(By Dr. Edmond Fernandes and Dr. Neevan Dsouza)
The story of organ donation dates back to 1965 when the first human kidney transplant was performed on a cadaveric donor at King Edward Memorial Hospital in Mumbai. However, the donor succumbed to the surgery and the receiver of the transplant died on the eleventh day post-surgery. Today, India has come a long way since that.
In 1994, the Transplantation of Human Organs Act was passed to provide for removal, storage and transplantation of human organs for therapeutic purposes and for prevention of commercial dealings with regard to human organs. This act served to strengthen the curbing of malpractices like kidney rackets where people would sell off one kidney for as little as Rs 25000. Scott Carney, in this book â€śThe Red Marketâ€ť, describes how India continued the business of illegal transplants and how a village in rural Tamil Nadu came to be called as Kidneyvakkam because most people in the village sold off their kidneys after being convinced that they will get more money and that two kidneys are not required for survival.
The current practice of organ donation for a first degree relative is comparatively easier with just a cross matching test that is required to be undertaken before any elective surgery. The proof of relationship is vetted through a legal document check. Organ donation can also be done when the person is brain dead, but the death has to be certified by a board of four medical experts before the personâ€™s organs can be removed.
In the present scenario, around 7500 kidney transplant surgeries take place at 250 transplant centres across the country. Among these, 90 per cent are living donors while 10 per cent are deceased. In the absence of a national transplant registry, the accuracy of the data can only be estimated roughly. Many groups have come forward to promote and pledge for organ donation. Among the organs that can be donated, the ones most commonly sought after are the kidneys, eyes, lungs and the heart. However, the number of doctors qualified to perform transplant surgeries is abysmally low and the escalating cost of transplant surgeries pushes families to the brink. The success rate of transplant surgeries is also questionable due to various factors. A lack of political will by the government, to deal with this dangerous situation given that human lives are at stake, is surprising. When will the nation start getting serious about saving patients suffering from kidney diseases, and how can awareness be created about organ donation.
In a study conducted by Usha Bapat, among 123 medical postgraduate candidates, she found that 69 per cent of the postgraduates were willing to donate the organs of their family members and eighty-nine percent wished to donate their organs but the study concluded that the condition of brain death was understood by only a small percentage of postgraduates. It is pertinent to note that if brain death is known to only a limited few among the medical community, then people from other fields would be even more ignorant about it.
Most often, it so happens that even if the person is willing to donate the organ, they donâ€™t know whom to donate to and how to pledge the organ. Ethical implications are way too many and often include serious emotional challenges. Many a time, although the person deceased has pledged for organ donation, the first-degree relative does not allow for the same because of emotional attachment. Organ donation needs to be done within 6 hours after the person is dead and the body needs to be returned to the family once the organs are removed. The body needs to be cleaned and returned in the same condition as it was taken.
In January 2016, the Government of Indiaâ€™s Ministry of Health issued draft guidelines to streamline kidney transplant in the country. The document listed several hospitals where a patient may be registered for inclusion in the list for cadaveric transplants. Different parameters would be looked into before the graft allocation scoring gets confirmed. The challenge for India to address the burden of increasing daily donors remains large. But it is compounded with multiple factors that spell success and failure for the country. The rising middle class, disproportionate assets among the rich and poor, lack of universal health cover simply makes organ donation a business where people often get taken for a ride. Organ trade in India is linked to societal and cultural issues. While we begin to promote organ donation, we need to protect the poor so that they are not exploited in this emerging market.
India is far from regularizing organ donation. Major steps need to be taken with regard to setting up of registries, activating emergency organ donation and setting up a dedicated website for registration, queries under all state health ministries. Mainstreaming organ donation should be taken up on priority by companies coming under the remit of Corporate Social Responsibility.
(Dr. Edmond Fernandes is Member â€“ Health Task Force, DDMA, Government of Karnataka and CEO, Center for Health and Development, Mangaluru, Dr. Neevan Dsouza is a Consulting Biostatistician and Administrative Co-ordinator, Center for Health and Development, Mangaluru).