There is a huge need for organ donors in the country. However, there is an imbalance and the key reason is that less than 1 out of every 5 organ transplants are from deceased donors says, DR VIVEK KUTE
Organ transplantation involves the surgical removal of the organ/tissue from one person (the donor) and its placement in another (the recipient). It is often called the ‘gift of life’ since it saves the lives of the recipients who are affected by organ failure. Depending on the organ being harvested, the potential donor can either be alive or one who has died naturally or in an accident. Despite this, there is a huge gap between the need for organs and donors in India.
Kidney failure occurs in nearly 1.8 lakh persons every year but only 9751 and 5486 renal transplants were undertaken in the year 2019 and 2020 respectively. Though an estimated 2 lakh lives are lost to liver failure and cancer every year, only 2592 and 1780 liver transplants were carried out in 2019 and 2020 respectively. Similarly, heart failure affects 50000 individuals every year but only 187 and 89 heart transplants were performed in year 2019 and 2020 respectively as per WHO Global Observatory on Donation and Transplantation. Though by volume, India performs the second-largest number of transplants globally, the need far outweighs the supply.
Deceased donor organ transplantation (DDOT) — the challenges
One of the key reasons for this imbalance is that less than 1 out of every 5 organ transplants are from deceased donors. Enhancing DDOT can be the way forward to fill this gap. The Transplantation of Human Organs (Amendment) Act (THOA) 2014 by the Government of India also promotes deceased organ donation to improve access to this life-saving procedure. However, DDOT is impeded by the lack of awareness amongst the general population as well as the medical community.
Also, there is widespread misinformation and hesitancy towards declaring or accepting brain stem death (in which the brain is non-functional and the person cannot regain consciousness or breathe without support). This is especially important since only a few organs can be harvested from a donor who has died of natural causes, whereas a brain-dead donor can donate up to 8 different organs. Other challenges include the lack of adequate infrastructure (specifically in the government sector), specialised transportation for the organs and a national registry to facilitate data collation and organ allocation. Last but not the least, the prohibitive costs (transplantation costs are two times more in private vs. public sector hospitals) make the procedure inaccessible to the poor.
Improving DDOT awareness and implementation — potential solutions
DDOT can be improved by implementing a robust national policy for declaring brain death and making the donor pledge form legally binding. On the other hand, the potential donor’s family can be supported by dedicated grief counselors to make the transition easier. Donors and their families can be honoured or initiatives such as a tree-planting drive can be conducted in the donor’s memory. Social support for cremation rituals can also be provided to acknowledge their contribution and to encourage others to pledge their organs similarly.
Cultural barriers to DDOT can be addressed via Information, Education and Communication (ICE) teams who can reach out to the general population with the help of health workers, social media, religious leaders and key opinion leaders to clear myths and misconceptions about organ donation. Organ donation pledges can be linked to driving license applications and disseminated by caller tunes.
Medical hurdles in transplant hospitals can be supported by a dedicated transplant procurement manager and a multidisciplinary team who can identify potential donors and proactively recruit them by creating awareness. State-of-the-art donor care can be implemented with the rapid transport of organs to increase their viability. Key features from states with successful DDOT programmes can be enforced across the country. A ‘One Nation One Policy’ can be instituted for digital organ allocation to ensure a transparent system at the regional, state and national levels. A uniform data collation and management system can be applied to ensure that the right organ reaches the right recipient at the right time.
Making every effort count
Lastly, all stakeholders must be knit together by the government’s policy which should aim for developing self-sufficiency in organ transplantation. Each link in the organ transplant chain—the donor, the non-transplant organ retrieval center, integrated organ allocation system, affordable care at transplantation units in hospitals—can be optimised to bridge this life-saving resource gap. This November 27, as our country observes Organ Donation Day, let us pledge to donate our organs to save lives even after we are gone and encourage others to do so too.