NAKHORN SI THAMMARAT TISSUE DONOR

            CASE REPORT - 20TH - 22ND JUNE 2001



INTRODUCTION

On the 15th June 2001, the Bangkok Biomaterial Center received a phone call at around 15.00 hrs from a next of kin of a probable donor from the Nakhorn Si Thammarat Province of Thailand. The phone call was received by one staff of the Center, who rejected the donors plea on the grounds that the age of the patient was too much (79 years) and secondly due to his laziness that the place was very far from Bangkok. This rejection of tissue donation please was done on a personal behest without informing or consulting the Chairman.

On 16th June 2001 at 14.00 hrs, the next of kin undeterred by the initial outright rejection for his plea of tissue donation of his mother, who was already on the Center's list of Volunteer Tissue Donor, again called up the Center. This time another staff received the phone call, and he noted down the caller's details. He provided the telephone number of the Center's Chairman - Prof. Dr. med. YONGYUDH VAJARADUL and intimated the caller to call the Chairman directly. The next of kin contacted the Chairman and after lots of detailed discussions, he was assured that arrangements should be done to respect the donor's plea and the excellent cooperation of the next of kin. Accordingly on the following day i.e. 18th June 2001, Prof. Vajaradul called up the Center's tissue recovery team and asked them to coordinate with the local hospital authorities as well as be ready for the tissue recovery immediately on notice of donor's death.

OBJECTIVES


1. To recover tissues from the deceased donor
2. To carry out Public and Professional Awareness (PPA) of tissue banking in the province
3. To be a source of internal training for the Center's staffs in conducting PPA activities and tissue recovery
4. To establish a revised scientific management system for the process of tissue recovery
5. To present the case study of this special case at the National Tissue Banking Public and Professional Awareness Program to be held in Bangkok during November 2001

VISION


1. First case of Dead Donor from the Nakhorn Si Thammarat province of Thailand
2. First case of tissue recovery from a Volunteer Tissue Donor of the year 2001 and also in the last 5 year
3. The deceased donor was a registered Volunteer Tissue Donor and before death she has insisted to her next of kin to contact the Center for carrying out tissue recovery after her death
4. The cooperation of next of kin to the last wishes of the deceased and the contribution to the tissue donation movement of Thailand
5. Ideal opportunity to promote Tissue Banking PPA activities in the Chawang Crown Prince Hospital and the Nakhorn Si Thammarat province of Thailand

DONOR DETAILS

Ms. Dang Cheena, a 79 years old Thai Female from Nakhorn Si Thammarat province of Thailand had suffered Hemi-Paralysis 4 years back and was subjected to wheelchair. Two years back she had seen a TV Health Programme on Human Tissue Donation and Tissue Banking with Prof. Yongyudh Vajaradul explaining the topic. She developed interest and contacted the Center with the intent of registering as a Volunteer Tissue Donor (VTD). Her plea was accepted by the Center and she became a VTD on the Center's list. On 15th June 2001, she suffered a heart attack and was admitted to the Chawang Crown Prince Hospital at Chawang, in the Nakhorn Si Thammarat province. She asked her son to get in touch with the Center as she had the haunch that she will not survive. Her son contacted the Center as stated above. On 20th June at 13.00 hrs.

PLAN OF ACTION

On 20th June 2001, at 14.00 hrs, the Center received a call from the Chawang Hospital that the donor has passed away and that the Center can proceed with tissue recovery. Immediately the Center's tissue recovery team came into action and started preparing for the journey to Chawang. Train Tickets were booked for 6 people and other necessary arrangements and preparations were started. At 16.00 hrs, the Chairman called up a plan of action meeting of the team members to discuss and chalk out the job descriptions, tissue recovery plan, Public and Professional Awareness Activities (PPA) and other details of the recovery process. Finally a Tissue Recovery internal plan of action (Annexture - I) was finalized at 17.30 hrs and approved by the Chairman. The team left the Center at 20.00 hrs for Chawang by Train at 20.30 hrs from the Bang Bamru Railway Station.

THE ACTIVITY

The Center's team reached Chawang Railway station at 11.00 PM on the 21st June 2001 and was received by a Car from the Chawang Crown Price Hospital, which took the team straight to the hospital. On reaching the hospital the team was brought to the Director's room. The Hospital Director - Dr. Pittiya Sornplaeng, was a cordial person and after initial introductions and discussions about the recovery, the team was introduced to Dr. Kreetha Thosuwan, the surgeon in-charge of the donor. Dr. Kreetha happened to be an ex-student of Prof. Yongyudh at the Siriraj Hospital and also worked at the Siriraj Hospital during his residency training days. The team was then escorted by Dr. Kreetha to see the donor at the mortuary at 12.00 hrs. After initial inspection of general condition of the donor and the refrigerator temperature, the team went ahead to start the process of tissue recovery, but it was time for lunch and the team was led to the hospital canteen at 12.30 hrs. The hospital and the host Dr. Pittiya organized the lunch and Dr. Kreetha joined the team along with other house staffs and operating room staffs of the hospital. Post-Lunch at 13.00 hrs, the Center's team was divided into 2 parts viz. Media and Recovery. The first team composing of Mr. Reyaz, Mr. Somchok and Mr. Pisit commenced with the interview of the next of kin and other PPA activities. The 2nd team composing of Mr. Sahachat, Ms. Thanyawan and Ms. Rathathai commenced with the preparation of the deceased donor for tissue recovery. At 13.15 hrs, the media team leader proposed to Dr. Kreetha of his intention to have the Center's tissue donation drama to be played on a video at the hospital's OPD area TV. The request was accepted and the videocassette was played. As the drama was played the media team captured the glimpses of the patients sitting in the OPD area and watching the drama inquisitively. The Volunteer Tissue Donation registration forms of the Center were also kept with the nurses at the OPD registration area for willing people to come forward for registration as VTD. At 13.30 the next of Kin i.e. the son and daughter of the deceased donor had arrived. The Media team proceeded with the interview of the next of kin followed by consent for tissue donation. At 14.00 hrs, the Media team completed their part and gave the green signal for the recovery team to go ahead with the tissue recovery.

