Organ donations rise after Covid-19 dip: What do the numbers show?

Of the 12,387 organs — kidney, liver, heart, lungs, and pancreas among others — harvested in 2021, only 1,743 — a little more than 14% — were from deceased donors. The numbers harvested in 2021 were close to the highest in the last five years (12,746, in 2019), the data show.

The numbers are skewed in favour of living donations — organs like kidney and liver donated by living family members. A total 10,644 organs were harvested from living donors, which was more than the 10,608 living donations of 2019. Only 14.07% of the total organs harvested in 2021 were from deceased donors, much less than the 16.77% of 2019.

The proportion of deceased donations — and the absolute number of donations — was higher still in 2017 and 2018. Of the total donations, 2,152 or 22.5% were from deceased unrelated donors in 2017 and 2,493 or 23.6% in 2018.

There is also a geographical skew in deceased donations. All but two deceased organ donations in 2021 were in 15 states, with the top five — Telangana, Tamil Nadu, Maharashtra, Gujarat, and Karnataka — accounting for more than 85% of the total. Two organs were harvested from a deceased donor in Goa.

One reason for the geographical skew could be that most organ transplant and harvesting centres are concentrated in these geographies.

Dr Krishan Kumar, director, National Organ and Tissue Transplant Organisation (NOTTO), said the number of deceased donations were slowly picking up to pre-pandemic levels. “But our aim is to reverse the current trend of nearly 80 per cent transplants using organs from living donors,” he said.

Why is there a need to increase deceased donations?

The first reason is the gap in the number of organs needed and the number of transplants that happen in the country.

In absolute numbers, India conducts the third highest number of transplants in the world. Yet, of the estimated 1.5-2 lakh persons who need a kidney transplant every year, only around 8,000 get one. Of the 80,000 persons who require a liver transplant, only 1,800 get one. And of the 10,000 who need a heart transplant, only 200 get it.

Demand is on the rise because of the increasing prevalence of lifestyle diseases. Besides, organs like heart and lungs can be retrieved only from deceased donors.

The second reason is that without deceased donations, a precious resource is wasted.

Nearly 1.5 lakh persons die in road traffic accidents every year in India, many of whom can ideally donate organs. Although donations are possible after the heart stops working, almost all organs are currently harvested from brain dead persons.

India has an organ donation rate of about 0.52 per million population. In comparison, the organ donation rate in Spain, the highest in the world, is 49.6 per million population. Unlike India where a person has to register to be an organ donor — and the family has to consent to it after death — Spain has an opt-out system where a person is presumed to be a donor unless otherwise specified.

How can deceased donations be increased?

It is not just the law that has led to Spain achieving its high number of deceased donations, argues an article in the British Journal of General Practice; having a medically qualified transplant coordinator helps. In India, the larger hospitals that are capable of harvesting organs do employ transplant coordinators to explain and guide the families through the process.

At present, only 2.6 organs from a deceased donor are transplanted; there are at least eight.

Harvesting organs from those who have had cardiac death — instead of brain death — can also increase the numbers. However, there are practical problems. As Kalpesh Mhatre, Transplant Coordinator at the Maharashtra ROTTO-SOTTO (Regional and State Organ and Tissue Transplant Organisation) explained, “The organs have to be harvested very quickly after cardiac death because the circulation of blood carrying oxygen to organs stops. However, in India, by the time the family members are informed (of the death) and they come from different parts of the city or even from outside, it is too late.”

Dr Krishan Kumar also stressed on the need for awareness. “People in India are altruistic, what we need is more awareness about organ transplant so that people register as donors. We routinely organise events to increase awareness; we have also started reaching out to school children. Along with awareness, they also need to have faith that the donated organs are actually helping others and we are working on building that trust as well,” he said.

In addition, good transport networks between cities and states can help boost organ donation, Dr Kumar said. The government is working to improve coordination among the Road, Railway, and Aviation Ministries to facilitate the creation of green corridors for faster transportation of organs.

As per the current mechanism, the availability of an organ is reported by the hospital to the state organ and tissue transplant organisation that matches it with recipients locally; if a match isn’t found, it is referred to the regional organ and tissue transplant organisation, and then to NOTTO.

How can an individual become a donor?

To become a registered organ donor, you can take a pledge on the NOTTO website, or mail a filled-in Form 7 of the Transplantation of Human Organs Act.

In addition to registering, it is important for donors to explain their beliefs to the members of their family. This is because even with a donor card, the family’s consent is sought for organ donation after the death of the individual. If the family refuses, the organs are not harvested.