In the face of untimely deaths, a glimmer of hope emerges through the selfless act of organ donation. While the loss of a loved one is immeasurable, the potential to save numerous lives through organ transplantation offers solace to grieving families. However, due to prevalent myths, negative connotations, and a fundamental lack of information about the delicate procedure of organ transplantation, the reality of organ donation falls short of its promise globally.
While the concept is relatively new in Sri Lanka, a recent workshop held at the Teaching Hospital Peradeniya aimed to raise awareness and dispel misconceptions about this life-saving practice.
Recognizing the need for greater awareness, a group of dedicated individuals, including Dr. Arjuna Thilakaratne, Director of Teaching Hospital Peradeniya, Dr. Amali Jayasinghe, Organ Transplant Co-ordinator – Teaching Hospital Peradeniya, Professor Arinda Dharmapala, Professor in surgery – University of Peradeniya, Professor Rajitha Abesekara, Consultant Nephrologist – Teaching Hospital Peradeniya, Professor Bandula Samarasinghe, Consultant Surgeon – Teaching Hospital Peradeniya, Professor Saman Nanayakkara, Consultant Anaesthesiologist – Teaching Hospital Peradeniya, Professor Shenal Thagahagoda, Paediatric Nephrologist -, Teaching Hospital Peradeniya, Dr. Senani Samarasinghe, Consultant Anesthetist in transplant Anesthesia and intensive care – Teaching Hospital Peradeniya, Dr. Buddhika Dasanayake, Consultant hepatobiliary surgeon – Teaching Hospital Peradeniya organized a consultation workshop on organ transplantation on January 4, 2024, at the Peradeniya Teaching Hospital auditorium. The workshop, brought together experts in the field to share their knowledge and experiences.
Dr. Arjuna Thilakaratne, Director of Teaching Hospital Peradeniya, in his welcome address, set the tone for the workshop, emphasizing the urgency of dispelling misconceptions surrounding organ transplantation. He highlighted the workshop’s focus on elucidating the intricacies of the process, fostering a deeper understanding, and encouraging a shift in public perception.
“While organ transplantation may be a relatively new concept in Sri Lanka, the need for it is undeniable. Workshops like this play a crucial role in raising awareness and demystifying this life-saving practice. By educating the public on the transplant process, its benefits for recipients, and the post-operative journey, we can dismantle prevalent misconceptions and ideologies that hinder organ donation. This program holds immense potential to encourage understanding and foster a more positive attitude towards this selfless act of giving.”
Professor M. D. Lamawansa, the Vice Chancellor of the University of Peradeniya and a pioneer in organ transplantation at Teaching Hospital Peradeniya, shared his invaluable experiences. He highlighted the critical need for organ donation, noting that many lives are lost due to a lack of available organs. Despite witnessing the positive impact on recipients’ lives, he lamented the low levels of organ donation, due to prevailing misconceptions and a general lack of understanding about the concept of brain death.
He disclosed the disparity in Sri Lanka’s approach to organ donation. While practices like cornea donation and bequeathing bodies for medical study are relatively common, organ donation after death remains significantly lower. He attributed this to two key factors: a lack of public understanding about brain death (the crucial neurological state when organs can be ethically harvested) and limited knowledge about the organ donation process itself.
He then contrasted this with the profound gratitude and joy expressed by transplant recipients, a sentiment echoed by his own satisfaction as a physician witnessing these life-saving outcomes. In light of this transformative potential, Professor Lamawansa expressed his sincere appreciation for the workshop and its aim to raise awareness and encourage participation in this selfless act of giving.
The workshop unfolded with enlightening sessions, starting with Professor Arinda Dharmapala who provided a historical context to organ transplantation and an introduction to it.
Professor Dharmapala went into the extensive history of organ donation, including artwork from the 1400s. He cited a well-known 1495 piece depicting Saints Cosmas and Damian undertaking an organ transplant to demonstrate the concept’s prevalence in Western art history. He also showed comparable depictions in Sri Lankan art, where several pieces depict animals with switched body parts, implying a parallel cultural connection with the notion of organ donation even in ancient Sri Lanka.
He elaborated on the range of organs and tissues suitable for donation. Among organs, he listed hearts, lungs, kidneys, livers, intestines, and pancreas. Additionally, various tissues can be donated, including corneas, skin, heart valves, bones, blood vessels, ligaments and tendons, cartilage, and nerves.
While kidney and liver transplants are prioritised in Sri Lanka, it is worth noting that the country’s first heart operation was successfully completed in 2017 at the Kandy National Hospital.
Sri Lanka currently witnesses roughly 5 – 10 patients, seeking organ transplantation procedures abroad. These overseas ventures incur enormous expenditures, ranging between 100 and 150 lakhs, reflecting a significant financial outflow from the country. This highlights the potential economic benefits of increasing domestic organ donation, as a robust supply within Sri Lanka could eliminate the need for costly foreign procedures. Fortunately, the nation has already established a strong legal framework that readily facilitates seamless organ transplantation processes.
Despite having the necessary legal framework, readily available specialists, and dedicated transplant centres (such as MOH Ragama, Colombo, Kandy, Peradeniya, and the proposed North Colombo Liver Centre), DDT (deceased donor transplantation) remains significantly lower than live donations, according to Professor Dharmapala. While live donation is a vital alternative, it involves inherent danger to the donor, making DDT preferable from an ethical and safe aspect. As a result, considering the enormous advantages and low donor risk, raising awareness and promoting DDT should be a key emphasis of Sri Lanka’s organ donation initiatives.
