Organ donation: a true gift of life

Organ donation is when a person allows an organ of theirs to be removed, legally, either by consent while the donor is alive or after death with the assent of the next of kin. There are millions of people who develop end-stage kidney, liver or heart failure despite the best of treatments and, at times, the only option left is to get a transplant done to replace the function of the failed organ.

Though a very popular concept in the West, awareness on organ donation is pretty low in our country. Owing to myths, social stigma, religious belief and diversity, only a fraction of people come forward for the cause. Some people believe it’s unsafe, causes sexual disability in males (especially with kidney donation), interferes with fertility and pregnancy. Spain, the undisputed leader when it comes to organ donations, sees almost 60 times the number of donations and transplants than what we see in India.

The common solid organ transplants in our country are kidney, liver, heart, pancreas and lung, in that order. In patients with multiple organ failure, multi-organ transplants are conducted. The source of organ could be a living person or a deceased donor who has been declared brain-dead as per the Human Organ transplant Act (HOTA ), which came into being in 1994 and has been modified subsequently.

a) Living Donor Transplant: This occurs when a living person decides to donate his or her organ(s) to someone in need of a transplant. Living donors are usually family members or close friends of the person who requires a transplant. They must meet certain medical criteria and undergo comprehensive medical tests, as required by the particular circumstance, before being accepted as suitable donors. Liver, kidneys and pancreas are the organs that can be transplanted in this case.

b) Deceased Donor Transplant: This is when organs from a brain-dead individual are transplanted into the body of a living recipient. The deceased individual, in this scenario, can only be a victim of brain-death. This kind of transplant initially requires the recipient to be on a waiting list until a suitable organ is available based on his or her medical profile.

There is a wide gap between the number of transplants awaited and the organs available. The depressing statistics convey the urgent need for more people to step up and donate organs and save the lives of people languishing due to organ failure. Less than 5% of people who need a transplant actually get an organ on time and the rest — almost half a million people — die a slow painful death every year.

India has some alarming statistics in terms of people dying due to shortage of donors. Around 100,000 people die of liver disease every year, about 220,000 await kidney transplants, a million people await corneal transplants, 50,000 people await heart transplant and about 20,000 people need a lung transplant every year.

In Karnataka alone, there are over 2,000 waiting for kidney, over 700 for liver and 40 for heart transplants, and there is a long waiting list for cadaver donor transplants.
At any given time, there are about eight to ten brain-dead potential donors in hospital intensive care units in any major city, and each one can save up to seven lives by donating organs. Unfortunately, there is a huge demand-supply gap which has, in turn, led to unethical practices and have created a negative perception about transplants.

Overcoming roadblocks
Unethical practices and unscrupulous people indulging in such acts must be punished severely. Governments and NGOs must launch more public awareness campaigns to overcome the taboos and stigmas associated with transplants. Even people in the medical fraternity need to be educated.

Opening up more organ retrieval centres, including at large public and teaching hospitals, in addition to transplant centres and mandating brain-death recognition in ICUs are important steps. We also need to have mechanisms for stating preference for organ donation in driver’s licences, organ donation cards and ensuring your near and dear ones know of your wish so that they fulfil this when the time comes.
Organ donation is a true gift of life. Pledge your organ today to save a life, rather than burying or burning it upon death.

(The writer is Chairman, Manipal Hospitals)