Only 10 per cent of patients needing an organ get it: We need more deceased donors

We need to encourage brain stem death declarations in hospitals. Efforts are being made so that organs can be transported seamlessly through air, rail, metro rail and so on. It will be worth its while to explore organ transport via drones going forward, says Dr Sumana Arora, Senior Consultant, NITI Aayog

People hesitate in pledging their organs/agreeing to donate organs of their loved ones largely due to a lack of awareness and superstition (Source: Getty Images/Thinkstock)

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As a young doctor in a government medical college hospital, I remember the time when the parents of a young boy in the emergency room were desperately trying to increase the oxygen flow in their attempt to ease his gasping for breath. Oxygen cylinders are something that can be easily manufactured and provided. But what can one do for patients of end stage organ failure? There is no option but transplants. And till the time we can create organs in the labs or perfect xenografting, we must depend on harvesting organs from another human being, either through living donor donations or deceased donor donations.

There is an inherent risk to the living donor, not to mention the possibility of commercial trading of organs illegally (Designed by Abhishek Mitra)

Recently one of Brazil’s richest men announced that, inspired by the Pharaohs, he wanted his expensive Bentley car to be buried with him so that he can drive around in style in his afterlife. People exhorted him to sell his car and donate the money to charity instead. However, the gentleman was unfazed and even ordered a huge pit to be dug for the car. In an elaborate ceremony, the car was prepared to be lowered to the ground. This ceremony was broadcast live by the media. However, moments before it was done, the gentleman stopped lowering the car and said it was all a stunt. He then asked everyone how his car was more precious than the heart or eyes or kidney or liver that are regularly buried when one dies. Would it not be prudent to donate one’s organs to give a new lease of life to multiple people suffering from end stage organ failure? This apparently insane act turned out to be just a stunt to attract attention to the cause of organ donation.

THE DEMAND SUPPLY GAP

There is a huge gap between the demand and supply of organs and only around 10 per cent of the patients who need an organ get it. It is heartening to note that from 806 transplants in 2000, India has done over 15,000 transplants in 2022. However, over 80 per cent of these 15,000 transplants were living donor transplants. We need to promote deceased organ donation in India as living donor donation alone cannot fulfill organ requirements.

Additionally, there is an inherent risk to the living donor, not to mention the possibility of commercial trading of organs illegally. Furthermore, certain organs like the heart can only be harvested from a deceased donor. The organ donation rate (number of persons donating organs per million population) in India has increased from around 0.16 in 2012 to 0.52 in 2019. However, these are incredibly small and insignificant numbers compared to the statistics around the world. The organ donation rate in Spain and the US are over 40 per cent. Interestingly, the Union Territory of Chandigarh has a rate of 33 per cent and the state of Telangana has a rate of over five per cent even though the national average is under one per cent.

CAN WE MINIMISE TRANSPORT CHALLENGES?

It is in the above context that every organ donated is precious and needs to be transplanted in the shortest possible time to minimise the ischemia time (time between the chilling of a tissue, organ, or body part after its blood supply has been reduced or cut off and the time it is warmed by having its blood supply restored) and hence get good outcomes for the recipient post-transplant. This is not a problem when the deceased organ donor and the recipient are in the same hospital. However, at times the organs must be transported across city and state limits, which mandates the involvement of multiple agencies.

ROLE OF COUNSELLING

People hesitate in pledging their organs/agreeing to donate organs of their loved ones largely due to a lack of awareness and superstition. Facing death of a loved one is not easy at all and that, compounded with the complexities around brain stem death, is even more difficult to understand since the heart is kept beating by artificial support.

It becomes easier on the family members if the patient pledges his or her organs during his or her lifetime. This is specifically helpful in cases where family members cannot agree on donation. Concerted efforts by spreading awareness about organ donation and transplants, encouraging brain stem death declarations in our hospitals independent of the activity of organ donation, ensuring that each donation is utilised to the maximum and the donor family is helped through this heartbreaking process, are imperative. The role of transplant and grief counsellors is crucial in this entire effort in addition to the role of the clinical team.

NEW STEPS TO STREAMLINE PROCESSES

Many proactive steps have been taken by the government recently. Efforts are being made to streamline organ transport processes across seven ministries so that organs can be transported seamlessly through air, rail, metros and so on. In fact, the metro rules have been amended in May 2023 to allow for organ transport through metro rail as well. It will be worth its while to explore organ transport via drones going forward.

Further, the upper age of organ recipients has been removed, the domicile requirement to get registered in the organ recipient list has been removed, registration fee for registration of the recipient has been removed and there is an effort towards a “one nation, one policy” for which uniform listing and allocation criteria are required. This would also help in the national registry. Recently, a provision of a special casual leave of 42 days for Central government employees donating an organ has been made.

We owe it to the donor (whether living or deceased) to do our best in bringing about positive changes. A living donor gives a part of his/her body, fully knowing the risk to his/ her life, to save a loved one. The family of a deceased donor, in their time of grief, takes the bold decision to donate organs of their loved one to someone they do not even know. Though a lot of work has happened, much ground still needs to be covered. It is important to encourage brain stem death declaration in our hospitals, independent of donations. It is equally necessary to report on the transplant outcomes to ensure quality. Work around streamlining the training and utilization of transplant counsellors is under way. The creation of a transplant manual for easy reference is also currently under way. We need to take steps to increase the utilisation of organs from deceased donors and avoid wastage of any donated organs due to poor donor maintenance, delay in organ harvesting, communication gaps between clinical teams and so on.

Encouraging swap transplants and improving procedures around the same are important. Most importantly, showing our gratitude to the donors and their families is crucial.