By Sanjay Raman Sinha
In a recent edition of “Mann Ki Baat”, Prime Minister Narendra Modi urged the people to donate their organs and save lives. He also announced that the government had decided to abolish the age limit of 65 years for organ donation.
With these changes in the offing, patients who are 65 years and older can now register for receiving organs from a deceased donor. Which means more transplantation, but the shortage will persist.
India performs the third-most number of transplants in the world, but according to WHO, only about 0.01% of Indians donate their organs after death. Of course, these have to be cases of brain death so that the organs can be harvested.
Dr Naresh Chawla, Vice President, Delhi Medical Council, told India Legal: “No doubt raising the limit of organ donations beyond 65 years is welcome because the life span of people of India is rising but the shortage of donors is acute. People have to be made aware of organ donation and pledging of organs has to improve. Only organ donation sensitised people take a positive decision at the last moment when it is mentally and emotionally most difficult to do so.”
The Directorate General of Health Services website reads: “There is a wide gap between patients who need transplants and the organs that are available in India. An estimated around 1.8 lakh persons suffer from renal failure every year. However, the number of renal transplants done is around 6,000 only. An estimated two lakh patients die of liver failure or liver cancer annually in India, about 10-15% of which can be saved with a timely liver transplant.”
The right to life is an inalienable right and by making organ transplant easy, the State makes this right more accessible. The Transplantation of Human Organs (THO) Act was passed in 1994. It was aimed at streamlining organ donation and transplantation activities, including removal, storage and transplantation of human organs for therapeutic purposes and for prevention of commercial dealings in human organs.
The Act accepted brain death as a form of death and made the sale of organs a punishable offence. With the acceptance of brain death, it became possible to not only undertake kidney transplantations, but also do organ transplants such as liver, heart, lungs and pancreas. Despite the THO legislation, organ trade and kidney scandals are rampant.
Furthermore, the Union Health Ministry has recommended that all states do away with the domicile criterion for registering to receive organs so that patients can register in any state. The ministry also requested that states not impose any fees on patients seeking registration for organ transplantation as it violates the 2014 Transplantation of Human Organs and Tissues Rules. Acceptance of these recommendations can transform the organ transplantation landscape in the country.
Under THO, an organ may be sourced from
- A near relative donor: mother, father, son, daughter.
- Other than a near relative donor: Such a donor can donate only out of affection and attachment, subject to the approval of the authorisation committee.
- Deceased donor, especially after brain stem death, could also be someone who has suffered cardiac death.
However, for kidney and other organs, transplant from blood kin is necessary as this enables biological compatibility.
The government amended THOA 1994, and consequently, the Transplantation of Human Organs (Amendment) Act, 2011 was enacted. Herein the “near relative” definition has been expanded to include grandchildren and grandparents. There is a provision of swap donation of organs. A provision of mandatory “Transplant Coordinator” in all hospitals registered under the Act has been included. More, importantly, to protect the vulnerable and the poor, a provision of higher penalties has been made for trading in organs.
The major source of organs and tissues in the West has been from cadaveric (dead) donors. Living tissue deteriorates quickly, and organs need to be cooled and transported for implantation into the recipient fast within a medically stipulated time. In India, however, the cadaver transplant technology is not operational and therefore, organ transplant is a challenge.
Organ sales are banned in India and no foreigner can get a local donor. Human organ transplant laws are very strict in India and the penalty incurred for organ trade is also very high. As per surveys, 72% of the population was willing to donate eyes, but less than 50% was willing to consider solid organ donation. Plus, 74% of Hindus, 72% of Christians and 58% of Muslims were willing to consider organ donation. The concept of brain death is new and people are yet to accept it.
The hesitancy of people to donate organs is a major cause of organ shortage. Obtaining permission from the relatives of the deceased is also a major hindrance. Dr Chawla explained: “In any part of the world, but more particularly India, when family bonds are strong, it is difficult for most people to agree for organ donation, particularly among young deaths and when brain death is yet to occur. But people have to be sensitised in normal times so that they become positive for organ donation in times of crisis.”
Laws have been put in place, but medical technology and societal attitudes and values are found to be wanting. Organ donation and transplant is as much a medical issue as a social challenge. Hence, change will take a long time coming.