Cadaveric transplantation: A ray of hope for patients

Brain death is also known as brainstem death. Brain stem is the most important part of our brain. It controls vital parts of human body including heart, lungs and other organs. Brain death is the permanent, irreversible, and complete loss of brain function which may include cessation of involuntary activity necessary to sustain life. A cadaver is a dead human body. Cadavers are used by medical students, physicians and other scientists to study anatomy, identify disease sites.

Cadaveric transplant refers to multiple organ procurement through a surgical procedure by which organs of a brain-dead donor are taken for transplantation. We inaugurated The Sarah Islam Cadaveric Transplant Cell named after Bangladesh’s first cadaveric organ donor Sarah Islam at the Bangabandhu Sheikh Mujib Medical University recently, located in room 400 (cabin block). The young girl, Sarah Islam, scripted history through her posthumous organ donation on January 18.

20-year-old Sarah proved that. Despite her death, her gift of organ donation has brought new life to two kidney patients and two ophthalmological patients in the country’s first cadaveric kidney transplant – the process of transplanting kidneys from a brain-dead person.

Doctors began the separate surgeries after the donor Sarah Islam’s declaration of death. A team of surgeons led by Dr AKM Khurshid Alam conducted the transplant at Kidney Foundation, while Dr Habibur Rahman supervised the transplant at the BSMMU. Sarah Islam was diagnosed with tuberous sclerosis, a rare genetic disease, when she was only 10 months old. She recently underwent a brain surgery at a private hospital and subsequently was admitted to the ICU of BSMMU as her condition deteriorated.

Sarah’s mother Shabnam Sultana, said her daughter suffered a lot. “When she was a kid, everyone was afraid to see the tumours on her face. She often cried a lot after returning from school as other kids refused to sit next to her at classes.” Sarah fought the disease for almost 19 years. Even with the ailment, she passed her Secondary School Certificate (SSC) and Higher Secondary School Certificate (HSC) with distinction and got admitted to the Fine Arts Department at University of Development Alternative (UDA). She was a first-year student at the university. She was truly a gifted child.

Sarah was aware that she would not live long. At her sickbed, Sarah said she wanted to donate her organs after death. She had said, ‘Ma, you can donate everything of me for research.’ Sarah wished for her brain to be used in research. We decided that Sarah’s parents will be invited to all functions of BSMMU, and the family members will get lifetime free treatment here. In Bangladesh, around 2 crore people are suffering from kidney diseases and many of them die without receiving a transplant due to a lack of donors. Experts now call on the relatives of the brain-dead to come forward and save the lives of those in need.

Organs such as kidneys, hearts, lungs, livers, pancreases, and esophagi can be transplanted after a person is declared brain-dead. The Cadaveric National Committee works to guide, monitor, and advise on such organ transplantations. Before Sarah, we failed to convince a number of such cases for organ donations. But we continued the effort and succeeded eventually. We need shaping awareness and removing prejudices and misconceptions among the population regarding organ donation. According to the Human Organ Transplantation Act, kidneys of close relatives including parents, children, siblings, spouses, and extended family members such as grandparents, aunts, and cousins can be collected for transplant. The first kidney transplant in Bangladesh was performed in 1982, and around 3,500 transplants have been conducted so far. But doctors estimate that the country requires at least 5,000 kidney transplants per year.

A human uses only 60 per cent of a kidney’s capacity till 90 years of age. People step back from organ donation as they are less aware of the facts related to it. The biggest achievement in one’s life would be to save another life and to bring happiness to a family.

Somehow, whenever the issue of organ transplant comes up, people will instantly recall the name of Sarah Islam. From her deathbed, 20-years-old Sarah had told her mother about her wish to donate her organs to others. The country’s physicians have transplanted both of her kidneys and two corneas on four different people. With this, physicians of Bangabandhu Sheikh Mujib Medical University (BSMMU) and private organisation Kidney Foundation have first transplanted organs of a person, declared ‘brain dead’.

Sarah truly was a divine child. Wherever she went, she enchanted everyone with her behaviour. Sarah was diagnosed with incurable disease tuberous sclerosis at the age of just 10 months. One of the kidneys has been transplanted in the body of a kidney patient at BSMMU. The other kidney was taken to Kidney Foundation from BSMMU and was transplanted in a woman’s body there. Besides, both of Sarah’s corneas were transplanted in the eyes of two people.

Till now, kidney transplants have happened between close relatives in the country. But, kidney of a close relative isn’t always available. For several years, specialist physicians have been talking about transplanting kidneys of a person with no hope of survival. There are procedures and laws for these types of issues.

Organ donations save lives, there is no doubt about that. However there is an ongoing shortage of organ donors, that’s why living donors play such an important role. Sarah has shown us how to defeat death and stay alive with honour even after death. To me, she is a torch-bearer of humanity. The name of the first ever organ donor of the country, Sarah Islam will be immortalized. This sacrifice of her will create awareness among people. Many people will get a new life.

The writer is Vice-Chancellor of Bangabandhu Sheikh Mujib Medical University (BSMMU).

He can be contacted at skmahbubdt@gmail.com