The second day of the training gave further information on the nuances involving organ donation with specific details pertaining to the Indian society. It started with nephrologist Dr V S Reddy giving the trainees a brief overview of causes of Kidney Disorders. He also gave a comparison of cost and restrictions involved when patients opt for Transplantation Versus Dialysis. In a short while, the discussion dwelt deeply into the medical world with the nurses participating enthusiastically. Some of the social workers who were also in the audience could not participate actively but it was perhaps due to the fact that preference was given to the nurses considering that they were the ones involved first hand in the organ transplanting process.
Next Dr. M Subramanyam an Anesthesia specialist spoke about the definition of Brain death, the reason and relevance of brain death. He also talked about who had the authority to declare a patient as brain dead. It was followed by a discussion about the steps that should be taken to arrive at the decision that the patient is actually brain dead. It went from simple doll's eye movement, testing of pupil of eye, to the last apnea test. The discussion ended with details of Intensive care management of brain death patient, ensuring success rate for organ recipient patient who has spent money and is dependent on the organ donated, emotional care and anesthetic management of organ donation.
In the afternoon session, Dr. Sumana started off by explaining the Transplantation of Human Organ (THO) Act 1994. The trainees then sat for a very interesting and thought provoking session on Ethics of Organ Allocation and Paid Donation. The trainees were asked to make choices on who they would decide to give a preciously harvested organ to—a person who was a chain smoker or an alcoholic who had actually ruined his health, while there were so many who were waiting in the queue? Or would the organ be given to a criminal on lifetime imprisonment? Dr Sumana made the group notice how the group was divided on 50-50 choice on many issues with no clear majority on many of the questions raised. "Imagine how it would be when so many doctors were discussing?" Indeed Ethics was a tricky subject and needed a lot of deliberation which had to be made soon considering that the transplant had to be decided upon and performed within a timeframe.
The last session of the day was taken by Dr. Meena Hariharan a professor from Central University, about Communication and emotional aspect of the patient. The doctor took the group on a visual ride, into the cases she explained. There were no pictures, no slideshows— it was done just with her voice modulation and powerful with emotion. The rich experience that she was sharing with the trainees made them realize why simple steps like explaining to the patient about what is going to be done to him/her, taking care of the simple questions of families of patients in ICU was so important. Dr. Meena Hariharan emphasized the importance of the role of a Social worker and counselor which could not be filled by the doctor or nurse. A patient is not just someone with a disease or injury to be "cured", he/she is in fact a product of a bundle of financial, social and relationship issues. These should also be given due importance. She repeatedly stressed on the sensitive nature of Indian society and the unique way it needed to be handled when dealing with patients and their families. Bio-Psycho-social approach was her motto and she explained in detail the steps like listening to the patient, body language and including the family of the patient in the treatment process.
The second day of the Transplant Coordinator Training was highly informative and educative and it was evident that the course director and coordinators had put in so much thought and care into structuring the course for the benefit of the trainees.