Now’s the time to promote organ donation and save lives

#organ donation #organ transplants #save a live #health policy

Organ transplantation is the last resort for patients suffering from end stage organ failure. It is a is a surgical procedure in which an?organ is removed from the donor’s body and placed in the body of a recipient, to replace a damaged organ. Till the time that we can create organs artificially in the lab, organs must be transplanted from donors- whether living donors or deceased donors.

The field of organ transplants is not just a complex one clinically but also has complex administrative and legal considerations around it. The Transplantation of Human Organs Act (THOA) 1994, (amended in 2011) was enacted to provide a system of removal, storage, and transplantation of human organs for therapeutic purposes and for the prevention of commercial dealings in human organs.

There is a huge gap between the demand and supply of organs and only around 10% of the patients who need an organ get it.??It is heartening to note that from 806 transplants in the year 2000, India has done over 15,000 transplants in the year 2022. However, over 80% 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 the organ requirements. Additionally, there is an inherent risk to the living donor not to mention the possibility of commercial trading of organs. 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) 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 USA are over 40%. Interestingly, the Union Territory of Chandigarh has a rate of 33% and the state of Telangana has a rate of over 5% even though the national average is under 1%.

It is in the above context that every organ donated is precious and needs to be transplanted in the shortest possible time to minimize 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.?There is a potential of involvement of multiple agencies in this effort- the traffic police, airline, metro, railway, road transport and highways etc. This activity of transporting organs intra/inter city is very critical due to two main reasons, viz. the involvement of multiple agencies and the limited ischemia time of organs (for heart the ischemia time being as short as 4 hours).

Proactive steps taken by the government in recent times seem to be showing traction. Efforts are being made to streamline the organ transport process across 7 ministries so that organs can be transported seamlessly through air, rail, metros etc. In fact, the metro rules have been amended in May 2023 to allow for organ transport through metros 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 leaves of 42 days for central government employees donating an organ has been made.

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 also need to take steps to increase the utilization 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 etc. Encouraging swap transplants and improving procedures around the same is important. Most importantly, showing our gratitude to the donors and their families is crucial.

As we march towards a developed India, we soon hope to see India’s organ transplant program be amongst the best in the world. 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 and 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. There can be no bigger donation than this.

As we celebrate the Indian Organ Donation Day on 3rd August this year, let us pledge not just our organs, but pledge to follow both the letter and spirit of the organ transplant act so that we stop seeing the cases of trafficking of human organs. It is not just our legal responsibility, but also our moral and ethical responsibility to do so. For it is, in nothing do men more nearly approach the Gods than in giving health to men.

The above article was published in Deccan Herald. Link below:

https://www.deccanherald.com/opinion/panorama/now-s-the-time-to-promote-organ-donation-and-save-lives-1243326.html