Medically there are many lives that can be saved, but due to lack of awareness about the ORGAN DONATION people do not donate the organs of their near and dear ones after their death or in case of brain dead. Even the government is not pursuing the Organ Donation drive very seriously. There are certain communities in India, who due to religious reasons do not favour organ donation after death.
It looks like Organ donation in India needs big reforms
Organ donation is on the threshold of major changes in India. In February 2023, the Union Health Ministry decided to do away with the ceiling that those above 65 years of age are ineligible for the registration of cadaver organ transplants. Now it is possible for an individual of any age to register for an organ transplant.
The government has scrapped the clause in the National Organ and Tissue Transplant Organisation(NOTTO) guidelines as it violates the right to life. Also, earlier, an organ recipient could register for a prospective transplant only in the domicile state. States such as Gujarat have made it mandatory for registered patients to furnish a domicile certificate to be eligible for a transplant. Last November, the Gujarat High Court quashed the discriminatory policy of the state government.
Now a patient can register in any state for a transplant. The patient will be allotted a unique ID by NOTTO on registering, which will be carried forward even if the patient changes multiple hospitals in different states. The transplanting surgeons have welcomed this change. The Union Health Ministry has also directed states against charging any registration fees from patients awaiting organ transplants. Kerala and Maharashtra are among states charging fees ranging from Rs 5000 to Rs 10,000.
The process of organ retrieval, storage, and transplantation is governed in India under the Transplantation of Human Organs Act and Tissues Act (THOA), 1994. Though it has been adopted by many states, there are some clauses in this act that are leading to confusion, and some states have therefore evolved their own methods for its implementation. This makes it essential to have one nation, one policy initiative for organ donation and transplant.
However, there are some societal reservations on several counts against organ donation and transplants. The number of organ transplants has trebled from 2013 to 2022. Which is 4990 in 2013 and 15,561 in 2022. But only 837 in 2013 and 3153 in 2022 are deceased organ transplants.
Significantly the major share is of kidney transplant 11,423. This is against an estimated 200,000 renal failures a year, underscoring the importance of simplifying the process. The pattern is similar for liver, heart, and pancreatic transplants. That the bulk of kidney transplants were from a living donor is testimony to the challenge in getting people to pledge their organs or volunteer a deceased relative’s organs. There is some progress, an improvement in the harvesting of organs from deceased donors with the average organ transplants per donor increasing from 2.43 in 2016 to 3.05 in 2022. But this is nowhere near enough, given just 250 patients received heart transplants as against the estimated need of 50,000. It is clear that the dismal donation rate of 0.86 per million people needs to be drastically improved.
More than 200,000 Indians require transplants every year. But not even 10% manage to get it. This grim scenario makes any measure to make organ transplants more inclusive and welcome. On the other hand, the demand-supply divide enables unlawful operations to thrive, in the absence of a vigilant regulatory mechanism. To create awareness about the need for organ donations, the Health Ministry has drafted a chapter that will be included in school curricula from next academic year.
Enough is not done to create a wider appreciation that following brain stem death it is possible to harvest organs. While brain stem death is recognized by THOA, there is no mention of it in the Registration of Births and Death Act. The foremost challenge is in giving the deceased organ donation program a push.
The NOTTO waitlist already has 27,000 for transplants. Currently, about 30 living kidney and 3-4 liver transplants are done in a day. What needs to be popularized is simple. Anyone, regardless of age or gender, can become an organ and tissue donor. In the case of a person who is less than 18 years old, consent of the parent or guardian is needed. A living person can donate only for immediate blood relations (brother, sister, parents, and children). He or she can donate a kidney (as one kidney is capable of maintaining the body functions), a portion of the pancreas (as half the pancreas is adequate for sustaining pancreatic functions), and part of the liver (as the few segments that are donated will regenerate after a period of time).
A brain-dead person can donate 20 organs and tissues, including the heart, lungs, liver, kidney, intestines, pancreas, eyes, heart valves, skin, bone marrow, connective tissues, middle ear, and blood vessels.
In the end, the reality is we are missing out on many opportunities for donations as we lack systems and audits in tertiary care hospitals. Our aim should be to create ‘green corridors’ in hospitals too, besides the roads, and make the process foolproof and efficient.
Waiting for your views on this blog.
Anil Malik
Mumbai, India
18th September 2023