Santosh Kumar, the 33-year-old Dalit man who was given money for a kidney transplant by the PMO, died last week because the queue of patients ahead of him at the nearest transplant centre was simply too long. Two key figures tell the story of organ transplants in India — or the lack of them.
One, only 22 kidney transplant centres are registered with the still-under-preparation government registry.
Two, of the nearly 21,000 kidney transplants that have happened in the country since 1971, only 776 have come from cadaver donors, according to data from the Indian Transplant Registry, a non-government initiative supported by the Indian Society of Organ Transplantation.
The figures suggest that transplants have never been a matter of policy priority, even though diseases such as diabetes and hypertension are known to cause terminal organ damage in a large number of people. The National Organ and Tissue Transplant Organisation (NOTTO) was set up only last year — and so far only 38 centres have been included in its registry of transplant centres. Future plans include a registry of donors.
Following the passage of the Transplantation of Human Organs Act, 1994, a body called the Organ Retrieval Banking Organisation (ORBO) was set up at AIIMS with roughly the same mandate as that of NOTTO. ORBO continues to exist even now — even though the amended law passed in 2011 saw the setting up of NOTTO, which has taken up ORBO’s job.
DEMAND & NO SUPPLY
According to figures put together by ORBO, of the 1 lakh-1.5 lakh kidneys required every year, only about 3,500-4,000 are transplanted. Officials associated with NOTTO put the figure at approximately 4,500. Of the estimated 15,000-20,000 liver transplants required annually, only about 500-1,000 are actually performed. Cornea transplants have done better, with 18,000-20,000 procedures being carried out every year. NOTTO has 18 registered centres for cornea transplants. Heart transplants are still rare.
While the lack of organs is a serious impediment, most institutions that run cadaver donation programmes say even when individuals pledge their bodies, there is huge family resistance that needs to be overcome before the organs can start to be distributed among those who need them. Government awareness initiatives on cadaver donation have been sporadic, and have failed to make a dent. Sometimes lack of coordination and transporation faclities have caused precious organs to be rendered untransplantable. On the other hand, recurrent reports of organ “rackets” make any donations apart from those from close blood relatives suspect in the eyes of ethics committees.
Amid hand-wringing over cadaver donation not picking up — and how the large numbers of deaths in road traffic accidents are a veritable “organ bank” that can give lives to thousands — one fundamental problem is sometimes overlooked. That there simply aren’t enough surgeons and centres to cater to the lakhs of Indians in need of new organs. Santosh Kumar had both the money and the kidney he needed — thanks to the PMO and his sister — but Lucknow’s Sanjay Gandhi Post-Graduate Institute of Medical Sciences didn’t have the time for him.
There are no authentic registries, but ballpark estimates suggest there are 250-odd transplant centres in the country, with just about 150-odd surgeons. Of these, perhaps 15-odd would be surgeons of repute — performing maybe 100 surgeries a year.
There are very few training facilities for aspiring transplant surgeons. Training abroad costs between Rs 20 lakh and Rs 25 lakh. The massive startup costs of a transplant unit and the lack of experienced doctors ensure smaller centres cannot come up.