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From UPSC perspective, the following things are important :

Prelims level: Laws related to organ transplantation in India

Mains level: India's kidney crisis, challenges in procurement, transplant laws and Need for reforms

What’s the news?

India faces a grave crisis in its healthcare landscape, particularly concerning the shortage of kidneys for transplantation.

Central idea

India is grappling with a severe kidney crisis, marked by an alarming demand-supply gap in kidney transplantation. While kidney transplantation is the most effective treatment for end-stage renal disease (ESRD), India’s regulatory framework presents formidable obstacles to innovative kidney exchange methods.

In 2022, over two lakh patients required kidney transplants, but only about 7,500 transplants, a mere 3.4%, were performed.
This alarming disparity can be attributed to the high prevalence of chronic kidney disease (CKD) in India, which affects approximately 17% of the population.
CKD often progresses to end-stage renal disease (ESRD), for which kidney transplantation is the most effective treatment in terms of quality of life, patient convenience, life expectancy, and cost-effectiveness.
However, India lags far behind developed countries like the United States, which performs about 20% of the needed kidney transplants.
Importantly, this gap is not solely due to a lack of medical facilities but is largely influenced by stringent regulations in India.

Obtaining kidneys from deceased donors is one of the primary methods in India.
However, this method faces challenges due to low donation rates, specific conditions required for the nature of death, and the infrastructure needed to collect and store organs.
Families’ willingness to donate organs after a loved one’s death remains relatively low.

Another method for obtaining kidneys is through living relatives or friends.
Patients can request a kidney donation from a willing living individual who is a compatible match.
This approach requires compatibility in terms of blood type and tissue type, which can be a significant obstacle. It also involves complex emotional and ethical considerations.

Regulatory Barriers: Stringent regulations in India hinder innovative kidney exchange methods, such as kidney swaps and kidney chains. These regulations limit the participation of non-near-relatives in kidney swaps, and altruistic donations for kidney chains are often illegal.
Lack of Kidney Chains: Kidney chains, a method involving a series of altruistic donations, are nearly non-existent in India due to legal restrictions. In most Indian states, it is illegal to donate a kidney out of altruism.
Black Market for Kidneys: The stringent regulations around kidney exchange have led to the emergence of black markets for kidneys in India. The reference to selling a kidney is a mainstream expression, indicating the prevalence of such illegal operations.

Stringent Regulations: Current regulations impede innovative kidney exchange methods, hindering non-near-relatives’ participation and banning altruistic donations in many states.
Missed Opportunities: India has missed chances to expand kidney supply through effective methods like kidney swaps and chains due to legal barriers.
Disparity in Regulations: Inconsistent regulations between swap transplants and direct donations raise questions about fairness.
Lack of Coordination: India lacks a national coordinating authority, making it difficult to create diverse donor-recipient pools.
Black Market Concerns: Stringent regulations have led to a black market for kidneys, endangering those involved.

Transplantation of Human Organs and Tissues Act 1994: This legislation laid the foundation for organ transplantation in India by recognizing the possibility of transplants from brain-stem death.
2011 Amendment: In 2011, an amendment legalized swap transplants and initiated a national organ transplant program in India. This represented a significant step toward expanding transplantation options.
Reforms in February 2023: The government introduced reforms in February 2023, offering more flexibility in age and domicile requirements for organ registration. While noteworthy, the article suggests that these reforms fall short of addressing the core issue of inadequate kidney supply.

Altruistic Donations: Emulate countries like the US and the Netherlands in legalizing and encouraging altruistic kidney donations to expand the donor pool.
National Registries: Follow Spain and the UK by establishing national-level registries for kidney chains and swaps to streamline coordination.
International Collaboration: Explore international partnerships as seen in Spain to broaden the donor and recipient network.
Continuous Improvement: Commit to ongoing regulatory enhancements, inspired by the success of the United States in facilitating kidney swaps and chains.
Patient-Centric Approach: Prioritize patient-centered policies, drawing from global models, to improve patient access and quality of life.

Reforming India’s kidney transplant laws is not only a matter of urgency but also a humanitarian imperative. Along with the domestic reforms, learning from global best practices is the key to addressing this critical issue and ensuring a brighter future for kidney transplant recipients in India.

Also read:

Organ transplant rules In India: A Significant Step