I would like to thank the Madurai Rotary Club for inviting me to speak this evening. I am 
Christopher Barry and I am a liver and kidney transplant surgeon from Rochester, New York, currently serving a one year sabbatical as Advisory Board Member to the MOHAN (Multi Organ Harvesting Aid Network) Foundation based in Chennai. The Mohan Foundation is India’s largest and most productive organ donation NGO and is working with others to establish a National Deceased Donor Transplant Program in India.
Today, I will talk about chronic diseases common to the Indian population such as diabetes, high blood pressure, heart disease, and fatty liver disease. Recognizing the symptoms and knowing the treatments to these diseases and, more imp
ortantly, how to avoid them altogether, are important to leading healthy lives and never needing a transplant due to chronic organ failure.
Diabetes is a condition marked by high blood sugar in the body’s circulation. This can be caused by an autoimmune destruction of the insulin-producing cells in the pancreas (Type I Diabetes Mellitus) or a state of “insulin resistance” (Type II Diabetes Mellitus) in which normal amounts of insulin are produced, but the body’s cells do not respond correctly to the insulin signaling. Type II Diabetes is much more common and is quite prevalent among Indians.
Common symptoms of diabetes include excessive thirst, frequent urination, and fatigue. 
Other symptoms include always being hungry, sexual problems, sudden weight loss (common in Type I diabetics, but Type II diabetics are usually overweight), poor wound healing, infections, and blurry vision.
Common symptoms of diabetes include excessive thirst, frequent urination, and fatigue. Other symptoms include always being hungry, sexual problems, sudden weight loss (common in Type I diabetics, but Type II diabetics are usually overweight), poor wound healing, infections, and blurry vision.
Complications related to chronic or poorly controlled diabetes include nerve damage (or 
“peripheral neuropathy”), infections including gangrene, blindness, and kidney failure. The peripheral neuropathy increases the chances of acquiring unrecognized foot injuries (even simple cuts or scrapes) that can progress to sever infections including gangrene. Diabetes is a major cause of amputation, so diabetics need to be particularly careful about caring for their feet. Also, diabetes causes poor circulation, increasing the risks of infections and heart disease. Diabetic coronary artery disease is particularly difficult to treat because multiple blood vessels are often affected. Diabetes is also the leading cause of blindness (“diabetic retinopathy”) and frequent eye exams are necessary to gauge progression of this complication. Finally, kidney failure is common after several decades of poorly controlled diabetes and “diabetic nephropathy” (along with chronic hypertension) are the leading indications for kidney transplant worldwide.
Depending on the severity, diabetes can be treated with dietary modifications alone 
(avoiding excess sugars and other carbohydrates), oral medicines, or insulin shots. Diabetics need to continually monitor their own blood glucose levels to achieve good blood sugar control and avoid complications. For people progressing to kidney failure from diabetes, dialysis and transplant become necessary and these patients are at higher risk because of their predisposition to infections and their higher incidence of heart disease. Combined kidney and pancreas transplantation is an option for Type I diabetics with kidney failure, but this operation is relatively rare even in Western countries because the risks of surgery and life long immunosuppression drugs often outweighs the risks of remaining on insulin and dialysis. Newer treatments include insulin “pumps” and “islet cell” (purified insulin-producing cells) transplant, but these have yet to be perfected for routine clinical use.
High blood pressure, or “hypertension”, is also quite common among Indians. Contributing factors, other than genetic predisposition, include a stressful lifestyle, too much salt intake, and inadequate exercise and relaxation (such as meditation). Uncontrolled hypertension leads to stroke, heart attack, and kidney failure. Hypertension can be treated by decreasing the amount of salt in one’s diet and many different oral medications. It is important to choose the right medication(s) for a given individual, because severity of disease and side effects to the medicines differ from one person to the next.
Indians are at particularly high risk for developing heart disease. Studies have shown that the blood vessels supplying the heart (“coronary arteries”) in Indians are actually smaller than other populations and when heart disease does strike, it is more wi
despread and severe in Indians. Stressful lifestyles, poor diets (high fat, high cholesterol), physical inactivity, and smoking all increase one’s risk for heart disease. Chronic heart failure or sudden death from a heart attack are leading causes of mortality worldwide. In certain cases, heart transplant is required, but this is a relatively rare operation due to the scarcity of organs available. Implantable heart pumps (“ventricular assist devices”) are becoming more common in the West, but this technology is extremely expensive.
Unfortunately, obesity is an increasing problem in India. Although morbid obesity is much less common than in Western countries, Indians often have truncal obesity (or “pot-bellies”) and this in and of itself can cause health problems. A diet with too much fat, grease, cholesterol and not enough fruits, vegetables, and whole grains makes it difficult to maintain a healthy weight. But the main culprits for obesity are eating too much and exercising too little. Obesity is strongly associated with diabetes (Type II, or insulin resistance), heart disease, fatty liver disease, and joint problems. Obese people have a shorter lifespan compared to the general population.
Fatty liver disease is now recognized as the major cause of liver dysfunction worldwide, 
particularly in Western countries. Indians have an unfortunate genetic predisposition to fatty liver disease and it is often present even in the absence of obesity (as is more common in the West). Poor diet, overeating, inadequate physical activity, and diabetes are all risk factor. It is actually a spectrum of liver injury starting with simple accumulation of fat droplets in the liver cells. At this stage, liver function is not disturbed and the fat accumulation is actually reversible. In a small minority of people (1-2%) however, unabated fat accumulation can lead to inflammation and scarring of the liver, or NASH (“Non Alcoholic Steato Hepatitis”). NASH is associated with minor to moderate liver dysfunction and can progress to end stage scarring of the liver, or cirrhosis s. Cirrhosis often leads to liver failure and also greatly increases the risk of liver cancer. NASH cirrhosis is becoming the leading indication for liver transplant worldwide.
