Byline: Avnish. Seth, Twinkle. Singh

Background: A need was felt to have a simple scoring system for the objective assessment of hospitals for preparedness for donation after brain death (DBD). Materials and Methods: Eighteen tertiary care transplanting hospitals in India were scored on 20 parameters (Seth-Donation of Organs and Tissues [S-DOT] score). An independent observer scored each parameter as 2, 1, or 0 with a maximum score of 40. The loopholes in organ donation (OD) were addressed by monthly interactions and hospitals re-assessed at 6 months by the same observer. Statistical analysis was performed with the Wilcoxon signed-ranks test. Results: The median S-DOT score at baseline was 13.5 (range 3-33). On correlating baseline score with donations over preceding 4 years, 1 hospital with score >30 (good) had 17 donations, 8 hospitals with a score 15-29 (satisfactory) had 19 donations, whereas none of the 9 hospitals with score <15 (unsatisfactory) had a donation. After 6 months, S-DOT score improved for all hospitals to a median of 23.5 (range 4-37) with a median increase of 6.7 (range 1-22), P 30 had 6 donations, 9 hospitals with score 15-29 had 7 donations whereas none of the 5 hospitals with score 30 was frequently associated with OD, while a score <15 could consistently identify hospitals that did not have any donation.

Introduction

It is estimated by the WHO that 135,860 organ transplants were carried out in 2016 worldwide from deceased and living donors.[1] This number, however, caters to only 10% of the estimated requirement. There are close to 27,000 deceased donors annually, the majority being a result of donation after brain death (DBD).[2] Donation after circulatory death (DCD) constitutes significantly to the donor pool in some countries such as Spain, the US, and the UK. India follows an opt-in system for organ donation (OD) and majority of deceased donors are DBD. Even though the Transplantation of Human Organs Act was passed in 1994, there was very little deceased OD activity for several years. The revision in the Act in 2011 and the Rules of 2014 brought about much-needed change including the mandatory declaration of brain death (BD). OD rate has doubled over the past 5 years to 0.65 per million population in 2018. Data from the National Organ and Tissue Transplant Organization indicate that a total of 875 individuals donated their organs in 2018. Deceased OD now accounts for >32% of liver transplants and 15% of the kidney transplants in the country. While there is the reason for optimism, it is estimated that <5% of patients who need a transplant actually manage to get one.[3],[4],[5],[6],[7],[8]

There are three arms to a successful OD program, namely suitable legislation, an aware population and a robust medical system. Even as the first two components have now been addressed fairly, there is a systematic failure of recognition or declaration of BD in critical care units (CCUs) across the country. The critical care teams, often untrained or poorly motivated, are reluctant to go the extra mile to ensure donor...