India's transplant woes: Should everyone be signed up as donors by default?

Organ donation in India is as low as 0.3 per million population.
India's transplant woes: Should everyone be signed up as donors by default?
India's transplant woes: Should everyone be signed up as donors by default?
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With organ donation in India continuing to be as low as 0.3 per million population, leading health experts have called for an 'ethical and equitable' organ donation programme in India so that the benefits could reach the truly needy.

In India, currently, less than 5,000 kidney transplants are carried out annually against an estimated requirement of over 175,000. Similarly, only 1,000 liver transplants are performed every year in a country where over 50,000 die due to end-stage liver disease, mostly related to preventable causes like Hepatitis B and Hepatitis C. Most of the recipients are economically well-off.

"While paid donations exploit the poor and the vulnerable; deceased donations, if not allocated in a transparent and fair manner, preferentially end up serving only the well-off. This is a serious human rights issue. We need a monitoring system which ensures that the donations are made in an ethical manner and first reach those who need it the most," said Vivekanand Jha, a senior health expert at George Institute for Global Health - India.

According to public health experts, the interventions that are most likely to lead to large change are actions at socio-economic level, change the context in which organ retrieval decisions are made. 

In 2008, after the adoption of the revised 'WHO Guiding Principles and the Declaration of Istanbul', the Indian government amended the Transplantation of Human Organs Act, to improve the role and functioning of the authorisation committees. At the same time, the government has put into place a mechanism to promote deceased donations.

Stating that another area which needs to be looked at are paid donations, Jha said it is another method by which the poor and the vulnerable are being exploited by middlemen. 

"With a promise of a hefty sum in return, individuals agree to donate organs, but eventually receive far less money that what was promised to them. The number of participants for organ donation living below the poverty line actually increased by 20 per cent after the donation and 75 per cent of the participants whose motive for selling the kidney was payment of debts, continued to be in debt," said Jha.

Health experts have also suggested that the government should formulate a policy on organ donation to ensure that all people could become donors on their death unless they join an official register to opt out.

"Unless the person or family had previously expressed a clear wish for or against donation, hospitals should be authorised to harvest organs. Relevant authorities should also make it easier to get required permissions and complete procedures in quick time to prevent wastage of vital organs," said Sunil Prakash, Director of Nephrology and Renal Transplant at city-based BLK Super Speciality Hospital.

The BLK Super Speciality Hospital is among top Delhi hospitals and has managed to transplant 592 organs in recent years.

Currently, the situation in India is such that private healthcare has outdone government hospitals in terms of organ donation transplant surgeries. All India Institute of Medical Sciences (AIIMS), which in 2016 had seven organ donors in the hospital, has not been able to do any in the last eight months.

"A high number of transplants is being done in private hospitals. The National Organ and Tissue Transplant Organisation (NOTTO) is helping hospitals in transplantation by connecting hospitals for demand and supply of organs," said Ravinder Pal Singh, Director of Centre for Liver Transplant and Gastro Sciences at Saroj Super Specialty Hospital.

NOTTO is an apex centre for all India activities of coordination and networking for procurement and distribution of organs and tissues and registry of organs and tissues donation and transplantation.

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