Dear Indian Express Readers,
A matter of life and death. India’s first organ transplant was performed more than 54 years ago, on February 2, 1971, at the Christian Medical College, Vellore. Last year, more than 18,000 transplants were performed in the country – the third highest after the US and China. Yet, only about 4 per cent of patients needing a liver, kidney, or heart transplant receive one. At less than 0.8 per million, India’s organ transplant rate compares very poorly with that of global leaders like Spain, where around 40 people in a million donate organs.
The country’s organ transfer law recognises donations by the patient’s close relatives — parents, spouses, and siblings. In the event that a near relative is medically incompatible with the recipient, the pair is permitted to undergo a swap transplant with another related, but unmatched, pair. However, by all accounts, an overwhelming number of organ donations in the country are not by the close kin of patients. Such donors have to convince a screening committee of their altruistic motives. Regular scams have shone the light on a black market that lures the desperately poor to sell their organs, while disguising the transaction as altruistic.
Now, a study by researchers at AIIMS Delhi has shed light on another systemic deficit that hobbles the timely harvesting of organs. A survey of 177 of the country’s top neurosurgeons, neurologists, and critical care specialists shows that over half (59.2 per cent) were not trained in medical colleges to certify brain death — the cessation of all brain activity due to lack of oxygen to the brain cells is a fundamental condition for harvesting an organ. In many transplant protocols, brain death is declared first so that organs can still be maintained until removal. Timely certification is critical: Once circulation stops, organs begin deteriorating. Depending on the organ, viability may range from four to 12 hours — for instance, the heart and lungs can be harvested in four to six hours, and the liver in eight to 12 hours. But, as the AIIMS study shows, doctors are not trained to certify brain death urgently enough for the organs to be transferred to a needy patient.
A third of the physicians did not have a checklist for brain death declaration. The lack of comprehensive national guidelines on brain death certification also makes it difficult for doctors to take a call.
The knowledge gap, therefore, impacts organ donations. Every year, nearly 2 lakh people have brain deaths — 1.5 lakh die due to traumatic brain injuries, and another 50,000 die due to brain stroke. Yet there are only around 1,100 patients who donate their organs every year. A brain-dead person can donate several organs, including the heart, lungs, liver, kidney, intestines, pancreas, eyes, heart valves, skin, bone marrow, and connective tissue.
Organ donations can make a critical difference in a country with an enormous burden of chronic lifestyle diseases such as diabetes. But government data underlines the wide gap between demand and supply. Around 1.8 lakh persons suffer from renal failure every year, but the number of renal transplants carried out is just around 6,000. A government survey last year found that the waiting time for a kidney could go up to five years – a large number of people with end-stage renal disease do not survive that long. The lives of around 10-15 per cent patients who die of liver failure could be saved with a transplant. About 200 heart transplants are conducted annually in the country, where about 50,000 people die of heart failures annually.
In recent years, the government has simplified organ transplant rules. In 2023, it did away with an age cap that reduced the pool of organ donors for a large section of critically ill people above 65. Senior citizens in this age group can now register to receive donations from live donors. It also removed domicile-related restrictions – earlier, some states would either register recipients who lived there or accord priority to them in allocating organs. Now the health ministry needs to give attention to the AIIMS survey, especially because it comes close on the heels of its own report, in June, which highlighted that the country’s organ transplantation programme has been constrained by several issues, including insufficient funding, shortage of specialised doctors, and procedural delays. The least policymakers can ensure is this: People should not be left to die because of a lack of clarity in procedures.
Till next time,
Stay well
Kaushik Das Gupta
