Debunking Organ Donation Myths and Concerns
Here are answers to some common organ donation myths and concerns.
Myth: If I agree to donate my organs, the hospital staff won’t work as hard to save my life.
Fact: When you go to the hospital for treatment, the health care team tries to save your life, not someone else’s. You get the best care you can get.
Myth: Maybe I won’t really be dead when they sign my death certificate.
Fact: This is a popular topic in tabloids. But, people don’t start to wiggle their toes after a health care provider says they’re dead. In fact, people who have agreed to organ donation are given more tests to make sure they’re dead than are those who aren’t donating organs. These tests are done at no charge to their families.
Myth: I’m younger than 18. I’m too young to make this decision.
Fact: Many states let people younger than 18 register as organ donors. But if you die before your 18th birthday, your parents or legal guardian will make the decision. If you want to be an organ donor, make sure your family is OK with your wishes. Remember, children, too, need organ transplants. They often need organs smaller than adult size.
Myth: People who donate organs or tissues can’t have an open-casket funeral.
Fact: Donors’ bodies are treated with care and respect. And they’re dressed for burial. No one can see that they donated organs or tissues.
Myth: I’m too old to donate. Nobody wants my organs.
Fact: There’s no standard cutoff age for donating organs. The decision to use your organs is based on the health of your organs, not age. Let the health care team decide at the time of your death whether your organs and tissues can be transplanted.
Myth: I’m not in the best health. Nobody wants my organs or tissues.
Fact: Very few medical conditions keep you from donating organs. Maybe you can’t donate some organs, but other organs and tissues are fine. Again, let the health care team decide at the time of your death whether your organs and tissues can be transplanted.
Myth: I’d like to donate one of my kidneys now. Can I do that if it’s not going to a family member?
Fact: Yes. Most living donations are between family members and friends. But you can choose to donate a kidney to a stranger, so long as you’re a match. A non-related donor need permission from the authorization committee(government body) established by state You also can donate other organs and tissues, such as a lung or part of a lung or liver.
If you decide to become a living donor, the health care team at the transplant center asks a lot of questions. They want to make sure you know the risks.
You’ll have tests to make sure you’re healthy and that the organ you want to donate is in good shape. The health care team also will want to be as sure as possible that the donation won’t damage your health.
Myth: Rich and famous people go to the top of the list when they need a donor organ.
Fact: The rich and famous are treated the same as everyone else when it comes to organ donation. True, famous people might get a lot of press after a transplant. But who they are and how much money they have don’t help them get an organ. A computer system and strict standards ensure fairness.
Myth: My family will be charged if I donate my organs.
Fact: The organ donor’s family never pays for donation. The donor family pays for all the medical care given to save your life before your organs are donated. Sometimes families think those costs are for the organ donation. But the person who gets the organs for transplant pays the costs for removing the organs.
Why you should think about donating organs
Now that you have the facts, you can see that being an organ donor can have a big impact. And your donation helps not just the person getting the organ. By donating your organs and tissue after you die, you can save up to eight lives and improve 75 more. Many families say that knowing their loved one helped others helped them cope with their loss.
How to donate
Becoming an organ donor is easy. Just do the following:
- Sign up with your state’s donor registry. Most states have ways to sign up at https://www.organindia.org/
- Mark your choice on your driver’s license. Do this when you get or renew your license.
- Tell your family. Make sure your family knows you want to be an organ donor.
Being on your state’s organ donation registry and marking your choice on your driver’s license or state ID are the best ways to make sure you become a donor. But telling your family also is important because hospitals ask next of kin before taking organs.
However, hospitals don’t need to ask for consent if you are 18 or older and are on your state’s donor registry or have marked your driver’s license or state ID card for organ donation.
If you have named someone to decide about your health care for you if you are not able to do so, make sure that person knows that you want to be an organ donor. You also can include your wishes in a living will if you have one. But the will might not be read right at the time of your death.
All about Thalassaemia
What is thalassemia?
Thalassemia (thal-uh-SEE-me-uh) is an inherited blood disorder. It affects your body’s ability to produce normal hemoglobin. Hemoglobin is a protein in red blood cells. It allows your red blood cells to transport oxygen throughout your body, nourishing your body’s other cells.