As I have pointed out in my TEDx talk, all of you almost certainly know someone who has had a transplant or might benefit from
one. Chronic diseases of the kidneys, liver, heart and lungs are common and transplant is in many cases the best way to cure them. Transplantation is extremely successful these days with the majority of recipients returning to happy, fully functional lives just as they were before they ever got sick. It’s a life transforming endeavor and is one of the most phenomenal successes of modern medicine. In order to receive a transplant, you need an organ donor. Most donor organs come from deceased individuals, but it’s also possible to donate one kidney, part of your liver, or even part of your lung while you’re still alive to someone in need. I’m going to focus on deceased organ donation, but much of what I’m telling you also applies to living donation.
A single person can potentially save up to 8 people’s lives through organ donation: 1 heart, 2 lungs, 2 kidneys, 1 liver, a pancreas, and intestines. You could even s ave 9 lives, if you split the liver under ideal circumstances.
Through tissue donation such as corneas, bone, tendons, heart valves, blood vessels and skin, up to 50 people’s lives can be dramatically improved by just one donor. If you’re not an organ donor when you die, then you’re taking a lot of people with you.
The act of organ donation can bring profound meaning to the donor’s life because this act touches immediately the lives of the recipients and impacts the lives of the loved ones and family surrounding the recipients and the donor. Donor families often experience a profound sense of comfort and closure knowing that the tragedy of death and deep loss resulted in a renewal of life in many others. And this cycle of giving this incredible gift of life can continue by influencing others to consider donation either while we’re still alive or when we pass.
Throughout the world, there is a huge gap between the number of people needing transplants and the number of organs available to perform transplants. In the US, as many as 30 people die every day while waiting for an organ to become available. In India it’s estimated that 500,000 people could benefit from life saving transplants, but only 5,500 are performed each year. 5,000 of these are living donor transplants (mostly kidneys and some livers) where a family member or loved one donates one kidney or a part of liver to the person in need. Only 500 deceased donor transplants (using organs donated from brain dead accident victims or stroke victims) in India last year.
This discrepancy between donor organs and demand for transplants can lead to bad behavior. Kidney rackets unfortunately continue to this day in India despite their illegality. The possibility exists that increasing the number of deceased donor transplants through organ donation, black market transplant activity would cease because the demand could be met. If the organ donation rate increased in India by 10 fold, there would be enough organs for everyone to have a transplant.
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behavior. Kidney rackets unfortunately continue to this day in India despite their illegality. The possibility exists that increasing the number of deceased donor transplants through organ donation, black market transplant activity would cease because the demand could be met. If the organ donation rate increased in India by 10 fold, there would be enough organs for everyone to have a transplant.
The most common place where organ donation consent is considered is in the hospital at the time of a tragic death. This is not the best environment to thoughtfully consider such a profound decision. I think it’s very important to identify other, more suitable, environments for thoughtful consideration.
Take estate planning for example. Don’t you think that when a client sits down with his or her attorney to discuss such things as living wills, health care proxies, and advanced directives that a thoughtful discussion on organ donation should naturally be included? This isn’t routine practice and I think it should be.
Other suitable environments include primary care physician well visits and when corporations or institutions talk to their employees about health care and retirement benefits. These opportunities will allow people to think about donation, learn more about it, and move towards a decision beforehand. Importantly, this provides an opportunity for people to discuss with their family members and loved ones what they think about organ donation, so that everyone’s intentions perfectly are clear.
So let me challenge 6 common myths with 6 facts on organ donation and suggest what you might consider doing to take action.
Myths regarding organ donation are driven by fear and misinformation. “If I’m an organ donor then the doctors wont take care of me!” This is absolutely false. You must realize that all of those paramedics and nurses and ER docs and ICU docs are devoted to saving lives even in the most extreme circumstances. It’s not just a job for them, it’s a passion, a true calling.
Here is the fact: All people, regardless of their stated intention to be organ donors, receive the same level and quality of care. It’s only after the patient is declared dead that donation takes place. And this process is carried out by a separate team of health care professionals that is completely distinct from the paramedics and health care providers in the ER and ICU.
You’re not necessarily too old or too ill to be an organ donor. People in their 70s and 80s have donated live saving organs. If you have a health problem or had one in the past, you can still register. The decision of whether the organs are suitable for transplant is made by the transplant doctors at the time of donation.
Some aren’t sure that their religions are supportive of organ donation. In fact, all major organized religions support an individual’s decision to be an organ donor. I personally consider donation to be a profoundly spiritual act that honor s the sanctity of life.
Some worry that the process of deciding who receives organs for transplant is somehow unfair. The transplant allocation process—who rises to the top of the waiting list—is inherently fair. Celebrity or political or financial power do not influence this process.
Another fact is that there are no costs incurred to the family or estate of an organ donor. Organ donation is a true gift of life.
And finally, I can tell you from my personal experience as a transplant surgeon that organ donors are treated with the utmost care,,, respect,,,,and dignity. The operation I perform to remove the organs for donation is compassionate and is not disfiguring. The organ donor and the donor’s family is always honored at the time of retrieval.
So learn more about organ donation, talk with your family and loved ones about it, and even consider pledging your organs if you wish to do so.
More importantly, take care of yourself so that you may live a happy and healthy life.
Thank you!
