested for donation. So you can see one organ donor can save eight lives. Sometimes the liver can be split. It can even save nine lives. But one organ donor can save eight lives. Now, what about eye donation? Now, that comes in the realm of tissues, not organ. You can see when an eye is taken out for donation, it's not the entire eye that is transplanted. It's just the cornea. For patients with corneal blindness, it's the cornea that is taken out. And skin, skin can be used for patients who have burns. Again, dramatically changing their lives. Bones, veins, heart valves. These can all be used as grafts to improve outcomes of patients. Now, coming to this question, why is India's organ donation so low? Why do we stand at 0.86 per billion? There was recently this study done in 2022. This was done in North India in Haryana. Where they took a survey of a cross-section of population in a certain place and assessed them about three aspects. One, awareness. Two, attitudes to transplant in three perceptions. Just look at the numbers. When asked, are you aware that there is something called organ donation? Sixty percent were aware. Forty percent didn't even know that there is something called organ donation. Of the sixty percent that were actually aware. When you ask them, did you know that you can, as a living donor donate and as a diseased donor donate, twenty-five percent knew that organs can be harvested from brain and donors. Seventy-five percent didn't even know the concept of diseased donation. Then you educated them. Now you know. I've told you that there is a possibility of organ donation. Will you donate? Well, only twenty-seven percent were willing to donate. And of those, when you ask them why, sixty percent said, I don't want to donate because of religious reasons. My religion does not permit me to donate. Now, of those that were willing, twenty-eight percent reported that they would like the organ to go to the person of the same religion. So there are a lot of these attitudes and lack of awareness that is currently preventing organ donation and some of the other perceptions. Success rates are not good. My neighbor went for kidney transplantation. He survived only one year. I don't think this whole organ donation thing works. Why should I donate it? It's a waste. That's the perception. Now, transplant has phenomenal success rates in the current age. It is one of the major successes that we've had as far as organ medicine is concerned. It has the capacity to make a person fully functional, normal, like they were before they were sick. Look at the success rates. At the end of one year, a life donor success rate, patient survival was ninety-eight percent, kidney survival was ninety-four. Even disease donors, patient survival ninety-six percent, graft survival ninety-three. Let's look at five-year survival rates. Ninety-two percent and eighty-three percent for live and disease donor's respect. These success rates of the non-liver, the same kind of figures. So transplant, that concept that success rates of organ transplant is that is an absolute myth. One person denying an organ is actually denying lives to so many people. Now, let's look at some of the other myths and misconceptions because of which people don't donate. Now, we'll come to myth number one I will address in the end. Let's look at myth number two and three. I'm too old to be a donor. I have health problems. No one will want my organs. Common. I have diabetes. I do. They won't want my organ. But these are common misconceptions. There are diabetics who have donated. There are people with heart disease that have donated. Even HIV positive people have donated. And you can use those organs for HIV positive patients with organ failure. So you're not too old. You're not too ill to register yourself for organ donation. Please, the donors are charged for the cost of the donation. That is absolutely untrue. The donor family does not have to pay or bear the costs when the organs are being harvested. But this is a perception. My wills will go up if I decide I want to donate. Religion. We talked about it. My religion does not permit me to donate. Now, all major organized religions have no problem with organ donation. Anybody who is donating an organ is an altruistic donor. You are doing it to save lives. No religion is against it. And the only thing that I would suggest is you can go and speak to your spiritual advisor and your religion advisor and take their consent. Lastly, organs can be misused. Rich and powerful people will take my organs. The one who is truly deserving will not get it. There are waiting lists that are crucially monitored by the regional authorities, by the national authorities, and the process is extremely transparent. So this does not happen. Coming to width number one, this is something that we have a lot of people saying. Let's say somebody comes into a hospital with an injury. The only thing the hospital staff is interested in is to take the organ for transplant and they will not put their best efforts to save this patient. This is something too that is a perception, which is absolutely false. Hospitals and healthcare professionals put in all their best efforts to save patients. But sometimes you get patients with such bad injuries and one look at the CT scan, you know that this patient is brain dead. And you do all the tests to confirm. And it's not just you