The case for charity must begin at home
Considering India’s legacy of sages devoting organs for the sake of devas, organ donation rate in the country is pitiable. Increased awareness can change the situation
India is a country where sage Dadhichi donated his bone to save the lives of the devas. Given this grand legacy, donations should be an abiding value in the country. But when it comes to donating organs after death, to save lives, modern India presents a very uncharitable scenario. The fact is no donation can be as big as organ donation; donation of a single brain-dead patient can save multiple lives in one go. India lags far behind in this act of charity in comparison to other countries — it is a situation in the midst of plenty of organs to donate which remains unused. The sheer number of people who die of fatal accidents in India, there should be a surplus of organs to donate, but thanks to social and religious beliefs, they go to waste while large number of end-stage ailing people wait years for matching organs suitable for transplant. Awareness can change this, but that calls for a concerted campaign to underline the virtues of organ donation.
Organ donation rate in India is the lowest in the world. Within India, south is better than the northern part of the country on this score. It is merely lack of awareness which pushes north Indian States behind south Indian States such as, Tamil Nadu and Andhra Pradesh. A survey conducted for 2012-14 revealed that Tamil Nadu registered 350 cadaver donors whereas Delhi could get only 59. During this period, Kerala and Andhra Pradesh registered 105 donors each. Total organ retrieved in the said period by south India (Kerala 1,057) was several times more than northern States (Delhi 144). Lack of awareness and superstitions takes a heavy toll and, thereby, results in huge demand-supply gap in organ donation and transplant. Over five lakh people die awaiting organ transplants because of non-availability of organs. They die while on the waiting list as they do not get an organ on time. A brain-dead person's organs can give a new lease of life to at least nine patients suffering from organ failure.
Organ famine in India presents a very precarious scenario. Out of an estimated two lakh patients who need dialysis and transplant every year, only about 10,000 patients are able to get dialysis and only 6,000 patients are lucky to get a transplant done. 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. The annual requirement of hearts is estimated to be around 50,000 and lungs about 20,000. Every year, nearly 1,000,000 lakh people suffer from blindness and await transplant. But the rate of organ donation is as low as 0.3 per million population. India ends up losing approximately two lakh kidneys and other vital organs which could otherwise save many live. The need of the hour is also the country should bring changes in organ donation laws to alleviate the situation. Keeping in mind the overriding need of organ donation, BLK Super Speciality Hospital, initiated a campaign in 2016, called ‘Recycle Life’ to keep alive the legacy of those who give others a chance to live. It encourages people to join hands to pledge organs and make a difference.
In a span of four years, BLK Super Speciality Hospital has managed to transplant more than 500 organs and helped bridge the wide gap between demand and supply of organs. However, there is a long way to go. The staff involved in it found that the biggest problem is acute grief reaction of victims' family, a time not appropriate for such a dialogue as to persuade them for the donation. It is also time to move from Donors after Brain Dead to Donors after Circulatory Death. India needs to make centralised registry system for both DBD and DCD organ harvests. The success of this case also demonstrates the growing capabilities and expertise of our Indian surgeons as well as the crucial aspect for donating organs.
Transplantation is the best and, frequently, the only life saving treatment for end-stage organ failure, “Rafael Matesanz, MD, PhD, director of Organización Nacional de Trasplantes (ONT) in Madrid, Spain, and colleagues wrote, “In 2014, 119,873 solid organ transplants were performed worldwide; Although impressive, the annual number of organ transplants represent less than 10 per cent of the global needs. Organ shortage leads to deaths and poor quality of life for those on the waiting list. The example of Spain is worth emulating. In less than a decade, Spain increased from 15 donors per million populations to 40 donors per million populations through the ONT model. The Spanish model relies on healthcare professionals, namely intensive care physicians, to emphasise the importance of organ donation when a patient dies under circumstances that allow for organ donation.
The model prioritises identifying donation opportunities in emergency departments and hospital wards, in addition to intensive care units. Circulatory death — when circulation, heartbeat and breathing stops, as opposed to brain death is also a circumstance in which donation is considered under this model.
One strategy that has increased the pool of potential donors has been to identify patients with devastating brain injuries in whom further care has been deemed futile and posing the option of elective, non-therapeutic intensive care to facilitate organ donation. Organ donation is one consideration in the transition from active treatment to palliative or end-of-life care, and the responsible physician discusses organ donation with relatives as part of standard practice.
(The writer is Senior Consultant and Director, Nephrology and Renal Transplant Services, BLK Super Speciality Hospital)
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