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Be Indians, Be Donors: An interview with Dr. S. K. Sarin

Dr. Smriti Sharma Bhatia,
Assistant Professor, Miranda House, University of Delhi
smriti.sharma@mirandahouse.ac.in

The Institute of Liver and Biliary Sciences (ILBS), a facility with international standards that provides a comprehensive and most modern set up for the diagnosis and treatment in the field of liver diseases including liver transplantation, biliary diseases and allied disciplines. Dadhichi Deh Dan Samiti (DDDS) had the privilege of interacting with the director of ILBS Dr. S K. Sarin and discuss many aspects of organ donation.

Dr. S. K. Sarin (born 1952) is a renowned gastroenterologist, hepatologist, medical researcher, writer and a former chairman of the Board of Governors of the Medical Council of India. He is Adjunct Prof. Molecular Medicine, Jawahar Lal Nehru University, New Delhi, Honorary Professor, Jawaharlal Nehru Center for Advanced Scientific Research. He is the recipient of Padma Bhushan and Shanti Swarup Bhatnagar Prize, the highest Indian award in the science category. His contributions to reforms in medical education and health sciences are also noteworthy.

Dr. Sarin’s enthusiasm is contagious as one hears him talk passionately about organ transplantation and its need and scope in India. Here are some excerpts of his Interview with Dr. Smriti Sharma Bhatia from DDDS.

Sir, first of all I must congratulate you on your astounding achievements. You are indeed an inspiration for us all. What keeps you motivated in this field?

Thanks for your kind words. Well the motivation is helping to treat and cure as many people as possible! Also, it also motivates us when we come across stories of great compassion where people overcame their grief to help others in need. I will like to share some cases in ILBS with everyone. An 18-year-old student came to us with a failing liver. She died waiting for a liver donor. But what she couldn't get during her last days, she gave away in death. The teenager became an organ donor whose kidneys saved the lives of two recipients. We were overwhelmed by the courage and sacrifice of the family. They had just lost their daughter but they chose to help others in need. It is an irony that the girl could not get a donor herself but she gave life to others in her death. The other story is that of a 16 months old young baby who fell from a rooftop and was taken to AIIMS trauma Centre where she was declared brain dead. Her labourer father agreed to donate her organs. Her liver was donated to a four year old child and her baby kidneys to a 43 year old man. Both the recipients are doing very well. I also remember timely thinking and action of a Doctor whose 77 year old mother developed hip replacement complications. Her son realized that if his mother is not likely to survive, her organs should be donated. Her liver was transferred to a 35 year patient who is enjoying good health now. Age is not a bar especially for liver transplantation. These stories stand out because sadly such cases of organ donation are rare in India.

Why donation from deceased donors is so important when liver and kidneys can be donated from relatives?

Liver is an amazing organ. If you donate 60 percent of your liver, it regrows in about four weeks. It’s like cutting your hair. One can give whole right lobe and it grows back but unfortunately, mostly the patients that come to us have spoiled their liver completely and the only person capable of donation in most cases is the wife who has to take care of the kids also. At that time it pains us that even if the wife is willing and fulfills all criterion she will have to undergo an unnecessary surgery. Even if she has emotional love and attachment she should not become donor but such is life. Having seen this over the years and doing more than 100 transplants a year, it is a worthwhile cause that pool from deceased donors is harvested.

How does India compare to other countries in terms of organ donation?

More than two lakh Indians require organ transplantation annually. However, less than 10% are able to get this timely help. Although the number of organ donors and transplantations in India have increased significantly over the last decade, it is not sufficient. Organ donation immediately after the heart stops beating can help increase the organ pool. 36 persons per million of population donated organs in Spain in 2014, 35 donated in Croatia, 27.02 donated in the United States, and only 0.34 donated in India. With a 1 per million-donation rate, India would have 1320 organ donors or 2640 kidneys, 1320 hearts, 1320 livers, 1320 pancreas and 2640 eyes. This should take care of almost all current demands for organs. At a 2 per million-donation rate these figures would double.

That brings us to our most important question as to what can be done to improve the low rate of organ donation in India?

First of all, awareness and sensitization is very important. I therefore appeal that you all please join in the initiatives of Dadhichi Deh Daan Samiti. Government should come out with large scale campaign to educate people about benefits of organ donation. Care should be taken to clear all myths and misconceptions about organ donation in general public. We can also make use of mediums like advertising in TV, print, radio, social media, celebrity endorsements, theater & street plays, events to promote organ donation (marathons, concerts etc.) and awareness drives at schools, colleges, corporate offices, clubs etc. We in ILBS have been fortunate that Late Dr. A P J Abul Kalam, foemer Lt. Governor Nazeeb Jung are some of the few dignitaries who came to ILBS and helped us spread the message of organ donation.

Why there is such low organ donations from brain deaths in India?

Delhi has almost 2000 ICU beds of which 10 percent patients probably may not survive. Even if relatives and family members of 200 patients recognize the futility of continuous care, they may consider and come forward voluntarily for organ donation. One of the common causes for refusal of organ donation is lack of awareness about the consequences of brain death — irreversible loss of brain functions. Most families think their loved ones have a chance to recover till the heart is working. But if we can evolve standard operating procedures for retrieval of organs even after the heart beat stops, many such families may agree to donate.

How can we harvest organs from road accident victims?

Road accident is the worst thing to happen with anyone but it does happen. If there is awareness and some good citizen can bring the victim to the hospital, the organs can be harvested. To quote some statistics, in 1998, India had 1% of the world's road vehicles and 6% of the world's road accidents. These accidents have increased to 10% in 2006. The total number of road accidents is approximately 90,000 per annum .It is to be noted that in nearly 40–50% of all fatal road accidents in the world, the cause of death is head injury. Other causes of brain death such as sub-arachnoids' hemorrhage and brain tumors. Even if 5% to 10% of all these deceased patients became organ donors, it would mean that there would be no requirement for a living person to donate an organ. Promoting the deceased donation program would not only help kidney transplants but also liver, heart, pancreas, and lung transplants to thrive in the country.

Is it possible to bounce back to a normal life post organ transplant?

Of course!! One can live a full and healthy life after organ transplantation. Most patients can return to work within 3 to 6 months after a liver transplant. Playing sports and getting healthy exercise, socializing, and traveling for business and pleasure are all possible. Infact, His Holiness Dalai Lama visited ILBS and blessed the children who had undergone Liver transplant on 16th Hepatitis Day. If you see the pictures, you can see their full of life, smiling faces. Reason for that life and that smile is donation of organ by someone.

His Holiness Dalai Lama with liver transplant children on 16th Hepatitis Day

What would be your final message to public?

“Be Indians..Be donors. Be sensitive to the needs of the society. This is your wakeup call!”

Organ donation is something that will benefit all those in need, regardless of religion, age, sex, caste, or social profile. Dr. Sarin said your part is living in someone so organ donation is an eternal gift. I will urge you all to remember these check points regarding organ donation.

Register yourself and your friends and relatives for organ donation. Your target should be to get at least 100 donations done.

  • You must visit hospitals to see what suffering is and how timely care can make a difference.
  • Join a movement for organ donation without any religious bias.
  • Volunteer for various organizations working for this cause. Giving your time, thoughts, energy and commitment is much more than donation of money.
  • Our culture stresses upon the importance of Daan (donation) and what better Daan than organ donation.