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

Organ transplantation is the last resort for patients suffering from end-stage organ failure. It 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. Until we can create organs artificially in the lab, organs must be transplanted from donors, whether living or deceased.

The field of organ transplants is not just clinically complex but also has complex administrative and legal considerations. The Transplantation of Human Organs Act (THOA) of 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 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 will have done over 15,000 transplants in 2022. However, over 80 per cent of these were living donor transplants. We need to promote deceased organ donation in India, as living donor donation alone cannot fulfil the organ requirements. Additionally, there is an inherent risk to the living donor, not to mention the possibility of commercial trading of organs.

Also Read: Roadblocks in organ donation: What’s the way forward?

Furthermore, certain organs, like the heart, can only be harvested from a deceased donor. The organ donation rate (number of people donating organs per million people) 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 rates in Spain and the US are over 40 per cent. Interestingly, Chandigarh has a rate of 33 per cent, and Telangana has a rate of over 5 per cent, even though the national average is under 1 per cent.

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. There is potential for the involvement of multiple agencies in this effort: the traffic police, airlines, metro, railway, road transport, highways, etc. This activity of transporting organs intra- and inter-city is very critical due to two main reasons: the involvement of multiple agencies and the limited ischemia time of organs (for the heart, the ischemia time is as short as four 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 seven ministries so that organs can be transported seamlessly through air, rail, metros, etc. In fact, the metro rules were amended in May 2023 to allow for organ transport through metros as well. It will be worth it 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, the 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 with the national registry. Recently, a provision for a special casual leave of 42 days for central government employees donating an organ was made.

Though a lot of work has been done, much ground still needs to be covered. It is important to encourage Brain Stem Death declarations 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 utilisation 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 utilisation of organs from deceased donors and avoid the wastage of any donated organs due to poor donor maintenance, delays in organ harvesting, communication gaps between clinical teams, etc. Encouraging swap transplants and improving procedures around them 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 programme be among the best in the world. We owe it to the donor (whether living or deceased) to do our best to bring 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 the organs of their loved one to someone they do not even know. There can be no bigger donation than this.

As we celebrate Indian Organ Donation Day on August 3 this year, let us pledge not just our organs but to follow both the letter and spirit of the Organ Transplant Act so that we stop seeing 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 writer is a senior consultant at NITI Aayog, Government of India. Views expressed are personal)