Dr. Buddhika Dasanayake, Consultant Hepatobiliary Surgeon at Teaching Hospital Peradeniya, shed light on the complex and delicate process of liver transplantation. From the initial diagnosis to post-operative recuperation, he informed the audience that every precaution is taken to protect the safety and well-being of both the donor and the receiver. This includes the initial diagnosis of transplant need, as well as open communication with patients about both the advantages and potential hazards. The thorough method covers the whole recovery trajectory for live donors. In the event of a dead donor, the legal framework and ethical factors are given careful consideration. Organs are obtained only when a panel of independent physicians confirms brain death and with the informed agreement of legal guardians.
Professor Rajitha Abesekara, Consultant Nephrologist at Teaching Hospital Peradeniya emphasized the critical need for organ donation in Sri Lanka.
Sri Lanka faces a significant public health challenge with the high prevalence of Chronic Kidney Disease (CKD). Aside from Chronic Kidney Disease, Sri Lanka faces a grim reality in terms of liver and lung failures, which are mostly due to the increased incidence of smoking, alcohol, and drug addiction.
When it comes to CKD, this progressive and irreversible decline in kidney function severely impacts lives and demands effective treatment options. While dialysis, in its hemodialysis and peritoneal dialysis forms, provides temporary relief, kidney transplantation is a better option. Prof. Rajitha Bandara emphasises the benefits of transplantation in terms of cost, patient mobility, and overall quality of life, stating that it has the potential to provide a thousand fold improvement over dialysis.
As a result, increasing organ donation becomes critical to meet the demands of these patients and provide them with a much better life.
Two primary pathways exist for organ donation: live donation and deceased donation. While live donation, often involving family members, is more common, it poses unique challenges. Compatibility issues or pre-existing health conditions in potential donors may limit its feasibility. Ethical dilemmas can also arise, particularly in situations involving altruistic donations where motivations and potential risks to the donor require careful consideration.
Given these constraints, a deceased donor (brain death) donating appears to be the best option. Organs extracted from brain-dead patients with the legal approval of their families by certified medical experts provide a conveniently available supply for transplants while minimizing dangers to living persons.
The workshop also addressed the ethical considerations surrounding organ donation. Dr. Senani Samarasinghe, Consultant Anesthetist in Transplant Anesthesia and Intensive Care at T.H. Peradeniya, discussed the care provided to organ donors in the ICU, emphasizing the importance of a transparent and respectful process.
Dr. Senani went through the complexities of caring for organ donors in the ICU. She highlighted the painstaking labour of committed medical experts who operate under strict legal guidelines to get the best possible results. Whether for live or deceased donors, their focus is on upholding donor welfare and maintaining open communication with families throughout the process.
She emphasized the crucial fact that not all deceased people are qualified to donate their organs, highlighting the significance of careful medical evaluations and formal legal processes. This transparent approach fosters trust and ensures ethical practice in this life-saving field.
A pivotal aspect introduced by Dr. Amali Jayasinghe, Transplant Coordinator at Teaching Hospital Peradeniya, was the establishment of an organ donor register. The goal of this project is to simplify the legal procedure and increase the effectiveness and accessibility of organ donation. She highlighted the current limitations of organ donor registration, noting that it is primarily facilitated at Sri Jayawardenapura Hospital. However, she expressed exciting news that with this workshop, Teaching Hospital Peradeniya will be establishing a dedicated organ donor registry. This means individuals over 21 years old can now register as organ donors at either hospital.
In her explanation of the benefits of maintaining an accurate organ donor registry, Dr. Jayasinghe emphasised that a centralised system would speed up legal processes and reduce waiting periods for patients in urgent need of transplants. Donor data that is easily accessible makes the matching process more effective and, eventually, saves more lives.
She then focused on the potential of deceased donor (brain death) donations, urging the audience to move beyond negative misconceptions and consider the immense benefits this option offers. She underlined the need to treat those who have been deemed brain-dead by strict rules with the highest respect and care. Two senior specialists independently assess and confirm brain death before any further discussion takes place. The transplant coordinator then acts as an impartial mediator, openly discussing the situation with the family and the medical staff to come to a mutual decision about organ donation. This careful procedure guarantees moral behaviour and fosters confidence among all parties involved.
The event’s climax witnessed notable figures, including Rev. Wellawatte Seelagaveshi Thero, Dr. Arjuna Thilakarathna, and Prof. Arinda Dharmapala, symbolically registering as organ donors. This inspiring gesture prompted many attendees to follow suit, signifying a collective commitment to the cause.
Lending further credence to the workshop were esteemed guests like Dr. Kumudu Bandara, Deputy Director of Teaching Hospital Peradeniya, and Prof. Wasanthi Pinto, Dean of the Faculty of Medicine, University of Peradeniya. Adding gravitas were luminaries like Prof. Bhadra Hewawitharana, Prof. Udaya Ralapanawa, Dr Thilak Abesekere, Consultant Nephrologist, Consultant Dr. Jeewantha Rathnayake and Consultant Dr. Chulanga Wickramasinghe, and Consultant Psychiatrist Dr. W.A.L. Wickramasinghe, President of Nivahana Society of Kandy.
Death is unfortunate and unexpected, yet we all know that to be born is to die. This workshop resonated with the poignant message that, though death is inevitable, the act of organ donation can extend a lifeline to those in need. Organ donation is a gift, that can be a final act of generosity upon deathbed even. By raising awareness, dispelling myths, and encouraging people to register as donors, Sri Lanka can make a significant difference in the lives of countless individuals facing organ failure. More importantly, humanity can embrace the generosity of organ donation and collectively strive to make the world a better place, one life at a time. Organ donation where the donor is both treated with the utmost respect and blessed and the receiver feels saved and relieved to be able to live another day without less struggle is truly a feat humanity has achieved and it is best to support it as humans with conscience.