The shortage of organs for transplant is growing by the day. It is now clear that tweaking laws alone will not do and the focus must shift to spreading awareness that organ donation is a noble and life-saving act
By Deepti Jain
One of the worst kept secrets of the medical profession in India is the rampant and illegal trade in body organs. The unearthing of a kidney racket last fortnight in Delhi further underscored this dark malaise. It led to the arrest of five persons, including the personal staff of a nephrologist at the prestigious Indraprastha Apollo Hospital. The racket also exposed the network of middlemen who lure poor donors to sell their body parts for a relatively small sum and then resell it to prospective recipients at highly inflated prices.
Alarmed by the development, the Delhi government has ordered a probe and a committee will investigate whether there were procedural lapses on the part of the hospital. A team headed by Dr DK Tampe, dean of the Maulana Azad Medical College, will be examining the role of the hospital. Mean-while the police are continuing their investigations into the kidney racket which reportedly spanned several states.
More than anything else, the latest case only reiterates why the illegal organs trade flourishes in the country despite the 2016 Cadaver Transplant Policy relaxing the norms for recovering organs from the bodies of accident victims or those declared brain dead at hospitals. According to doctors, there is an increasing gap between the demand and the supply of organs for transplants in this country which allows the illegal trade to flourish. The human organ black market is reportedly worth `250 crore a year
The shortage of organs for transplants has been further compounded by the fact that the system of timely recovery of body parts from a cadaver is still not in place at several health facilities. Also, very few relatives agree to donate the organs of their deceased loved ones for varied reasons.
ORGANS WASTED
Last year, around five lakh patients died because they failed to get organs for transplant. Even VIP patients fail in this regard. Take the case of former Maharashtra chief minister Vilasrao Deshmukh who died in August 2012 because he couldn’t get a liver transplant. Dr K Ravindranath, MD of Global Health City hospital, Chennai, where he was admitted said the patient might have survived had he got a donor liver in time.
In India, there is need for two lakh kidneys, 50,000 hearts and 50,000 livers every year. However, hardly 2-3 percent of the demand is met. This is primarily because most brain death cases go unreported. Dr Sunil Shroff, head of the Chennai-based Mohan Foundation, an NGO dealing with organ donation, reportedly said: “Such wastage can only be prevented by rolling out mandatory certification of brain death. Also, it is vital for hospitals to have a team of well-trained doctors and nurses who can effectively identify, certify and use brain dead patients for organ transplantation.” His observation is based on the study—“The deceased organ donation environment in Delhi–NCR”—by Parashar and Mohan Foundation.
POLICY IMPERATIVE
The Union Ministry of Health & Family Welfare introduced new guidelines this year for cadaver-based (kidney) donations. This raised the maximum age of a recipient from 65 to 75 years but it accorded priority to children in the 6-12 age group who would get a donor organ before older patients.
However, the policy does not distinguish between the urgency of patients requiring transplants and those who can wait. This has its negative fallout. So even if a 60-year-old requires immediate transplant, he will be asked to wait even as a 12-year-old gets priority even if his need is not as urgent as the older patient’s. There have been cases of patients afflicted with liver cirrhosis or terminal hepatitis C being asked to wait. Rekha Jain, a resident of Gwalior, told India legal, “My husband was diagnosed with liver cirrhosis and was waiting for the transplant for the past three years. But due to shortage, he passed away last month.”
There are four major reasons behind the huge wastage of organs in India:
- Donated organs often do not meet the stringent specifications for transplant.
- Lack of infrastructure for harvesting, storage and preservation of organs from cadavers.
- No centralized registry, hence no records of potential donors and recipients.
- Relatives are reluctant to donate organs of a diseased kith due to superstition.
MINDSET CHANGE
Prathap C Reddy, chairman, Apollo Hos-pitals, put it succinctly in an interview to a business daily: “Don’t take organs to heaven; god knows we need them on this earth.”
A health professional at Apollo hospital in Delhi said how this works. “A few months back, an accident case came to our hospital and our team persuaded the family members to donate the organs of the victim. But they refused on the grounds that their guruji had made them believe that those who donate organs are born disabled and suffer in their next birth.” To change this kind of mindset requires a collective effort from the government, doctors and social activists.
Some other systemic changes have to be introduced to improve the current situation vis-a-vis cadaver transplants. Till now, India has not put in place the “opt-in” framework of organ donation. Under it, harvesting of organs is done only if the donor explicitly agrees to it.
Countries like the US, the UK, Germany and Netherlands already have a proper family consent system in place which helps in increasing the number of donors. These countries are witnessing a two-fold increase in donations per million population (PMP) averaging between 10-30 PMP.
In contrast in India, there are only a few state governments which have tried to improve the mechanism for organ donation. In 2008, Tamil Nadu announced a mechanism to encourage organ donation which includes procedures to be adopted for cadaver transplant, criteria for non-transplant centers to retrieve organs, mandatory declaration of brain deaths, postmortem procedures and a counseling department for all registered hospitals.
Also, the Maharashtra government in 2012 made it mandatory for all non-transplant hospitals to be equipped with an ICU and operation theater so that organs can be transferred to other hospitals urgently. This was announced after Deshmukh’s demise.
There have been other positive initiatives. Green corridors are being created for the smooth transporting of an organ through a series of alert signs at traffic signals. Recently, a green corridor was created by the traffic police from Delhi airport to Medanta hospital in Gurgaon to facilitate the transfer of a heart and liver of an 18-year-old brain dead victim from Indore.
Developing proper infrastructure and better coordination between the various agencies is the need of the hour. But more than that, a vigorous and sustained awareness campaign needs to be launched to alleviate the misery that many face.