Mentors Comments:

• https://www.thehindu.com/opinion/lead/getting-organ-donation-to-tick-again/article30118791.ece
• What is the importance of organ donation in India and it’s current status?
• What are the challenges for the same?
• Highlight solutions to tackle the issues around it.

Answer:

The shortage of organs is virtually a universal problem but Asia lags behind much of the rest of the world. India lags far behind other countries in Asia.  It is not that there aren’t enough organs to transplant. Nearly every person who dies naturally, or in an accident, is a potential donor. Even then, innumerable patients cannot find a donor.

What is organ donation?

• Organ donation is the donation of biological tissue or an organ of the human body, from a living or dead person to a living recipient in need of a transplantation.
• Transplant: A transplant is a medical procedure where one person’s dysfunctional organ or tissue is replaced by that of a healthy person, thus restoring its function.

Importance of organ donation in India:

• According to the report, at least more than 5 lakhs of the Indians are dying every year just because of the failure of their major functioning organs anytime.
• They still want to live their life as they are not fully satisfied with their life and want to live more.
• The organ transplantation could play a major role in their beautiful life by increasing their period of living a life more than expectations.
• The donor of the organs plays the role of God in the life of an organ transplanted person.
• Thus, donating an organ is like gifting life to someone because one organ donor can save up to eight lives.
• Every year, nearly 150,000 people await a kidney transplant, but only 5000 get one.
• In India, the country of 1.2 billion people, the PMP i.e. persons as organ donor per million population is just 0.08 which is extremely low compared to other countries.
• Every year, nearly 1,000,000 lakh people suffer from blindness and await transplant.
• Demand and supply gap (Annual)

Government initiatives to promote Organ transplantation

• • To improve access to transplantation for needy patients by promoting deceased organ donation, the Government has put in place the National Organ Transplant Programme (NOTP).
  • Under this programme, an apex level National Organ and Tissue Transplant Organisation (NOTTO) at New Delhi.  NOTTO disseminates relevant information to all concerned.
  • Five Regional Organ and Tissue Transplant Organizations (ROTTOs) at Chandigarh, Mumbai, Chennai, Kolkata and Guwahati have been set up.
  • The Government has released funds to establish State Organ and Tissue Transplant Organizations (SOTTOs) in the States of Madhya Pradesh, Kerala, Rajasthan, Haryana, Goa, Jammu & Kashmir, Odisha and Uttar Pradesh to organize an efficient mechanism for organ and tissue procurement/retrieval to promote deceased organ and tissue donation.

Issues and Challenges:

• Demand and Supply Gap: Huge gap between demand and supply of organs.
• Socio-cultural beliefs: Religious beliefs hinder deceased organ donation. Superstitions prevalent such as being born (rebirth) with a missing organ (that has been donated), being tangled in the life-death-rebirth cycle
• Lack of awareness: The concept of ‘brain death’ and its legal implications unfamiliar to the majority of the Indian population
• Infrastructural issue: Limited facilities for transport of donated organs; no air ambulance facilities
  • Lack of training for intensive-care unit personnel to maintain brain dead person
  • Lack of awareness among doctors
  • Lack of effective transplant coordinators
  • Not all hospitals in India are equipped to carry out the process of organ transplantation and retrieval.
  • Out of 301 hospitals equipped to handle the process, only 250 are registered with National Organ and Tissue Transplant Organisation (NOTTO)
• Wastage of organs: Organs (especially hearts and lungs) not used due to lack of suitable recipient. This leads to wastage of organs.
• High Cost of transplant surgeries: Unregulated cost of transplant surgeries; cost out of reach of poor people
• Regional Variation: All states in India do not have active organ donation programmes. Organ donation rates in North India is abysmally poor.
  • Further, since health is a state subject, there are issues with the implementation of THOA
  • There are only 5 Regional Organ and Tissue Transplant Organisation (ROTTO)
• Negative propaganda by media: False proclamation of “scandals”; organ rackets
  • News of improper practices of organ collection breaks public trust and is an impediment to the entire process of organ donation

Way Forward:

• Public awareness: Reducing the shortage of organs by promoting deceased organ donation
  • Public awareness is the most important step that can lead to improved rates of deceased organ donation
  • Example: In 2017, the Andhra Pradesh government had initiated the screening of “Punarjanam” (one -minute short film on organ donation) before starting of each show for one week.
• Infrastructure: Increasing the number of transplantation centres
  • Training transplant coordinators
  • Training doctors, paramedical personnel
  • Improving transport of organs; developing air ambulance services
  • Proper storage facilities; setting up tissue banks
• Finance: Reducing the problem of finances; reduction in cost of transplants
  • Financial support for poor
• Organizational: Strengthening the role of NOTTO for coordinating the organ distribution system
  • Effective centralised organ donation registry
• Legislation: Declaring brain-death should be made mandatory in all hospitals
  • The Centre proposed to amend the law on motor vehicles to include a choice for voluntary organ donation in new or renewed driving licenses. The draft to amend the Central Motor Vehicles Rules, 1989 should be implemented
• Ensuring zonalization of organ sharing: To ensure more effective sharing of organs a zonalization should be done (the USA has such a provision). This would help in transporting and transplantation of organs which can be preserved only for shorter durations e.g. hearts.
• Process of allocation to be more transparent: The process of allocation of organs should be made more transparent. It should be made monitored and tracked; made accessible to the public.
  • Further, the outcome of transplantation should be properly monitored.
• Responsible media: The media should be more responsible before proclaiming scandals, rackets. Information should be properly investigated before being published.

It is suggested that we need to switch over to either presumed consent or opting-out system of consent and tap cadaver organ pool from traffic accidents, brain dead patients along with generating awareness amongst masses about organ donation. In India, the potential for deceased donation is huge due to the high number of fatal road traffic accidents and this pool is yet to be tapped.