Dr Dharmakanta Kumbhakar
(The writer can be reached at drkdharmakanta@yahoo.com)
Organ donation and transplantation provide a second chance at life for thousands of people in India each year. However, thousands of Indians die each year while waiting for an organ transplant as there is an acute imbalance between the number of organs donated and the number of people waiting for a transplant.
Finding an organ donor is the main issue in India. Improper infrastructure facilities, administrative hurdles, lack of centralized registry for organ donation, lack of awareness among people, conservative mindset of people and a lot of myths associated with organ donation affect the organ donation and transplantation scenario in India. At present in India, organ transplantation is running either from relative donor or from unrelated donor. According to the Transplantation of Human Organs and Tissues Rules, 2014, when the donor is unrelated and if the donor and/or recipient belong to a State/Union Territory other than the State/Union Territory where the transplantation is proposed to be undertaken, a No Objection Certificate from the State/Union Territory of domicile of the donor and/or recipient is required. Such a certificate is not required for a donor who is a relative of the recipient.
Most of the transplants among unrelated people are currently being done with the approval from an authorization committee. The quorum of the authorisation committee should be minimum four and is not complete without the participation of the chairman, secretary (Health) or nominee and director of Health Services or nominee. The authorisation committee is required to take the final decision within 24 hours of holding the meeting for grant of permission or rejection for transplant and the decision of the authorisation committee should be displayed on the notice board of the hospital and the website within 24 hours of taking the decision. The website of the transplantation centre is linked to state/regional/national networks through online system for organ procurement, sharing and transplantation. The National Organ and Tissue Transplant Organization (NOTTO), an autonomous body under the Union Health Ministry, is the nodal agency coordinating all organ transplants in India.
Kidney transplants in India first started in the 1970s and since then India has been a leading country in the field of organ transplant in the subcontinent. There are currently over more than 100 transplant centres in India performing kidney transplants. Very few transplant centres in India undertake liver transplants, while some do an occasional heart transplant. The evolutionary history of organ transplants in the last five decades has witnessed commerce in organ donation becoming an integral part of the programme. The growing disparity between the rich and the poor, demand for human organs and availability of technology in the country makes the trading of organs a quick means to riches for some and a relief for others. Invariably, organ trade leads to exploitation of the poverty–stricken people by tempting them with financial gains to meet their immediate short–term financial needs.
Making organs a commodity is fraught with erosion of social, moral and ethical values and is not an alternative that can be acceptable to meet organ requirements in a civilized society. The World Health Organization (WHO) in its statement on the sale of human organs clearly states that it violates the Universal Declaration of Human Rights as well as its own constitution. So, the Government of India passed the Transplantation of Human Organ Act in 1994 which made unrelated transplants illegal and deceased organ donation a legal option with the acceptance of brain death. Deceased organ donation is the process of giving an organ or a part of an organ at the time of the donor's death for the purpose of transplantation to a needy person.
The concept of brain death has never been promoted or widely publicized in India. So, there is a problem of certifying brain deaths in India as most of the Indian people are not aware of what is brain death. Hence, it becomes difficult to convince the relatives of the patients in India for deceased organ donation.
Deceased organ donation from the brain dead, also referred to cadaveric organ donation, is still very low in India. While Spain has 43.9 deceased organ donors per million people and the US has 30.9 deceased organ donors per million people, India's count stands at a mere 0.8 deceased organ donors per million people. In Assam it is almost nil. Anyone from a child to an elderly person can be an organ donor. Vital organs such as heart, liver, lungs, kidneys, pancreas and intestines, and tissues such as corneas, heart valves, skin, bones, ligaments, tendons, veins, etc., can be donated in case of brain death. It is not that the Indian people don't want to donate organ, but there are no mechanisms in hospitals to identify and certify brain deaths. Moreover, no one empowers the relatives of a brain–dead person to save lives by donating his/her organs.
In India, the potential for deceased organ donation is huge due to the high number of fatal road traffic accidents and this pool is yet to be tapped. At any given time, every major city would have 8–10 brain deaths in various ICUs. Some 4–6 per cent of all hospital deaths are due to brain death. In India, road accidents account for around 1.4 lakh deaths annually. Out of these, almost 65 per cent sustain severe head injuries as per an AIIMS, Delhi study. This means there are almost 90,000 patients who may be brain dead annually.
A living person may wish to donate organ after his brain death. Signing a donor card is the first step in making your wishes about donation known. A donor card is not a legal document but an expression of one's willingness to donate. While signing a donor card demonstrates one's desire to donate organ after death, letting the family or friends know about the decision is very important. That is because family members will be asked to give consent for the donation. The decision will be considered final when they give consent.
In the near future, the emerging field of regenerative medicine may create organs, to be regrown from the patient's own cells (stem cells, cells extracted from the failing organs). This would improve the availability of compatible organs.