If you have thalassemia, your body produces fewer healthy hemoglobin proteins, and your bone marrow produces fewer healthy red blood cells. The condition of having fewer red blood cells is called anemia. As red blood cells serve the vital role of delivering oxygen to tissues in your body, not having enough healthy red blood cells can deprive your body’s cells of the oxygen they need to make energy and thrive.
How does thalassemia affect my body?
Thalassemia can cause mild or severe anemia and other complications over time (such as iron overload). Symptoms of anemia include:
Who is at risk for thalassemia?
The gene mutations that cause thalassemia arose in humanity as partial protections against malaria. So, thalassemia affects people who have ancestral links to parts of the world where malaria is prevalent, such as Africa, Southern Europe and West, South and East Asia. Thalassemia is inherited, which means the condition is passed from a biological parent to their child.
SYMPTOMS AND CAUSES
What causes thalassemia?
Hemoglobin consists of four protein chains, two alpha globin chains and two beta globin chains. Each chain — both alpha and beta — contains genetic information, or genes, passed down from your parents. Think of these genes as the “code” or programming that controls each chain and (as a result) your hemoglobin. If any of these genes are defective or missing, you’ll have thalassemia.
- Alpha globin protein chains consist of four genes, two from each parent.
- Beta globin protein chains consist of two genes, one from each parent.
The thalassemia you have depends on whether your alpha or beta chain contains the genetic defect. The extent of the defect will determine how severe your condition is.
What are the types of thalassemia?
Thalassemia is classified as trait, minor, intermedia and major to describe how severe the condition is. These labels represent a range where having a thalassemia trait means that you may experience mild anemia symptoms or no symptoms at all. You may not need treatment. Thalassemia major is the most serious form and usually requires regular treatment.
There are two types of thalassemia — alpha thalassemia and beta thalassemia — named after defects in these chains.
Alpha thalassemia
You inherit four genes, two from each parent, that make alpha globin protein chains. When one or more genes are defective, you develop alpha thalassemia. The number of defective genes you inherit will determine whether you experience anemia symptoms and (if so) how severe they’ll be.
- One defective or missing alpha gene means that you won’t experience symptoms. Another name for this condition is alpha thalassemia minima.
- Two defective or missing alpha genes means that if you experience symptoms, they’ll likely be mild. Another name is alpha thalassemia minor.
- Three defective or missing alpha genes means that you’ll experience moderate to severe symptoms. Another name for this condition is Hemoglobin H disease.
- Four defective or missing alpha genes usually results in death. In those rare instances when a newborn survives, they’ll likely need lifelong blood transfusions. Another name for this condition is hydrops fetalis with Hemoglobin Barts.
Beta thalassemia
You inherit two beta-globin genes, one from each parent. Your anemia symptoms and how severe your condition is depends on how many genes are defective and which part of the beta globin protein chain contains the defect.
- One defective or missing beta gene means that you’ll experience mild symptoms. Another name for this condition is beta thalassemia minor.
- Two defective or missing beta genes means that you’ll experience moderate to severe symptoms. The moderate version is called thalassemia intermedia. More severe beta thalassemia involving two gene mutations is called beta thalassemia major or Cooley’s anemia.
What are the symptoms of thalassemia?
Your experience will depend on the type of thalassemia you have and how severe it is.
Asymptomatic (no symptoms)
You likely won’t have symptoms if you’re missing one alpha gene. If you’re missing two alpha genes or one beta gene, you may be asymptomatic. Or, you may have mild anemia symptoms, like fatigue.
Mild to moderate symptoms
Beta thalassemia intermedia may cause mild anemia symptoms, or it may cause the following symptoms associated with more moderate disease:
- Growth problems.
- Delayed puberty.
- Bone abnormalities, such as osteoporosis.
- An enlarged spleen (the organ in your abdomen that plays a part in fighting infection).
You may eventually need surgery to correct skeletal problems. Your healthcare provider may need to remove your spleen if it grows too large.
Severe symptoms
Missing three alpha genes (Hemoglobin H disease) often causes anemia symptoms at birth and leads to severe lifelong anemia. Beta thalassemia major (Cooley’s anemia) often leads to severe anemia symptoms noticeable by age 2.
Symptoms of severe anemia include those associated with mild to moderate disease. Additional symptoms may include:
- Poor appetite.
- Pale or yellowish skin (jaundice).
- Urine that’s dark or tea-colored.
- Irregular bone structure in your face.
