Article published in Parivartan – TCS50
This article examines the statistics, existing status and trends influencing organ donation in India. It further provides a detailed approach to increase the number of donors and organ donations in the country.
India has seen an increase in the rate of organ donation in recent years. Yet, the list of patients waiting for successful organ transplant procedures continues to grow. This article attempts to present an overview of the current status and explores corrective measures to address the issue.
Current Status, trends, comparison
As per NOTTO, the number of organ donations in India has steadily grown over the years in the recent past. However, it is to be noted that we do not have an organized central co-ordination system in the country to monitor organ donations. Hence, the figures may not accurately reflect the actual numbers on the ground.
Figure 1: Statistics on the number of liver, kidney, heart transplants
(Source – NOTTO – https://www.notto.gov.in/organreport.htm)
Figure 2: Ratio of male-female candidates
Figure 3: Ratio of living vs cadaver transplants for all organ transplants.
The overall situation on organ donation in India can be summarized as follows. There is a huge gap in the demand for and supply of organs for transplant due to various factors that we will discuss further ahead in this article. This gap however, is contributing to the growth of organ black-market operations and organ trafficking, particularly kidneys.
Figure 4: Current state of organ transplant
India has an organ donation rate of 0.8 per million, which is very low when compared to other countries such as Spain with a significantly higher organ donation rate of 40 per million. Implementing the right measures can certainly help us work towards increasing the donor rate in the country, especially cadaver donors.
Figure 5: Source – Library of Parliament using data obtained from Global Observatory on Donation and Transplantation, Organ Donation and Transplantation Activities, 2015, September 2017
Listed below are some of the important legislations and government agencies involved in monitoring and regulating the organ donation process in the country:
- Important laws and legislations pertaining to organ donation include:
- Transplantation of Human Organs and Tissues Rules, 2014
- THOA Amendment 2011
- Transplantation of Human Organs (Amendment) Rules, 2008
- THO Rules, 1995 (Original Rules)
- THOA 1994
- The laws stipulate that the physician on-record treating the patient must ascertain the patient as being brain-dead as per prescribed process, and also sensitize the family about organ donation
- State governments to allow ‘non-transplant hospitals’ equipped with an ICU and operation theatre to retrieve organs
- NOTTO – Apex body in India on organ donation
- ROTTO and SOTTO – Function at regional and state levels
- ZTCC – Work at the zonal level within states
What can we do to save more lives?
Increasing organ donation and transplant numbers will require significant coordinated effort by the medical, regulatory and governing agencies. Listed below are some measures that we can adopt to increase the rate of organ donation in the country:
- Spread awareness across all stakeholders:
One of the key aspects to focus on is to continuously spread awareness on the state of organ transplants across all stakeholders involved. For organ donations to increase, there must be significant social change. People need to be educated and informed about the benefits of organ donation in order to overcome myths, superstitions and customary beliefs that are impeding positive change.
Stakeholder here would include:
- General public
- Transplant coordinators
- Donor families
- Recipient families
- Streamline processes and infrastructure:
- It is extremely important and crucial to put in place appropriate processes and supporting infrastructure to ensure an improvement in the rate of organ donation. These include:
- Availability of seamless transportation services for speedy delivery of donor organ
- Standardized online data base that can instantaneously match donor organs with potential receivers
- Implementation of the latest technology to further hasten and simplify the process
- Increase the number of certified hospitals that can facilitate organ retrieval and transplantation
- Increase in certified doctors to assist with complex procedures
- Streamline and simplify various legalities and regulations pertaining to organ donation
- Create centralized registries:
Centralized registries that include data on both donors and recipients are a big advantage in identifying immediate and the most suitable matches for organ transplants. A key aspect to bear in mind is that zonal, regional and state agencies will continue to play a major role in a vast country like India, as time is of essence in successful organ transplants. For instance, the heart and lungs must be transplanted within 4-6 hours. Regional co-ordination might be important in this regard to help speed up the transplant process.
- Presumed consent:
Another key aspect to consider is that of presumed consent. Under presumed consent, a person is deemed to be registered as an organ donor by default unless he opts out. However, given the social and cultural considerations in India, this factor is not considered a major facilitator in increasing organ donation, unless accompanied by significant investment in streamlining processes, infrastructure as well as changing people’s mindsets.
- Incentivizing donor families:
The question of incentivizing donors and their families is a complex issue. Any form of tangible incentive presented towards organ donation is likely to be viewed as unethical and counterproductive. However, one option to consider is to reward the donor’s family with the promise of a prioritized position on the waitlist should they require an organ transplant in future.
- Using data analytics:
While there is a lot of data available about organ donation, data quality and standardization needs careful assessment. Investments must be made in data analytics and related software and applications to gain relevant and actionable insights.
India is seeing an increase in the rate of organ donation, but we have a long way to go to ensure no life is lost due to the unavailability of a suitable donor organ. All parties including medical bodies, government agencies and regulatory authorities and the public at large need to work together to create an eco-system conducive for increased organ donation. This is a slow process and while change cannot happen overnight, consistent efforts will ensure that the organ donation statistics in India grow to match the statistics in Spain and other developed nations.
About the Author
Tejpal Singh Batra is co-founder and president of IGiftLife – an NGO which focuses on saving more lives by facilitating organ donation. Tejpal has over 28 years of global experience in diverse leadership roles. Tejpal is also a visiting faculty member at various business schools across the country and runs his own transformation and analytics consulting firm. Since its inception in 2015, IGiftLife has made tremendous progress in the field of organ donation across 9 cities by conducting 190+ sessions and engaging 25000+ people across the country. The organization has also conducted two major events reaching out to 1,60,000 people on the topic of organ donation.