A hospital is a place where one gets to witness a concoction of emotions. The anguish and melancholy being experienced by the kin of a deceased patient is a deep contrast to the kind of optimism and enchantment experienced by a patient who has just been given a good prognosis by the White Coats for his life threatening illness. This is the reason most people are very anxious about entering the building that smells like bleach, the sheer ambiguity about the news in the consultation room. But its often a place where miracles take place.
Organ Donation and Transplantation is one such miracle that can impact not just an individual but several families at once. Up to 8 organs can be donated by a deceased patient to different recipients and up to 2 organs can be donated by a living donor. But the challenges faced in India with respect to it have been that of a perennial one. According to the NGO Organ India the number of Kidney transplants required annually is about 2 Lakhs and only about 10,000 of those take place and the number of Heart transplants required is about 50,000 while only about 340 take place. There are similar statistics with regard to other organs as well. A wide gap between the necessity and reality exists. The organ donation rates are at about 0.8 persons per million in India compared to 32 persons per million in USA and 42 persons per million in Spain annually.
Some pioneering work has been done by the Americans in terms of donation and transplantation over the years due to State-of-the-art facilities and infrastructure. United Network for Organ Sharing (UNOS) is a non profit scientific organization that overlooks the organ donation and transplantation 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 where a deceased patient is routinely considered for donation unless they choose 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 process to be a success.
A recent breakthrough in transplant surgery occurred in March 2019 at Johns Hopkins University, Baltimore when the world’s first kidney transplantation took place from a HIV positive Donor to a HIV positive recipient. These recent advances make it possible for individuals with end stage diseases have a fighting second chance at life.
India being the second most populated Country in the world and enroute to being a global superpower boasts of a farrago of obstacles in achieving the required number of donors and success in transplantation. The main challenges faced in India range from sociocultural and religious taboos to having superstitions such as not being freed from the cycle of Life-Death-Rebirth if organ donation is done. The lack of awareness is being curtailed off late by the involvement of many NGO’s like MOHAN Foundation and Organ India but the process is ongoing. Community Outreach Programs need to be conducted by all health organizations regularly to spread awareness about the issue. At the Hospitals a standard protocol needs to be followed to declare a patient brain dead and eligible for organ donation. The power of organ donation from a deceased patient lies to their next of kin. Its essential to train healthcare individuals about being empathetic and counselling the families of the deceased about the benefits of donating organs to and possibly bringing about a change in the lives of many families.
Considering the next of kin have agreed for the organ donation, a coordinated process occurs between the Hospitals and National Organ and Tissue Transplant Organization (NOTTO) with the help of various State organizations and NGO’s to transport the organs to the recipients hospital. The logistical nightmare has been eased by the creation of Green Corridors which involve managing the traffic lights manually so as to provide Green lights to the vehicles carrying the organs at subzero temperatures. The organs needs to be transported under the stipulated time frame to maintain their viability, of which the lungs and heart need to be transplanted within 4-6 hours after retrieval.
After all these predicaments, the final nail in the coffin of a person who needs a transplant surgery is the financial burden it entails. The recipient of the organ has to bear the cost of retrieving the organ from a donor and transporting it in addition to the cost of the transplant surgery. The transplant surgeries cost anywhere between 5-10 Lakh Rupees for a kidney transplant and upto 25-30 Lakh Rupees for a Heart and Lung transplant. This makes the expenses of a transplant surgery one of the biggest causes for failure of the organ donation and transplantation campaign. The surgeries are dominated by the Private Health sector which have the latest infrastructure and facilities and the Public Hospitals make a small fragment of centres conducting transplant surgeries. Health Insurance by the private sector only covers a fraction of the cost which is not inclusive of the outpatient visits or the expensive lifelong immunosuppressant drugs required by the patients. Considering that most people pay for healthcare out of their pockets in a country like India , getting a second chance at life can be a very expensive and tedious process.
There is a definite need to improve the administrative process of organ donation and transplantation along with formulating community based outreach programs to educate families as a whole. A movement needs to be brought about to introduce a possible government aided organ transplant insurance scheme in order to prevent sticking a price tag on a suffering person’s life.
The process of doctors cutting up into a loved one soon after they are no more and removing organs which once used to make them whole; smile, laugh, cry and live is a very daunting process 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. Heaven does not need organs. The 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 empathize. It is about time we all take an initiative to educate our near and dear ones about the the miracle that is, Organ Donation.
Dr Shivakumar A
Yenepoya Medical College and Hospital, Mangalore.