Opinion Changes in organ transplant rules: A new lease of life

trade data, The changes to the organ transplant rules announced by the Union health ministry last week, are small, but significant, steps towards giving a new lease of life to many people with failing organs. The ministry has done 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. The removal of domicile-related restrictions is another much-needed move to make organs accessible for timely transplants. Earlier, some states either registered recipients who lived there or accorded priority to them in allocating organs. States such as Maharashtra, Kerala, Gujarat, and Telangana charge between Rs 5,000 and Rs 10,000 to register patients who need an organ replacement. The health ministry has rightly directed these states to stop charging this fee.

India conducts the third highest number of transplants in the world every year. Yet barely four per cent of the patients who require a liver, heart or kidney transplant manage to get one. The percentages are very likely to go up once the changes in the rules announced last week take effect. The organ shortage problem is, however, a complex one, that continues to confound planners, even in nations whose healthcare systems are far better equipped than that of India’s.

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The country’s organ transfer law recognises donations by the patient’s close relatives — parents, spouses and siblings. In case, a near relative is medically incompatible with the recipient, the pair is permitted a swap transplant with another related unmatched pair. But by all accounts, a majority 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. Suggestions to make the proceedings of the committees more transparent have largely been ignored by authorities. But the country’s growing burden of lifestyle diseases mean that such tasks cannot be put off for long. Increasing the pool of organs will require regulatory creativity without compromising on ethical imperatives — including those related to showing sensitivity to the concerns of a prospective donor’s relatives. For that reason, the opt-out system — it assumes all citizens to be donors unless they “opt out” — adopted in some Western countries may not be apt for a country such as India, where awareness of organ donation is low. Last week’s changes in rules show the government’s inclination to resolve a difficult predicament. It needs to do more.