DIAGNOSIS AND TESTS
How is thalassemia diagnosed?
Moderate and severe thalassemia are often diagnosed in childhood because symptoms usually appear within the first two years of your child’s life.
Your healthcare provider may order various blood tests to diagnose thalassemia:
- A complete blood count (CBC) that includes measures of hemoglobin and the quantity (and size) of red blood cells. People with thalassemia have fewer healthy red blood cells and less hemoglobin than normal. They may also have smaller-than-normal red blood cells.
- A reticulocyte count (a measure of young red blood cells) may indicate that your bone marrow isn’t producing enough red blood cells.
- Studies of iron will indicate whether the cause of your anemia is an iron deficiency or thalassemia.
- Hemoglobin electrophoresis is used to diagnose beta thalassemia.
- Genetic testing is used to diagnose alpha thalassemia.
MANAGEMENT AND TREATMENT
How is thalassemia treated?
Standard treatments for thalassemia major are blood transfusions and iron chelation.
- A blood transfusion involves receiving injections of red blood cells through a vein to restore normal levels of healthy red blood cells and hemoglobin. You’ll receive transfusions every four months with moderate or severe thalassemia, and with beta thalassemia major, every two to four weeks. Occasional transfusions may be needed (for instance, during times of infection) for hemoglobin H disease or beta thalassemia intermedia.
- Iron chelation involves the removal of excess iron from your body. A danger with blood transfusions is that they can cause iron overload. Too much iron may damage organs. If you receive frequent transfusions, you’ll receive iron chelation therapy (which you can take as a pill).
- Folic acid supplements can help your body make healthy blood cells.
- Bone marrow and stem cell transplant from a compatible related donor is the only treatment to cure thalassemia. Compatibility means the donor has the same types of proteins, called human leukocyte antigens (HLA), on the surface of their cells as the person receiving the transplant. Your healthcare provider will inject bone marrow stem cells from your donor into your bloodstream during the procedure. The transplanted cells will start to make new, healthy blood cells within one month.
- Injection that’s given every three weeks which can help your body make more red blood cells.
What are the complications of thalassemia?
Your body may get too much iron (iron overload), either from frequent blood transfusions or the disease itself. Too much iron can cause damage to your heart, liver, and endocrine system. Your endocrine system includes glands that produce hormones that regulate processes throughout your body.
You may get frequent severe infections, especially if you receive a lot of blood transfusions. The infections may be carried in the blood you receive during a transfusion. Healthcare providers carefully screen donor blood during transfusions to prevent this from happening.
PREVENTION
Can thalassemia be prevented?
You can’t prevent thalassemia, but genetic testing can reveal whether you or your partner carry the gene. Knowing this information can help you plan your pregnancy if you plan to conceive.
Speak to a genetic counselor for guidance on family planning if you suspect you or your partner may carry gene mutations for thalassemia.
OUTLOOK / PROGNOSIS
Can thalassemia be cured?
A bone marrow transplant from a compatible sibling offers the best chance at a cure for thalassemia. Unfortunately, most people with thalassemia lack a suitable sibling donor. Also, a bone marrow transplant is a high-risk procedure that may result in severe complications, including death.
Meet with a thalassemia specialist to determine whether you’re a candidate for a transplant. Choosing a high-volume hospital that regularly handles bone marrow transplants improves your chance of a cure while reducing your risk of complications.
What is the life expectancy of someone with thalassemia?
You should expect a normal life expectancy if you have mild thalassemia. Even if your condition is moderate or severe, you have a good chance of long-term survival if you follow your treatment program (transfusions and iron chelation therapy).
Heart disease from iron overload is the leading cause of death in people with thalassemia, so keeping up with your iron chelation therapy is extremely important.
LIVING WITH
What kind of ongoing care will I need?
You’ll need frequent complete blood counts and blood iron tests. Your healthcare provider may recommend yearly heart function and liver function tests. They may also recommend tests for viral infection (as having thalassemia increases your risk of certain serious infections). You also will need a yearly test for iron overload in your liver.
Immunization protects people against diseases.
What is immunization?
Immunization is the process of giving a vaccine to a person to protect them against disease.
Immunity (protection) by immunization is similar to the immunity a person would get from
disease, but instead of getting the disease you get a vaccine. This is what makes vaccines
such powerful medicine. Most vaccines are given by needle (injection) but some are given
by mouth (orally) or sprayed into the nose (nasally). Immunizations are also called
vaccinations, needles, shots or jabs.
