India continues to perform poorly on organ donation. Along with changes in the law, people must be persuaded about how they can make a difference. Awareness regarding this is a must
In 2016, Spain conducted a total of 4,818 organ transplants. It translated into 43.4 individual donors per million people (pmp), a figure much higher than the US’ average of 26.6 or the EU average of 19.6. For over two decades, Spain has been the world leader when it comes to organ donation, thanks to a robust system and high numbers of deceased organ donors. Among the many factors that make Spain’s organ donation a huge success are a highly organised process of deceased donation as well as an “opt-out” system wherein all citizens are automatically registered for organ donation unless they specifically choose otherwise. Other countries that rank high on organ donation rates include Croatia, France, Norway and Italy.
India, on the other hand, continues to fare poorly with thousands of people dying annually while waiting for a transplant of a vital organ. According to Ministry of Health and Family Welfare’s estimates, the annual requirement for kidneys in India ranges between one to two lakh. However, a paltry 5,000 transplants actually happen. A majority of these are from live donors rather than cadaver donors.
According to a paper published in the Journal of Medical Sciences, India’s need for liver transplantation is estimated to be around 20/million population or 25,000 per year. However, just around 1,200 and 1,400 liver transplants were performed in 2013 and 2014 respectively.
As often discussed, a poor rate of cadaver donors has been a major challenge to India’s organ donation programme. According to estimates, the deceased organ donor rate in India stands at around 0.34 per million, which is much lower than the developed countries. An overwhelming majority of organ donors in our country are live donors, who are either related to the patient or are part of an organ swap arrangement. Lack of awareness about brain death, socio-cultural factors, religious beliefs and lack of organisational support, including enough transplant centers and well-trained transplant coordinators, are major challenges to our organ donation programme.
Since 2011, a rule was introduced in the Indian law and amendments to introduce a provision of “required request” for intensive care doctors to ask for organ donation in the event of brain death. However, the concept of brain death still confounds people and a lack of efforts to improve awareness implies a status quo persists.
People are unaware of the concept of brain death, where a person suffers from irreversible brain damage because of head injury or stroke but other organs function with or without support. In India, around 1.5 lakh people suffer from fatal road accidents annually, many of whom end up brain dead and are ideal candidates for organ harvesting. Even if half the number of these brain deaths translates into organ donation, many lives can be saved. However, with the heart still beating, it becomes difficult to convince the family to donate the body for organ retrieval.
Not only is there a dire need to initiate campaigns to educate people about the concept of brain death and how it is an irreversible phenomenon, there is also need to have more trained transplant coordinators, counsellors and facilities to harvest these possibilities. One organ donor can save up to eight lives by donating heart, two lungs, pancreas, two kidneys and intestine.
Should we consider the “opt out” system? Spain, as discussed above along with several Western countries, follows an “opt out” system of organ donation under which every citizen is considered an organ donor unless they “opt out” and notify their decision on an organ registry. England is the latest country to adopt this approach. As a country struggling to bridge disparity between demand and supply of organs, India must also consider the “opt out” system of organ donation to improve the rate of deceased donors.
Some experts believe that as a country with high levels of illiteracy and lack of awareness, India might not yet be ready to make the shift to an “opt out” system. This argument does hold ground, especially given the fact that religious beliefs are also associated with the dead. Some communities even consider a post-mortem as a desecration of the human body. There are also myths associated with organ donation. And some communities believe it is against their religious beliefs.
To be fair, no such initiative can succeed unless accompanied by adequate awareness among the masses. It is, therefore, important to involve influential people such as popular celebrities, sportspersons as well as religious leaders as part of awareness campaigns.
India has already adopted the practice of providing the option of pledging organs on the driving licence. In 2018, the Government mandated a change in the format of the driving licence to display whether the individual has pledged his/her organs in case of brain death. Much like the driving licence mentions the blood group of the individual, it will also now include a column stating whether the individual consents to become a donor.
For people, who have never heard or know about organ donation, the option to ask for their consent on a driving license can prompt them to inquire about the possibility of organ donation and agree to the noble act. This has been a welcome move. However, this also needs to be accompanied by awareness drives to educate and encourage people to pledge their organs.
(The writer is Managing Director of a private healthcare company)