Hospitals are places where one gets to witness a range of emotions. The sadness and anguish of the kin of a deceased patient contrasts with the feeling of hope of a patient who has just been given a good prognosis by doctors for his life-threatening illness. This is why most people are anxious as they enter the building that smells like bleach -- the uncertainty of the news one may get in the consultation room. But it’s often a place where miracles happen.
Organ donation and transplantation (ODT) is one such miracle that impacts not just an individual but several families at once. Upto eight organs can be donated by a deceased patient to different recipients, and two by a living donor. But the challenges faced in India with respect to ODT have been perennial ones. According to the NGO Organ India, the number of kidney transplants required annually is about two lakh, but only some 10,000 take place; the number of heart transplants required is about 50,000, only about 340 take place. There are similar statistics with regard to other organs, too. The organ donation rates are at about 0.8 persons per million in India, compared to 32 persons per million in the US and 42 in Spain.
Some pioneering work has been done by the Americans in terms of donation and transplantation, thanks to their state-of-the-art facilities and infrastructure. The United Network for Organ Sharing (UNOS) is a non-profit scientific organization that overlooks ODT administration in the country. In Spain, the Organizacion Nacional de Transplantes (ONT) handle the donation and transplant process. They operate on an “opt-out” system, in which a deceased patient is routinely considered for donation unless they had chosen to state otherwise beforehand. The administrative prowess and superior logistical support of these organizations are the reasons for their success. Training of intensive care specialists also makes sure that they act on time for the ODT process to succeed.
A recent breakthrough in transplant surgery occurred in March 2019 at Johns Hopkins University, Baltimore, when the world’s first kidney transplant took place from a HIV-positive donor to a HIV-positive recipient. These recent advances make it possible for individuals with end-stage diseases to have a fighting second chance at life.
In India, ODT is riddled with obstacles at every stage. The main challenges faced range from sociocultural and religious taboos to superstitions, such as not being freed from the cycle of life and death if one donated organs. NGOs such as Mohan Foundation and Organ India are spreading awareness, but it’s a long battle. Community outreach programs need to be conducted by all health organizations regularly to spread awareness about the issue.
At the hospitals, a standard protocol must be followed to declare a patient brain-dead and eligible for organ donation. The power of organ donation from a deceased patient lies with their next of kin. It’s essential to train healthcare professionals to be empathetic and counsel the families of the deceased about the benefits of donating organs to and positively impacting the lives of many families.
When the next of kin have agreed to organ donation, a coordinated process occurs between the hospitals and the National Organ and Tissue Transplant Organization (NOTTO) with the help of various state organizations and NGOs to transport the organs to the recipient’s hospital. The logistical nightmare has sometimes been eased by the creation of ‘green corridors’, which involves managing the traffic lights manually so as to let through the vehicles carrying the organs at subzero temperatures. The organs need to be transported within a stipulated time. For instance, lungs and heart need to be transplanted within 4-6 hours after retrieval.
If these hurdles are overcome, what remains is the financial burden of a transplant on the patient and his family. The recipient has to bear the cost of retrieving the organ from a donor and transporting it in addition to the cost of the transplant surgery. A kidney transplant can cost Rs 5-10 lakh; a heart or lung transplant Rs 25-30 lakh.
Health insurance covers
The expense of a transplant surgery is one of the biggest causes for the ODT campaign in India. These surgeries are dominated by private hospitals, which have the latest infrastructure and facilities; there are only few public hospitals that have the facilities. Private sector health insurance covers only a fraction of the cost, which is not inclusive of the outpatient visits or the expensive lifelong immune-suppressant drugs required by the patients. Considering that most people in India pay for healthcare out of their pockets, getting a second chance at life is a tedious as well as an expensive proposition.
There is a definite need to improve the administrative process of ODT, along with formulating community-based outreach programs to educate families as a whole. We also need a government-aided organ transplant insurance scheme.
The process of doctors cutting up a loved one soon after their death and removing organs which once used to make them whole, smile, laugh, cry and live, is a daunting experience for a family. But what needs to be understood by society as a whole is that there’s no greater gift a person can receive than the gift of life. Nobody in heaven needs a dead one’s organs, patients on the waiting list do. The miracle of organ donation and successful transplantation needs to happen more often, and it’s our responsibility as individuals to make it happen. It is about time we all took initiative to educate our near and dear ones about the miracle that is organ donation.
(The writer is a Medical Intern at Yenepoya Medical College and Hospital, Mangaluru)
