IT IS unlikely that the huge gap between demand for organ transplants and available donors, both living and cadaver, will be closed soon, nephrologist and other medical experts said at a virtual meet organised by the Institute of Law and Medicine on Tuesday. Besides a lack of awareness on organ donation, the rise non-communicable and lifestyle diseases, such as hypertension and diabetes, experts said, made matters difficult.
Dr Manoj Gumber, a consultant nephrologist at Apollo Hospital in Ahmedabad, said an estimated four lakh people die in India every year waiting for an organ transplant, and of them, at least half are eligible for the same.
While there are 46 dialysis centres with 465 machines in the state that provides free-of-charge service, former state health minister Jay Narayan Vyas, who was among the panellists, said the dialysis centres in the state “are grossly under-equipped… We should also have more facilities for an organ transplant. While patients come for kidney-related treatment at IKDRC (Institute of Kidney Diseases and Research Centre), one can see them waiting and staying on the footpaths outside the hospital for months”.
While calling the government’s free-of-cost dialysis programme a benefit, Dr Gumber said there are other aspects that require to be factored in in case of dialysis that in turn tilts the needle in favour of a transplant. “There is a vast difference in the quality of life of a patient who undergoes transplant and one who opts for dialysis. There is a dependency on others in case of dialysis — they have to come thrice a week with a relative. Cost of dialysis at the end of one-and-half years will be equivalent to the cost of the transplant. If a patient is assured that in case of a transplant, the surgery cost and post-transplant medication will be taken care of by the government, then obviously the number of transplants will increase.”
However, there can never be complete reliance on transplants although efforts should be made to maximise the option for patients, he added.
Umesh Desai (45) from Dakor, who survived end-stage-renal-disease (ESRD) condition following dialysis treatment at Ahmedabad-based IKDRC since the past 18 years, said his attempts to find a match for kidney transplant had borne no result. So, Desai finally opted for regular dialysis under the Gujarat Dialysis Programme. The programme includes a state-wide network of dialysis centres, managed by IKDRC and funded by National Health Mission.
According to data provided by IKDRC, there are over 52,000 ESRD patients in the state but only 16,000 patients are served through the dialysis delivery infrastructure available in Gujarat, that is less than a third.
An organ transplant can be done through live donation or cadaveric donation. The latter remains chequered with religious prejudices, unclear legal framework and no uniform definition of death, as legal and medical experts point out. There is a unanimous agreement that organ donation can be bettered by awareness created via textbooks and improving doctor-patient relationship including with patients’ relatives/caregivers.
Dr Gumber says, “Even with a superb cadaver donation programme, we will not be able to catch up with the demand because non-communicable diseases are increasing day-by-day (which affects organs). Ultimately prevention is the answer.”
Among other shortcomings of living organ donation is India’s policy of two-child norm and an apparent gender bias, says Dr Gumber.
With Covid-19 also impacting other organs of the body, especially kidneys, a double-edged situation may emerge. Dr Gumber says “For Covid-19 patients who require dialysis, mortality is very high. And patients with acute kidney injury (AKI) who recover are susceptible to chronic kidney failure over long-term.”