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Teen dies waiting for liver, gives life to two after death

Akansha, who aspired to be a doctor and had gone to Kota to prepare for the entrance test, was diagnosed with a hepatitis A infection which led to acute liver failure.

NEW DELHI: Akansha Joshi, an 18-year-old student with a failing liver, died last month waiting for a liver donor. But what she couldn't get during her last days, she gave away in death. The teenager became an organ donor whose kidneys saved the lives of two recipients. 

Akansha, who aspired to be a doctor and had gone to Kota to prepare for the entrance test, was diagnosed with a hepatitis A infection which led to acute liver failure. No matching donor could be found for a liver transplant and she died at the Institute of Liver and Biliary Sciences (ILBS). 

Doctors said when her parents were told about the prospect of donating Akanksha's organs, they immediately consented. "It is overwhelming. They had just lost their daughter but they overcame the grief to help others in need," said Dr S K Sarin, director of ILBS. 

The procedure, however, was a huge challenge. Usually, organs are harvested from brain-dead patients but, in this case, the procedure had to be conducted after cardiac death — when blood supply to organs stops and the time-window for harvesting is very small. 

Right after death, doctors quickly flushed the abdomen and arteries with ice to freeze the internal organs before. 

"Her blood pressure levels were very low and inconsistent as she slipped into death due to which brain death could not be certified. Two teams were kept on standby and within five minutes of cardiac death the retrieval process began," said doctors. 

While in a normal transplant the organs revive within hours of transplantation, organs retrieved after cardiac death take longer to revive. In this case, the doctors said, it took nearly 48 hours for the kidneys to revive in the two recipients, a 52-year-old male patient from Kota in Rajasthan and another 58-year-old man from Delhi. 

"One of them has been discharged and another is likely to be discharged in few days. Both patients are doing fine," said a member of the renal transplantation unit at ILBS. 

ILBS doctors said Akanksha, a resident of Kotdwar in Uttarakhand, diagnosed with hepatitis A while studying in Kota. Her condition deteriorated despite medical intervention necessitating liver transplant. 

"It is an irony that the girl could not get a donor herself but she gave life to others in death. Her kidneys have been used while her heart valve and cornea have been preserved for donation," said a doctor. 

More than two lakh Indians require organ transplantation annually. However, less than 10% are able to get this timely help. Although the number of organ donors and transplantations in India have increased significantly over the last decade, it is not sufficient. Medical experts say organ donation immediately after the heart stop beating can help increase the organ pool. Countries such as Spain, UK and Australia are already doing this. 

Aarti Vij, chief of the Organ Retrieval and Banking Organisation at AIIMS, said one of the common causes for refusal of organ donation is lack of awareness about the consequences of brain death — irreversible loss of brain functions. "Most families think their loved ones have a chance to recover till the heart is working. But if we can evolve standard operating procedures for retrieval of organs even after the heart beat stops, many such families may agree to donate," she said. 

The experts said kidneys and liver can be retrieved even after the loss of circulatory function, also referred to as cardiac death, from patients who are on a ventilator due to irreversible brain injuries.

http://timesofindia.indiatimes.com/photo/11350517.cms