Organ donations for transplant in India has seen a recent surge. Total organ donations have gone up from 1,149 in 2014 to 2,870 in 2017. This includes a two-and-a-half times increase in kidney and liver donations, and a 6.5 times rise in heart donations.
Some relevant data:
- Less than one in a million Indians donates an organ.
- More than three million Indians have died for want of a life-extending transplant since 2005.
- Just 9,000 out of 200,000 patients needing a kidney get one.
- India has only 301 hospitals that can perform organ transplantation which means there exist only one hospital equipped for organ transplantation and retrieval for around 43 lakh people.
- At a given point of time, about 1 lakh people die of liver diseases in India and only 1,000 get liver transplant.
Primary challenges to organ donation in India:
- Lack of Infrastructure – Out of 301 hospitals equipped to handle the process of organ transplants, only 250 have registered with National Organ and Tissue Transplant Organisation (NOTTO). Which means to conduct an organ transplant, there exists one fully equipped hospital for around 43 lakh people. Currently, in India, there are only 5 Regionl Organ and Tissue Transplant Organisation (ROTTO) and 6 State Organ and Tissue Transplant Organisation (SOTTO) are in the proposal state. Lack of trained retrieval and transplant surgeons and other trained manpower are also major issues.
- Strict timeframes – A kidney can be preserved for 12-18 hours, a liver for 8-12 hours and hearts and lungs should be transplanted within six hours, otherwise outcomes are likely to be poor. So while sharing of livers and kidneys across the country is possible, it is very difficult as far as hearts and lungs are concerned, considering the size of our country. In the absence of a viable and accessible air ambulance service to transport organs, feasibility will depend on the timing of the donation and the flight schedules of commercial airlines.
- Lack of Education and Awareness – Lack of proper education to the attendants of a brain dead patient, lack of awareness among general public about organ donation, organ donor cards, process of organ donation, add to the superstitions and misconceptions associated with organ donation in our country and make organ donation a tedious task.
- Opaque Process – A particular concern is the opaque process in harvesting and transplanting organs. The bias in implementing organ transplant laws has raised suspicions about a lack of transparency. The Transplantation of Human Organs and Tissues Rules clearly give priority to citizens enrolled on the state and national waiting lists rather than foreigners. But in some cases (e.g. in Tamil Nadu), it has been found that hospitals and surgeons perhaps make preferential allotment to foreign patients, possibly with overriding commercial factors.
- Lack of trust in the system – Organ donation is a highly emotive topic. When a family agrees for organ donation, they are making a decision to be generous to some unknown person in the midst of a great personal crisis. For this to succeed, they should have utmost trust in the process of organ donation and allocation. Even in highly developed countries, donation rates drop temporarily when news of suspicious practices surfaces.
- Creation of Infrastructure and trained personnel – There is a need for a structured network of transplant centres, organ donation centres and transplant co-ordinators. Moreover, doctors and personnel trained for organ transplants are needed.
- A fair allocation infrastructure – A uniform organ allocation infrastructure needs to be realised in both the public and private sectors, along with the need for more transparency in availability of outcomes after transplantation. The practices of favoritism to the rich and affluent need to be checked.
- Creation of a publicly funded air ambulance service – for speedy transportation of donated organs.
- Tracking of donated organs – Each donated and allocated organ must be tracked so that it is transplanted in a systematic manner and corrupt practices are prevented. This would also boost the trust of the donor/family of the donor.
- Need for outcome registries – A registry needs to be created where the results of all organ transplants can be maintained which can help understand the quality of life after transplant (for a minimum of 1 year) and the rate of success. Kidney transplantation has been practised in India for over 25 years. There is public confidence in the procedure. On the other hand, liver transplant as a treatment whose results in India were poor in the early stages has been witnessing increased success and as a result the demand for liver transplants has increased. Thus maintenance of a public registry would also boost public trust in the process of organ transplants.