www.dehdan.org

India's Deceased donor transplantation program

Transplantation of solid organs or tissues is not a new concept in India. Lord Ganesh is the first example of Xenotransplantation. Maharishi Dadichi also donated his bones to create weapons to defeat the demons. Shushruta in 600 B.C. used the skin as an auto graft to reconstruct the nose. The first successful kidney transplant was performed in 1953 in Boston. India too progressed in this direction and achieved technical success in living kidney transplantation. But there was no program in extra renal solid organs like heart, lungs, liver, kidneys & other composite tissues transplantation which could not be done by living donor. The continuous shortage of organs had led to many illegal activities like organ trafficking and transplant tourism. As a first step, GoI promulgated Transplantation of Human Organs Act (THOA 1994) and amendments THOTA 2011. It is time that we introspect our efforts to make the deceased donor transplantation a successful program.

India is a vast country with diverse culture and religious faiths. There is a large gap in the economical and literacy level of the population. The brain death and organ donation process is a recent complex concept. The right kind of awareness is required to change the mindset of all strata of society for the success of DD program which is a time bound, cooperative and coordinated activity. From the beginning till 2010, it was a NGO oriented program in most states except in Maharashtra where Government’s firm participation had strengthened the program to grow scientifically. Even today, various NGOs are creating awareness across the country about brain stem death, cardiac death and organ donation. Inclusion of body donation in this program is probably not advantageous as both donations are controlled by 2 different laws. The protocols are different as organ donation is for therapeutic purposes which depends upon many donor and recipient criteria & medical and ethical issues. Body donation is for teaching anatomy for first MBBS students, which is an important foundation for medical education.

The most important pillar of this program is the hospital and medical experts. Over the last decade, there have been many trained doctors who have carried out successful extra renal solid organ transplants which have gained the confidence of society. The graph of all Southern states, Maharashtra, Gujarat, Odisha, West Bengal, Delhi, Chandigarh, Rajasthan is slowly increasing. The reasons for this are trained medical fraternity, cooperative institutional chiefs, active support from the state government and continuous involvement of NOTTO, ROTTO and SOTTO.

30 years of THOA 1994 will be completed in July 2024. Its progress has been fairly slow. It is time that we put a roadmap for the progress of the DD program.

The Government -

1. Must proactively fill in the gaps in the chain of BSD declaration, organ donation and successful transplantation to make it a seamless program.

2. The archival post mortem law which is controlled by CrPC must be brought upto date so the family of DD is not harassed.

3. The DD transplantation is an extremely complex, time bound andcoordinated activity which is also an expensive affair. The professionals

who are compassionate, skilled and walk the extra mile braving the hanging sword of the Consumer Protection Act on their head. This is a singular major factor for dissuading young, talented, hardworking medicos.

Training –

1. All strata of society must have the required training and awareness.

The administrators, medical fraternity, NGO and the police must be aware about BSD and organ donation.

Medical Institutions –

1. Must upgrade the infrastructure and adopt a donor action program. State Appropriate Authority
2. Should be proactive in registering every small hospital with adequate facilities as NTORC.

Society

1. Society has become the scapegoat for all failures relating to BSD and organ donation. A recent survey carried out by CVoter, an international agency, clearly analyzed and published the results which are contrary to this belief.

2. According to a mega survey of this agency, 85 percent of the Indian the population is not aware of deceased organ donation but more than 90% of them were not against it, irrespective of religion, literacy,gender and economical status.

So, in conclusion, at the cost of sounding repetitive , one needs to understand that DD transplantation program is a coordinated, cooperative medical program which requires support not only from the Government but also continuous cooperation from all like - minded NGOs to clear the myths and misconceptions of society and change the mindset of the people.