Spotlight
New
Delhi, 9 April 2015
Organ
Transplant
DONATION,
AWARENESS VITAL
By Dr H R
Keshavamurthy
Organ donation and transplant
provides a second chance at life for thousands of people each year. The growing
disparity between the rich and poor, demand for human organs and availability
of technology in the country makes the trading of organs a quick means to
riches for some and a relief for others. Invariably organ trade leads to
exploitation of the poverty-stricken people by tempting them with financial
gains to meet their immediate short-term financial needs.
Each year hundreds of Indians die
while waiting for an organ transplant. The reason: there is an acute imbalance
between the number of organs donated and the number of people waiting for a
transplant. While 2.1 lakh Indians require kidney transplantation annually,
only 3000-4000 kidney transplants are done. The situation is not very different
in relation to heart transplants. While annually around 4,000–5,000 patients in
India require a heart transplant, so far only 100 heart transplants have been
conducted across the country.
According to the National Programme
for Control of Blindness (NPCB) 2012-13 report, only 4,417 corneas were
available in 2012-13 against a whopping requirement of 80,000-1, 00,000 per
year. There are currently over 120
transplant centres in India
performing approximately 3,500 to 4,000 kidney transplants annually. Out of
these, four centres undertake approximately 150 to 200 liver transplants
annually while some do an occasional heart transplant.
Finding a donor is the critical issue.
Lack of awareness and improper infrastructure facilities are the main reasons
behind the existing scenario. Administrative hurdles and conservative mindset
further affect organ transplant scenario in India. There are number of myths
associated with organ donation which need to be addressed to solve this
problem. Most Indians generally believe that it is against nature and religion
that body parts are mutilated. Some are suspicious that the hospital staff may
not work hard to save their lives if they want organs.
Others believe there might be a
temptation to declare them dead before they are actually dead. The lack of a
centralized registry for organ donation acts as another hurdle for people to
donate organs or get data about donors. Further, there is a problem of
certifying brain deaths as it becomes difficult to convince relatives of
patients for organ donation, if they are unaware of it.
Kidney transplants in the country first
started in 1970s and since then India
has been a leader in this field in the Asian sub-continent. The evolutionary
history of transplants in the past four decades has witnessed commerce in organ
donation becoming an integral part of the programme. The Government passed the
Transplantation of Human Organ Act (THO) in 1994 which made unrelated
transplants illegal and deceased donation a legal option with the acceptance of
brain death.
Overcoming organ shortage by tapping
into the pool of brain-dead patients was expected to curb the unrelated
transplant activity. However, despite the THO Act, neither the commerce has stopped
nor have the number of deceased donors increased to take care of organ
shortage. The concept of brain death has never been promoted or widely
publicized. Most unrelated transplants currently are being done with the
approval from an Authorization committee.
In 2011, the Government enacted the
‘Transplantation of Human Organs (Amendment) Act, which made provisions for
simplifying the procedure for organ donation. The provisions included retrieval
centres and their registration for retrieval of organs from deceased donors,
swap donation and a mandatory inquiry by the registered medical practitioner of
a hospital in consultation with transplant coordinator (if available) from the
near relative(s) of potential donor admitted in ICU and informing them about
the option to donate and if they consent to donate, inform the retrieval centre
for retrieval of organs.
The potential for deceased donation
is huge due to the high number of fatal road traffic accidents and this pool is
yet to be tapped. At any given time, every major city would have 8–10 brain
deaths in various ICUs. Some 4–6% of all hospital deaths are due to brain
death. Annually, road accidents account for around 1.4 lakh deaths and of these
almost 65% sustain severe head injuries as per a study carried out by AIIMS, Delhi. This means there are almost 90,000 patients
who may be brain dead.
While it cannot be said that people
don’t want to donate, a major problem is that there are no mechanisms in
hospitals to identify and certify brain deaths. Plus, no one empowers the
relatives of a brain-dead person to save lives by donating his organs. Anyone
from a child to an elderly person can be a donor. Organ donation from the brain
dead – also referred to a cadaveric donation is still abysmally low in India. While
Spain has 35 organ donors per million people, Britain has 27 donors, US 26 and
Australia 11, India’s count stands at a mere 0.16 per million people.
What should be done? Signing a donor
card is the first step in making your wishes about donation known. A donor card
is not a legal document but an expression of one’s willingness to donate. While
signing a donor card demonstrates one’s desire to donate organ after death,
letting the family or friends know about the decision is very important. That
is because family members will be asked to give consent for the donation. The
decision will be considered final when they give consent. Vital organs such as
heart, liver, lungs, kidneys, pancreas and intestines, and tissues such as
corneas, heart valves, skin, bones, ligaments, tendons, veins, etc can be
donated in case of brain death.
The recently notified
Transplantation of Human Organs and Tissues Rules (THOT), 2014 has many
provisions to remove the impediments to organ donation while curbing
misuse/misinterpretation of the rules. These include: The medical practitioner
who will be part of the organ transplantation team shall not be a member of the
Authorisation Committee constituted under the Act; when the proposed donor or
recipient or both are not Indian nationals or citizens whether near relatives
or otherwise, the Committee shall consider all such requests and the transplant
shall not be permitted if the recipient is a foreign national and donor is an
Indian national unless they are near relatives; when the proposed donor and the
recipient are not near relatives, the Committee shall evaluate that there is no
commercial transaction between the two.
Every authorised transplantation
centre must have its own website, which shall be linked to
State/Regional/National Networks through online system for organ procurement,
sharing and transplantation, and a National Registry on Donors and recipients
of Human Organ and Tissue accessible on-line through dedicated website having
National, Regional and State level specificities will come into force.
Making organs a commodity is fraught
with erosion of social, moral, and ethical values and is not an alternative
that can be acceptable to meet organ requirements in a civilized society. The WHO
in its statement on the sale of organs clearly states that it violates the
Universal Declaration of Human Rights as well as its own constitution: “The
human body and its parts cannot be the subject of commercial transactions.
Accordingly, giving or receiving payment… for organs should be prohibited.”
Enhanced awareness among people is needed to encourage people to donate organs.
This requires involvement of the civil society, religious leaders and other stakeholders
in creating awareness. A comprehensive campaign is indeed the need of the hour.
--- INFA
(Copyright,
India News and Feature Alliance)
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