doing all the tests to confirm. The whole process of brain death has to have a panel of four doctors. And two of them are not from your hospital, they are from the government. They are nominated by the appropriate authority. So it's not just your hospital doctors that can declare brain death. They have two doctors coming from the government to certify brain death. They repeat the tests after six hours. Two consecutive tests confirming brain death is when that person is legally declared to be brain dead. So there is no scope, there is no way to work around this mechanism. And only after that second test happens does the transplant coordinator come in and start talking to the family. Now how we approach this is, it's a difficult time for the family. They gently break the news, have you heard of eye donation? And if they said yes, are you willing to donate the person's eyes? A lot of them say no, some say yes. The ones that say yes, then you approach the concept of organ donation to them and how the other organs can be harvested and can save up to eight to nine lives. This is the way hospitals work. Now if you as an organ donor have registered for organ donation and are carrying a card with you and we find that you have a card but the family, the next step in is still not willing to donate but you will cannot be done. Now let's say this whole process goes through what families have consented. We've seen families in the face of devastating loss agreeing to donate because they realize that this is the right thing to do and the only good thing to have come out of this horrible tragedy is the ability to gift organs to get somebody else to live. Families have said yes. Now once the process is through, these are the organs that you can retrieve and that's how long they survive. Once you have retrieved them, refuse them with preservative solutions keep them in ice, transplant, carry them in a sterile container and transport it to organs for patients on the way first. Earlier I saw a video on potential eye injury so hopefully you fainted here that's why I'm going to show you this slide. This is how the graft looks when you retrieve it, when you take it out of ice then you prepare the graft on table to identify the artery and the vein and dissect it and prepare it for harvest. That's the prepared kidney which will then be transplanted into the recipient you transplant, you connect the blood supply of that kidney to the blood supply going to the feet that's how the blood circulation gets. The red is the artery, the blue is the vein, that's the vein that's completed that's the artery in process and that's the artery completed. Once blood flow is established the kidney starts to produce to it and this patient typically stays in the hospital for five to seven days and once there's a good amount of urine output he goes back to his family free from viruses, free from all the burdens and expenditure going back to a fully functional normal lives. So today how can you help? Sign up as an organ donor today, how can you do that? Yes we have a stall outside, it will facilitate you but that's the website Orban India.org, it's an online form. Fill it up, you will get an organ donor card possibly in a month's time but remember this card only signifies intent, it does not carry any legal weight That's why it's so important that you tell your family and friends that I have opted to be an organ donor because tomorrow when the event something happens they should respect your wishes. A family is twice as likely to donate if they have heard it from you where they are, otherwise in that time most of the family is going to say no. Other things you can do is spread the word, tell people about it talk to people about organ donation, dispel all the myths and misconceptions that people have about organ donation and today's day and age most of the awareness comes from social media, social media is playing a huge role when it comes to organ donation awareness. Now just a quick show of hands, you all heard about transplantation, correct? Now the concept is, I think you are aware of the concept of blood groups that a B positive can donate to a B positive, right? Now how many of you sure of fans were aware that you can actually give your organs outside of the blood groups, can a A positive give a B positive? How many of you knew that this was possible, right? Did you know that? Okay, one hand. Now it is possible. Just recently we had this event whereby we conducted 27, we've done 27 so far ABO incompatible kidney transplant. Now this is currently in the kidney transplant, well not in the other organs but we've done about 27 at Mahipal Yashwankur and Hybal together, 27 was only at Yashwankur. It is possible to donate across the blood groups in centers that have the experience to do so. Now this release has reached out to a lot of people and now people are getting aware that okay, I didn't know my wife was B positive, I was A positive. All these days I thought I could not donate or my wife could not donate. Now they are aware that it is possible to go across the blood groups. So that's the whole social media place in these days to create awareness. So transplantation works, organ donations save lives. I urge all of you to be a part of this miraculous endeavor and thoughtfully consider registering yourself as a donor. Sorry to leave alone, I'm sure you can save about 2000 lbs. Thank you.