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Organ transplantation in India: Bridging demand-supply gap


To tackle the problem, India should adopt the system of "presumed consent" in which everyone, post death, is considered a donor unless one has opted out of the process in his lifetime.

By Anubhav Srivastava

July 15, 2009

Though the advances in medical science have made transplantation of vital human organs possible, millions of people in India lose their lives because the donors are not available is adequate numbers. More than 150,000 people are diagnosed with end-stage kidney disease every year in India. 


However, not more that a few thousand transplants are performed every year and the patients are forced to survive on dialysis. Similarly, it is a perpetual wait for many a blind people who can be cured by cornea transplantation.  

The low organ availability in India has led to organ rackets in several parts of the country where people belonging to the poor and marginalised sections of the society have been duped into selling their kidneys. There have also been many instances when one kidney of a person was fraudulently removed during operation. 

According to experts, in developed countries, there are 20-25 cadaver donors per million population whereas in India gets only 30-40 cadaver donors in a year despite having a population of more than a billion people. Hence there is an urgent need to promote cadaver donation among the people to bridge the demand and supply gap of human organs. 

The organs that can be easily transplanted from a brain dead person are heart, kidneys, eyes, lungs, pancreas, liver, bone marrow, blood vessels, heart valves, middle ear, connective tissues, bones and skin. A single cadaver donor can thus save lives of many terminally ill patients. Though retrieval of organs from brain dead persons was legalised in India in 1984, there are several hurdles before cadavar donation programme in India can be made successful. 

One big challenge that must be overcome in making cadaver donation widespread is making the donation process less complex. According to the Transplantation of Human Organs Act, 1994, even if a person has pledged to donate his/her organs after death, the consent of the family of the deceased must be taken before the retrieval of vital organs takes place. And more often than not, families back out.

There is also a distinct lack of awareness among the general public in India about how immensely beneficial donating organs can prove to be for the recipients and their families. Most of the people needing transplantation belong to the people of the young and middle age groups. Hence the donating vital organs to a person belonging to these age groups can save a whole family from being ruined. 

Another reason for the poor response to the call from the government agencies for organ donation is the religious considerations. This is because the vast majority of people in India believe in the theory of life after death and rebirth. There is a superstition among many people that by donating organs, they will be born deformed and disfigured in their next birth. 

Hence urgent action is required on several fronts if the acute shortage of human organs in India has to be met. Awareness should be increased about the benefits of organ donations through the means of mass communication and superstitions among people should be fought by the way of religious injunctions. 

The government could even consider giving incentives to the donors which could be in the form of health insurance for the donor and his family. This practice has been adopted in several countries. This will help a great deal in putting a check on the trade of illegal organs which is a result of the widespread poverty in the country. 
 
However the best way to tackle the problem in India, considering the high gap of demand and supply of human organs, would be adopting the system of "presumed consent" in which everyone, post death, is considered a donor unless one has opted out of the process in his lifetime. This system has been highly successful in Spain. In this case, the body of a brain dead person becomes a state property and all the vital organs are retrieved before it is handed over to the family members. 
 
If this system is adopted in India, along with a motivating awareness campaign for organ donation, it can more than fulfill the demand for vital organs. On a spiritual and religious note, it needs to be propagated among the citizens that India is the land of sage Dadhichi who, according to the legends, gave up his life so that Gods can use his bones to make 'Vajra', the ultimate weapon that would defeat the demons. 

The story signifies that if the end result is the good of the world then no sacrifice is too great. It is ironical that our country, with such an inspirational legacy to look up to, is struggling with the shortage of vital organs, which are harvested after the death of a person. However, with proper policies in place, India will certainly do much better. 

[A personal note - The commitment of the agencies involved in the process of organ retrieval and transplant is essential for the programme to succeed. The author, who earned admiration from family members for his decision to pledge his organs in April 2008, ended up becoming a laughing stock among them as the agency in charge of organ retrieval and transplantation at India’s premier medical institute located in Delhi did not send the consent form at his address even two months after he had got his name listed by a phone call.  

When he tried to follow up with the concerned agency, which had promised that consent form would reach him within two weeks, he found to his horror that all his calls to the three numbers given on their website including that of the 24-hour Help Line remained unanswered. He has since delayed his plans to pledge his organs, a possibility of death before pledging notwithstanding, as he is not sure that whether the concerned agencies, acting with such a high degree of indifference, will be able to retrieve his vital organs in time after he dies and whether the process will be carried out in a way that causes least agony to his near & dear ones. 

And more importantly, considering that corruption has become a hallmark of almost every activity that involves the Indian government agencies, what is the guarantee that the recipients will not end up “paying” for the organs “donated” by him.] 

The author is the Editor, Policy Proposals For India.


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