Every teenager looks forward to turning 18 and getting a driving licence. But the licence could be a tool for driving home a very important cause organ donation. When a person applies for a driving licence,she will have the option of ticking either Yes or No to her willingness to donate organs,and that would be incorporated into a smart chip in the licence. This recommendation was made to the parliamentary standing committee on health in 2010 and the committee has included it in its final report. With about 114,000 deaths on the road annually and almost 67 per cent of them being brain death,this simple inclusion in the driving licence has the power to save many lives.
Acute shortage of organs is a universal problem,more so in developing countries like India. What makes it worse is that the majority of organ failure patients never receive any care. Added to this is the rising incidence of diabetes mellitus,hypertension and hepatitis B and C carrier states. The rate of living renal transplantation in India is 3.25 per million population and the deceased organ donor rate is only 0.08 per million population. However,the average crude and age-adjusted incidence of end-stage renal disease is estimated to be 151 and 232 per million population respectively in India. The Indian Chronic Kidney Disease registry shows that 74.5 per cent of its patients do not receive any form of renal replacement therapy. However,there is a ray of light and hope in all this gloom the success of the deceased organ donation programme in Tamil Nadu and Andhra Pradesh.
Of course,none of this would have been possible without the publics will to give. In some cases,it has been the familys complete commitment to organ donation that has actually motivated the medical fraternity. Therefore,creating public awareness should be made a priority.
Organ allocation is a sensitive area. The government-run Tamil Nadu Network for Organ Sharing has shown the way forward in this. Organ sub-committees were set up to decide on allocation criteria for each organ and sharing was done based on these pre-determined criteria. It is to the governments credit that its involvement has resulted in better utilisation of organs. In fact,the 85 per cent utilisation of the liver is better than the world average of 70 per cent.
However,the Centre needs to do its bit by bringing in much-needed changes in policy. A step in the right direction has been taken with the cabinet clearing amendments to the Transplantation of Human Organs Act. The amended bill is listed for consideration and passing this session. These amendments include making the appointment of transplant coordinators mandatory in hospitals before they can be registered as transplant hospitals. What needs to be emphasised is that these transplant coordinators need to undergo formal grief counselling training and be able to handle the legal aspects of organ donation and retrieval process. In addition,other recommendations from the parliamentary standing committee like required request (making a request in all cases of brain death),expanding the pool of specialists who can certify brain death,simplifying post-mortem procedures,and an intensive ongoing national campaign have all been incorporated into the amendments. It is also proposed that the new act shall now be called the Transplantation of Human Organs and Tissues Act.
There will be no dearth of organs if the deceased organ pool here is properly utilised. The standing committee has,in fact,recommended the setting up of a National Human Organs and Tissues Removal and Storage Network after a thorough study of networks in southern states. Based on the experience of these states,a model framework can be circulated in the rest of the country.
Very briefly,what is required is creating awareness about the concept of brain death among the public and placing trained counsellors in intensive care units to support the deceased organ donation programme.
The writer is head of the department of urology and renal transplantation,SRMC,Chennai,express@expressindia.com