Background note on Immunization:-
Expanded Programme on Immunization was launched in 1978. It was renamed as Universal
Immunization Programme in 1985 when its reach was expanded beyond urban areas. In
1992, it became part of Child Survival and Safe Motherhood Programme and in 1997 it was
included in the ambit of National Reproductive and Child Health Programme. Since the
launch of National Rural Health Mission in 2005, Universal Immunization Programme has
always been an integral part of it.
Universal Immunization Programme (UIP) is one of the largest public health programmes
targeting close of 2.67 crore newborns and 2.9 crore pregnant women annually.
It is one of the most cost-effective public health interventions and largely responsible for
reduction of vaccine preventable under-5 mortality rate.
Under UIP, immunization is providing free of cost against 12 vaccine preventable diseases:
Nationally against 9 diseases – Diphtheria, Pertussis, Tetanus, Polio, Measles, Rubella,
severe form of Childhood Tuberculosis, Hepatitis B and Meningitis & Pneumonia caused by
Hemophilus Influenza type B
Sub-nationally against 3 diseases – Rotavirus diarrhoea, Pneumococcal Pneumonia and
Japanese Encephalitis; of which Rotavirus vaccine and Pneumococcal Conjugate vaccine
are in process of expansion while JE vaccine is provided only in endemic districts.
A child is said to be fully immunized if child receives all due vaccine as per national
immunization schedule within 1st year age of child.
The two major milestones of UIP have been the elimination of polio in 2014 and maternal
and neonatal tetanus elimination in 2015.
How do vaccines work?
Vaccines contain the same germ that causes disease. But the germs in the vaccine have
been killed or weakened so that they do not make you sick. Some vaccines contain only a
part of the germ that causes disease.
When you get immunized, your body is tricked into thinking that it has been infected with the
disease. It makes antibodies that kill the germs. These antibodies stay in your body for a
long time and remember how to fight the germ. If the germs from the disease enter your
body in the future, the antibodies destroy the germs before you can become sick. It is much
safer to get a vaccine than the disease.
Most people are fully protected against the disease after getting immunized. In rare cases,
people who are immunized can still get the disease because they only get partial protection
from the vaccine. This is more common in people with medical conditions that affect the
immune system. Although these people may still get the disease, they will most likely get a
milder sickness and not suffer serious complications.
What is herd immunity (community immunity)?
When enough people in a community are immunized against a disease, the chance of an
outbreak is greatly reduced. This type of community protection is known as ‘herd’ or
‘community’ immunity. To reach herd immunity against a disease, a community must have
between 74 to 95 per cent of the people immunized depending upon the disease.
Indian Government Initiative- Mission Indradhanush
Mission Indradhanush (MI) was launched in December 2014 and aims at increasing the full
immunization coverage to children to 90%.
Under this drive focus is given on pockets of low immunization coverage and hard to reach
areas where the proportion of unvaccinated and partially vaccinated children is highest.
A total of six phases of Mission Indradhanush have been completed covering 554 districts
across the country.
It was also identified as one of the flagship schemes under Gram Swaraj Abhiyan (16,850
villages across 541 districts) and Extended Gram Swaraj Abhiyan (48,929 villages across
117 aspirational districts).
While the first two phases of Mission Indradhanush resulted in 6.7% increase in full
immunization coverage in a year, a recent survey carried out in 190 districts covered in
Intensified Mission Indradhanush (5th phase of Mission Indradhanush) shows 18.5% points
increase in full immunization coverage as compared to NFHS-4 survey carried out in 2015-
16.
Fatty Liver
The liver, located on the upper-right side of the abdomen, is the largest internal organ of the human body. The main functions of the liver are to remove toxins and process food nutrients. Blood from the digestive system filters through the liver before travelling anywhere else in the body.
Fatty liver disease (steatosis) is the build-up of excess fat in the liver cells, and is a common liver complaint in Western countries. It affects about one in every 10 people. It is normal for the liver to contain some fat, but if fat accounts for more than 10 per cent of the liver’s weight, then you have fatty liver and you may develop more serious complications.