At 13.15 hrs, the Prof. Vajaradul arrived at the Chawang Hospital and after launch with Dr. Pittiya followed for personally conducting interview of the next of kin and the hospital director. At 14.15 hrs the interview session commenced and was followed at 15.30 hrs by felicitation of the next of kin with a Volunteer Tissue Donation certificate, a Ambassador of Tissue Donation badge, Tissue Donation promotion materials and a sum of Baht 1000/- towards meeting the cremation ritual expenses. The Chawang Hospital's director was felicitated with a badge of the Center and tissue donation promotion materials. At 16.00 hrs, the Prof. Vajaradul, Dr. Pittiya, Mr. Reyaz and Mr. Pisit went to the nearby Chawang Government Secondary School. There was a meeting arranged with Mr. Chokdi Nudang, Mr. Somnuck Maiboonkaew, Mr. Choochai Suwanmanee Scout masters of the School. At the meeting, Prof. Vajaradul sought to lay the foundation and organize a scout tissue donation project between the School and the hospital. The project titled "Campaign for eradication of acute haemorraghic fever through environmental management". This project will also be later utilized for the volunteer tissue donation project.

At 17.00 hrs, the team was back to the Chawang hospital and the tissue recovery was also completed. The tissue recovery team had recovered 2 classical knees, 1 right whole humerus and 2 proximal femur. The team bid farewell to Prof. Vajaradul who left for the Nakhorn Si Thammarat Province. At 17.00 hrs, the Chawang hospital administration was gracious to take the Center's team for a visit of the town market and a very old historical Thai Buddhist temple. At 16.00 hrs the Center's team returned back to the hospital had their dinner, fresh up and packed off for Bangkok. The hospital ambulance dropped the team at the Chawang Railway station at 20.00 hrs. The team caught their train at 20.40 hrs and was back in Bangkok's Bang Bamru railway station at 11.00 A.M. on the 22nd June 2001. Immediately the team headed for the Center where, the allografts were transferred to the quarantine and the team members made initial reports. Finally individual team members gave a briefing to the Chairman of the entire trip.

DISCUSSIONS

1. It is ironically pathetic that a staff of the Center had turned down the request of a donor without informing or consulting the Chairman. Furthermore there were no corrective action taken in this matter.
2. The tissue recovery team did not make the list of instruments, equipment and other disposable that they had carried with them and that had come back after the program.
3. The recovery team was instructed by the media team to prepare the donor for tissue recovery but not to start with the incision without informing them as the media team was supposed to capture in the cameras, the incision and certain other important steps of tissue recovery process. Due to this lack of sincerity documentation of the tissue recovery process could not be done.
4. The recovery team knowing the fact of the arrival of the Chairman did not get in touch with him and neither did they appraise him of their intent of going ahead with the tissue recovery process.
5. The recovery team did not coordinate with the Chawang hospital about the availability of dry ice and the recovered tissue carrying thermocol box. The host hospital was kind enough to organize both the mandatory items from the neighboring district by sending their staffs on an emergency basis.
6. The Media team leader was not informed about the expected arrival of the Chairman at the venue. In that event some arrangements would have been done in a better manner.
7. The Media team lacked a tripod for the video and still cameras. This equipment may have enhanced the photo quality of the coverage.


CONCLUSIONS

The tissue recovery of the deceased donor at Nakhorn Si Thammarat was a very good opportunity for the Center in many ways. First of all the Center was able to contribute to its negligible stock of tissue allografts. Secondly the Center was able to overhaul its tissue recovery team and attempted to commence with a more scientific method of management for deceased donor tissue recovery case. Thirdly it was a good opportunity for the Center's staff to be trained in the tissue recovery process of deceased volunteer tissue donor in a place away from Bangkok. Lastly it was a good exercise of conducting PPA activities at Chawang Hospital in the Nakhorn Si Thammarat province of Thailand.

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Fig 1: Temperature of the Refrigerator in the Mortuary of the hospital containing the Donors body before tissue recovery     
           
                

Fig 2: The Center's team outside the mortuary before the commencement of tissue recovery

 

Fig 3: Inquisitive onlookers at the OPD of the Hospital watching the Drama on Tissue donation being played on TV          
            
  

Fig 4: Center's media staff taking interview of the next of kin and completing necessary formalities

 

Fig 5: (From left) Dr. Pittiya, Prof. Yongyudh and next of kin stand for a pose      
                   

Fig 6: Prof. Yongyudh taking interview of the next of kin

 

Fig 7: Prof. Yongyudh taking interview of Dr. Pittiaya, Chawang hospital Director        
          

Fig 8: The Volunteer Tissue Donation certificate and other insignias for the next of kin

 

Fig 9: Dr. Pittiya giving the Volunteer Tissue         
    Donation certificate to the next of kin           

Fig 10: Prof. Yongyudh felicitating Dr. Pittiya for his hospital's cooperation


Fig 11: Hospital admission registration card of the donor         

Fig 12: Thai ID card of the donor

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Fig 13: Prof. Yongyudh with the Scout masters of the Chawang School            
                
Fig 14: The deceased donor body transported for funeral cremation rituals


Fig 15: The Center's recovery team sight seeing around Chawang            
                   

Fig 16: The reclining Buddha a landmark of the Chawang Buddhist community