Organ Donation: Challenges from Indian Perspective
Dr. Smriti Sharma Bhatia
Assistant Professor, Department of chemistry, University of Delhi
With the surgical methods becoming more precise and effective techniques of organ preservation being developed, there has been an incredible growth in the field of organ transplantation. These improvements have translated into increasing number of organ transplants worldwide but sadly India lags behind terribly. The deceased donor donation rate in India is 0.34 per million, which is appallingly low compared to the developed countries. What are the reasons for such a low performance by a country like India which is otherwise hailed for its humanitarian culture? In this article, the author has tried to investigate the reasons behind India’s dismal performance in organ donation.
The first and foremost reason is the way the concept of life after death is ingrained in Indian psyche with respect to notions of ethics, religion and spirituality. Things are changing but the change is very slow. People believe that body should be properly cremated and last rites should be given respect. The volunteers of DDDS encounter such beliefs from general public in majority of the cases. Superstitions such as being born with a missing organ that has been donated and that tinkering with the body will not free their dead relatives from the cycle of life-death-rebirth create a negative attitude towards organ donation. Infact the patron of the society, Shri Alok Kumar shares a story which reflects how deep these beliefs are and how innovative methods are required to deal with them. A person who was approached for eye donation argued that if he donates his eyes, he would be born blind in his next birth. To this, Shri Alok countered that then he must donate his body for the cause of medical science and he won’t be born in the next birth and would attain moksha.
The next challenge is the lack of awareness among general public regarding organ donation. The concept of 'brain death' and its legal implications are not familiar to the majority of the population in India. Unfortunately, there is a lack of awareness about these issues even among the medical professionals. It very important to effectively communicate and educate the general public. It has been the experience of our samiti that more people come forward when they are explained about the concept of organ donation. To this end, Samiti organises regular ‘Dehdaniyo ka Utsav’ and publishes a bimonthly e-journal containing news, activities, articles, messages/interviews of social, religious, political leaders and experts in medical fraternity. In our experience, an educated donor who is willing to donate his organs will successfully communicate with the family members regarding his willingness to donate his organs. Persons who sign for organ donation without having a complete knowledge about the issues involved are less likely to stick to their decision.
At the organisational level, much needs to be done. Even if public is sensitised to the cause of body and organ donation it is not enough with the existing infrastructure. Unfortunately, there is lack of an adequate number of transplant centers and not enough transplant coordinators who are themselves well versed with the laws and procedures of organ and body donation.
People are more open to eye donation but not that receptive to organ and body donation. It has been the experience that mostly the families of the potential organ donor are reluctant to determine brain death or do not accept the medical diagnosis of brain death reported to them by doctors. Sometime technical issues arise like the inability to perform apnea test or logistic problems in conducting the mandatory confirmatory tests. A tragic example comes to mind about the infant organ donation which highlights these infrastructure failures. There have not been many infant organ donations in India so far. Dr. Umesh Sawarkar, and his wife Dr. Ashwini Sawarkar, along with their three-month-old daughter Meera met with an accident. Both parents survived with injuries but unfortunately the CT scan of baby Meera revealed brain hemorrhage. Both parents decided to donate her organs. They were discouraged by the hospital saying the rules on infant organ donation were not clear. Still they persisted. On contacting NOTTO they were told that the donation was possible, but they did not have any expert to certify brain death for a child this small. This led them to ask the Health Ministry which approved the request within 12 hours. With insistence, the Nagpur-based Central India’s Children Hospital and Research Institute (CICHRI) began the process of certifying brain death. Meera’s first apnea test came out positive. Another test was supposed to be carried out within 24 hours to finish the process of brain death certification. A national search was initiated to help find Meera’s pediatric match. Within six hours, there were requests for two recipients. A three-year-old child, wait-listed with Max Super Specialty Hospital, Saket, in New Delhi, for kidney was found compatible and another child who had been wait-listed with Medanta hospital, Gurgaon, was found compatible for liver transplant. All the arrangements were made but precious time was already lost. Meera’s body was under a lot of stress as it was her fourth day on the ventilator. She suffered cardiac arrest and couldn’t make it. This reflects much need to be done to streamline the process.
When we talk about body donation, it seems there is a great gap between the number of people who pledge for body donation and actual cadaveric donors. There are many reasons for this like lack of awareness, misconceptions, feud among family members and social criticism.
Therefore it is of utmost importance that all the stakeholders, non-governmental organizations and religious leaders should be involved in changing the perception of the general public towards deceased organ donation. Provisions and protocols related to brain death should be clearly stated and declaring brain-death should be made mandatory in all hospitals.
Nobody should have to wait for an organ for transplantation. This is an idealized goal but one should strive to work in that direction. There are numerous challenges that have to be met but with proper planning and organizational set up we can achieve the goal of ‘Sarve bhavantu sukhina’.
References:
- Srivastava A, Mani A. Deceased organ donation and transplantation in India: Promises and challenges. Neurol India [serial online] 2018 [cited 2019 Jun 25]; 66:316-22. Available from: http://www.neurologyindia.com
- Guidelines for the determination of death: report of the medical consultants on the diagnosis of death to the Presidents commission for the study of ethical problems in medicine and biochemical and behavioural research. 1981; 246:2184–6. doi: 10.1001/jama.246.19.2184.
- Guibert EE, Petrenko AY, Balaban CL, Somov AY, Rodriguez JV, Fuller BJ. Organ preservation: Current concepts and new strategies for the next decade. Transfus Med Hemother 2011;38:125-42.
- Transplantation of Human Organs and Tissues Rules, 2014. The Gazette of India: Extraordinary Part II Section 3 Subsection (i) March 27,2014.
- Abraham G, Vijayan M, Gopalakrishnan N, Shroff S, Amalorpavanathan J, Yuvaraj A, et al. State of deceased donor transplantation in India: A model for developing countries around the world. World J Transplant 2016;6:331-5.