“A single person who is brain dead can save the lives of up to eight people,” says Dr Mohankumar, Consultant Urologist and Renal Transplant Surgeon at Apollo Hospitals, Chennai. “We can save so many people’s lives if more people are willing for organ donation,” he says, pointing out that a brain-dead person’s heart, liver, kidneys, lungs, and eyes can all provide new life to others.
Sadly, however, transplant surgeons like Dr Mohan preside over an abysmal situation where thousands of people die each year because of prejudice and lack of awareness about organ donation. According to expert estimates, there is a need for approximately 5 lakh organs per year, but only 2-3% of this demand gets met. While an estimated 1.5 lakh brain deaths due to accidents occur each year, organs are donated by less than a thousand such patients.
“The situation is the exact reverse between the West and India,” says Dr Mohan. “In the West, 90% of kidney donations are cadaveric donations, where the organs are taken from brain dead patients. In India, it’s the reverse, the majority of donations are from live, related donors.”
TN shows the way
That this situation can be turned around can be seen in the example of Tamil Nadu in recent years. “It’s a proud fact that Tamil Nadu is now leading the way in cadaveric donations,” observes Dr Mohan. According to reports, between 2008 and 2016, 4,938 organs were transplanted in Tamil Nadu, and the sustained efforts of the TN government and several NGOs have made it possible to raise TN’s organ donor rates well above the national average. In 2014, for instance, when the national average stood at just 0.34 per million population, TN’s donation rate stood at a heartening 1.9 per million.
Much of this dramatic shift happened because of thorough revamp of legal, medical and administrative procedures for organ donation, all of which made the process much more transparent, trustworthy, and effective. A big part was also played by awareness campaigns among the general public and medical professionals, which helped increase levels of consent for organ donation after brain death. “We also have to appreciate the media, who gave very positive coverage to people who donated their organs.
As heartening as the shift in TN has been, even this leading state has a long way to go before catching up to global levels of organ donation, which stand at around 26 per million population in the US, 35 per million population in Spain, and 36.5 per million population in Croatia.\
Dr Mohankumar, Consultant Urologist and Renal Transplant Surgeon, Apollo Hospitals.
What stands in the way of this shift is a set of misconceptions and prejudices about organ donation, says Dr Mohan. From myths like ‘my religion does not allow me to donate’ – which is untrue since more major religions don’t forbid organ donation, to misconceptions about the process of donation, there is a general lack of public awareness. Here are a few popular myths, and why they are wrong.
Myth 1: Organs can be donated after death
One of the major misconceptions about organ donation have to do with the conditions under which organs can be transplanted, says Dr Mohan.
“We cannot take organs, except the eyes, from non-heart-beating patients, where the heart has stopped pumping blood to the rest of the organs. We can only take organs when a patient is brain-dead, that is where the brain stem has stopped functioning, but the heart and other organs are kept working by the ventilator,” he explains.
Brain death occurs due to traumatic injuries, as in road accidents, or from certain conditions such as aneurysms that affect the brain’s functioning. It is only with such patients, where the rest of the body is kept functioning on a ventilator that the other organs are preserved in a condition suitable for donation.
Myth 2: Doctors may declare brain death prematurely for want of organs
India has a very robust and transparent system for all procedures associated with organ donation, explains Dr Mohan. The entire organ donation process is regulated by The Transplantation of Human Organs Act, 1994, the rules under which were updated in 2008. Under this Act, there are very specific rules governing when a patient can be declared brain dead and eligible for organ donation.
“A team of doctors has to certify that a person is brain dead, and this has to be done after a number of tests over the course of several hours. These doctors have to be empanelled with the government, and none of them will be a part of the transplant team, they are a separate independent team of specialists,” he explains.
Myth 3: Doctors harvest organs for money
Given that India has seen scandals in the past over organ donation, such as the kidney racket in the 1990s and 2000s, it’s not surprising that powerful fears about organ donation continue to prevail. However, as the TN example shows, current cadaveric donation processes have actually gone a long way in preventing such rackets.
This is because much of the donation process is now automated and comprehensively documented, with little room for discretion in individual hands. “The waiting list of those needing organs is all computerised and automated,” says Dr Mohan.
“All of the preference factors (age, severity of illness, duration of waiting for a new organ, and so on) have already been pre-set, and nobody can jump the list. Whoever is the patient at the top of the list they get the priority, irrespective of what background they come from,” he explains.
Myth 4: The person’s body will become disfigured due to organ donation
Dr Mohan clarifies that surgeons carrying out cadaveric organ donations take the utmost effort to ensure that donor’s body is not unnecessarily affected during the process. “We ensure that there is only one suture line through which we access the organs. We only harvest the organs that are necessary, and clearly document what organs have been taken,” he explains.
Myth 5: Organ donation will result in bureaucratic delays
“It’s understandable from the relatives’ point of view that when the patient has been declared brain dead, they want to complete all the procedures and funeral rites as soon as possible,” says Dr Mohan. In line with this, procedures for organ donation have become highly streamlined, so that the donor’s relatives do not have to wait long for the body to be handed over to them. “We usually assure them that the whole process will not require more than three to four hours,” he says.
“We don't know whether there is life after death. But when you donate you can give life to at least eight people. So you can think of this as living even after your death,” the doctor says with a smile. Do you want to be an organ donor? You can register here.
This article was produced in association with Apollo Hospitals by TNM Brand Studio.