Fatty liver may cause no damage, but sometimes the excess fat leads to inflammation of the liver. This condition, called steatohepatitis, does cause liver damage. Sometimes, inflammation from a fatty liver is linked to alcohol abuse. This is known as alcoholic steatohepatitis. Otherwise, the condition is called non-alcoholic steatohepatitis, or NASH.
An inflamed liver may become scarred and hardened over time. This condition, called cirrhosis, is serious and often leads to liver failure. NASH is one of the top three leading causes of cirrhosis.
Causes of fatty liver disease
Eating excess calories causes fat to build up in the liver. When the liver does not process and break down fats as it normally should, too much fat will accumulate. People tend to develop fatty liver if they have certain other conditions, such as obesity, diabetes or high triglycerides.
Alcohol abuse, rapid weight loss and malnutrition may also lead to fatty liver. However, some people develop fatty liver even if they have none of these conditions.
Risk factors for fatty liver disease
Most, but not all fatty liver patients are middle-aged and overweight. The risk factors most commonly linked to fatty liver disease are:
- overweight (body mass index of 25-30)
- obesity (body mass index above 30)
- diabetes
- elevated triglyceride levels.
Metabolic syndrome and fatty liver disease
Many researchers now believe that metabolic syndrome – a cluster of disorders that increase the risk of diabetes, heart disease and stroke – plays an important role in the development of fatty liver.
Signs and symptoms of metabolic syndrome include:
- obesity, particularly around the waist (abdominal obesity)
- high blood pressure (hypertension)
- one or more abnormal cholesterol levels — high levels of triglycerides, a type of blood fat, or low levels of high-density lipoprotein (HDL) cholesterol, the ’good’ cholesterol
- resistance to insulin, a hormone that helps to regulate the amount of sugar in the blood.
Of these, insulin resistance may be the most important trigger of NASH. Because the condition can remain stable for many years, causing little harm, researchers have proposed that a ‘second hit’ to the liver, such as a bacterial infection or hormonal abnormality, may lead to cirrhosis.
How a liver becomes fatty?
It is unclear how a liver becomes fatty. The fat may come from other parts of your body, or your liver may absorb an increased amount of fat from your intestine. Another possible explanation is that the liver loses its ability to change fat into a form that can be eliminated. However, the eating of fatty foods, by itself, doesn’t produce a fatty liver.
Symptoms of fatty liver disease
A fatty liver produces no symptoms on its own, so people often learn about their fatty liver when they have medical tests for other reasons. NASH can damage your liver for years or even decades without causing any symptoms. If the disease gets worse, you may experience fatigue, weight loss, abdominal discomfort, weakness and confusion.
Diagnosis of fatty liver disease
Your doctor may see something unusual in a blood test or notice that your liver is slightly enlarged during a routine check-up. These could be signs of a fatty liver. To make sure you don’t have another liver disease, your doctor may ask for more blood tests (including liver function tests), an ultrasound, a computed tomography (CT) scan or medical resonance imaging (an MRI).
If other diseases are ruled out, you may be diagnosed with NASH. The only way to know for sure is to get a liver biopsy. Your doctor will remove a sample of liver tissue with a needle and check it under a microscope.
Some questions to ask your doctor after diagnosis include:
- What is the likely cause of my fatty liver?
- Do I have NASH? If not, how likely am I to develop NASH?
- Do I have cirrhosis? If not, how likely am I to develop cirrhosis?
- Do I need to lose weight? How can I do so safely?
- Should I be taking any medication to control my cholesterol and triglyceride levels?
- What medications or other substances should I avoid to protect my liver?
Prevention and reversal of fatty liver disease
There are no medical or surgical treatments for fatty liver, but some steps may help prevent or reverse some of the damage.
In general, if you have fatty liver, and in particular if you have NASH, you should:
- lose weight – safely. This usually means losing no more than half to one kilogram (one to two pounds) a week
- lower your triglycerides through diet, medication or both
- avoid alcohol
- control your diabetes, if you have it
- eat a balanced, healthy diet
- increase your physical activity
- get regular check-ups from a doctor who specialises in liver care.
Treatment for fatty liver disease
Fatty liver is currently the focus of intense research. Scientists are studying whether various medications can help reduce liver inflammation, including new diabetes medications that may help you even if you don’t have diabetes.
Several drug are being investigated such as a medication that blocks the absorption of some of the fat from your food and may reduce the amount of fat in the liver.