Strengthening deceased donor organ transplantation – the way ahead for India, Health News, ET HealthWorld -

Strengthening deceased donor organ transplantation – the way ahead for India, Health News, ET HealthWorld


Strengthening deceased donor organ transplantation – the way ahead for IndiaBy Dr. Vivek Kute

As India observes Organ Donation Day on November 27, we get an opportunity to reassess our priorities towards this life-saving procedure. In 2019, India performed 12,666 transplants which was the second-largest number of transplants globally in terms of volume. But the sweeping impact of the coronavirus disease 2019 (COVID-19) had a devastating effect on this number with only 7,442 transplants being performed in 2020. Since nearly 80% of organ transplants in our country involve living donors, deceased donor organ transplantation (DDOT) can offer a way forward to meet our burgeoning needs.

DDOT challenges

The Transplantation of Human Organs Act (THOA) initially passed in 1994 and subsequently amended in 2011 and 2014 by the Government of India also promotes deceased organ donation. However, improvements are needed to ensure clarity and simplicity. DDOT in India is impeded by a general lack of awareness across the community, both medical and otherwise. There is widespread misinformation and hesitancy towards declaring/accepting brain stem death too. The lack of adequate infrastructure (specifically in the government sector) and the need for specialised transportation for the organs make DDOT implementation difficult across the country. The considerable expense involved in organ transplantation (costs are two times more in private vs. public sector hospitals) makes the procedure inaccessible to the poor.

Potential solutions for expanding DDOT implementation

  • Legal measures: A robust national policy for declaring brain death must be implemented and reporting of brain death must be made mandatory at the state level. The brain death declaration must be delinked from DDOT. The donor pledge form (form 7) must be made legally binding and the potential donor’s family must be supported by dedicated grief counselors in emergency rooms and ICUs to make the transition easier. Treating doctors, ICU/primary care doctors must be trained to initiate grief counselling/DDOT discussion to foster trust between the donor’s family and the organ retrieval team.

  • Enhancing awareness: The contribution of the donors and their families can be suitably acknowledged by honouring them publicly or with the help of specific social initiatives (tree-planting drive, support for cremation rituals, government health cards for the donor’s family). This may encourage others to pledge their organs too. Cultural barriers to DDOT can be addressed via Information, Education and Communication (ICE) teams who can reach out to the general population with the help of health workers, social media, religious leaders and key opinion leaders to clear myths and misconceptions about organ donation. Organ donation pledges can also be linked to driving license applications and relevant information can be disseminated by caller tunes.

  • Transplant-specific systems: Transplant hospitals must be supported by a dedicated transplant procurement manager and a multidisciplinary team who can identify potential donors and proactively recruit them by creating awareness. State-of-the-art donor care can be implemented and rapid transport of organs can be instituted to increase their viability.

  • Government policies: The government has already enforced new rules which allow autopsies to be conducted after sunset in areas where relevant infrastructure is available. This is a step in the right direction to bolster the organ donation programme. Key features from states with successfully implemented DDOT programmes can also be enforced across the country. A ‘One Nation One Policy’ can be established for digital organ allocation to ensure a transparent system at the regional, state and national levels along with priority licensing of non-transplant organ retrieval centers. Government guidelines for donation after circulatory death must also be developed. A centralised data organ transplantation registry and management system can be created in coordination with the states to optimise every step of the DDOT process. The entire process can be aligned towards self-sufficiency by working collaboratively with national and international societies. Lastly, expanding the organ transplantation capacity of government hospitals by appropriate manpower and infrastructure development can make DDOT accessible to a larger proportion of needy Indians.

The future of organ donation may involve the use of machine perfusion to utilise organs from expanded criteria donors as well as list exchanges and the development of a national kidney exchange programme. However, in the present scenario, enforcing a robust and transparent DDOT programme with relevant support from both governmental and non-governmental organisations can generate public trust and be the driving force behind achieving self-sufficiency in organ transplantation.

By Dr. Vivek Kute, Secretary, Indian Society of Organ Transplantation (ISOT) and Councilor, The Transplantation Society (TTS) and Asian Society of Transplantation

(DISCLAIMER: The views expressed are solely of the author and ETHealthworld.com does not necessarily subscribe to it. ETHealthworld.com shall not be responsible for any damage caused to any person/organisation directly or indirectly)





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