Challenges of Organ Donation

Recently, the critical shortage of organ donations, particularly deceased donations, has led to a dire situation in India, with thousands of patients waiting for transplants and a significant number losing their lives daily.

• The Ministry of Health and Family Welfare has earlier modified National Organ Transplantation Guidelines, allowing those above 65 years of age to receive an organ for transplantation from deceased donors.
• In India, the Transplantation of Human Organs Act, of 1994 provides various regulations for the removal of human organs and their storage. It also regulates the transplantation of human organs for therapeutic purposes and for the prevention of commercial dealings in human organs.

Status of Organ Donation in India

• Growing Demand and Persistent Shortage:
  • Over 300,000 patients are on the waiting list for organ donations in India.
  • The supply of organ donors has not kept up with the increasing demand.
  • Approximately 20 individuals die daily while awaiting organ transplants due to the shortage.
• Slow Growth in Donor Numbers:
  • Donor numbers, including both living and deceased, have shown slow growth over the years.
  • From 6,916 donors in 2014, the count increased to about 16,041 in 2022, indicating a modest rise.
  • The deceased organ donation rate in India has remained consistently below one donor per million population for a decade.

• Deceased Organ Donation Rate:
  • Urgent efforts are required to raise the deceased organ donation rate to address the shortage.
  • Countries like Spain and the United States have achieved significantly higher donation rates, ranging from 30 to 50 donors per million population.
• Prevalence of Living Donors:
  • Living donors constitute the majority, accounting for 85% of all donors in India.
    • However, deceased organ donations, especially for kidneys, liver, and heart, remain considerably low.
• Regional Disparities:
  • Disparities in organ donation rates exist among different states in India.
    • Telangana, Tamil Nadu, Karnataka, Gujarat, and Maharashtra have reported the highest number of deceased organ donors.
    • Delhi-NCR, Tamil Nadu, Kerala, Maharashtra, and West Bengal are prominent regions with a high number of living donors.
• Kidney Transplants:
  • Kidney transplantation in India faces a significant disparity between demand and supply.
  • Annual demand for 200,000 kidney transplants is met with only around 10,000 transplants each year, creating a substantial gap.

Challenges Regarding Organ Donation

• Lack of Awareness and Education:
  • Limited awareness among the general public about organ donation and its impact.
  • Insufficient education among medical professionals to identify potential donors and counsel families effectively.
• Family Consent and Decision-Making:
  • Family reluctance to give consent for organ donation, even when the deceased individual had expressed a willingness to donate.
  • Emotional and ethical dilemmas that families face when making decisions about organ donation.
• Organ Trafficking and Black Market:
  • Illegal organ trafficking and the existence of a black market for organs.
  • Criminal activities exploit the demand for organs and undermine legitimate donation processes.
• Medical Eligibility and Compatibility:
  • Matching suitable donors and recipients based on medical compatibility and organ availability.
  • Limited availability of compatible organs, leads to prolonged waiting periods for patients.
• Donor Incentives and Compensation:
  • Debates over the ethical implications of offering financial incentives or compensation to organ donors.
  • Balancing the need for increasing donation rates with ensuring ethical practices.
• Infrastructure and Logistics:
  • Inadequate infrastructure and resources for organ retrieval, preservation, and transplantation.
  • Challenges in the timely transportation of organs from donors to recipients, especially across different regions.

Highlights of the New National Organ Transplantation Guidelines

• Removed Age Cap:
  • The age limit for organ recipients was eliminated due to improved life expectancy.
  • NOTTO (National Organ and Tissue Transplant Organization) guidelines previously prohibited end-stage organ failure patients above 65 years from registering for organ transplants.
• No Domicile Requirement:
  • Domicile requirement waived for organ recipient registration.
  • ‘One Nation, One Policy’ approach allows patients to register for organ transplants in any state.
• No Registration Fees:
  • Removal of registration fees for organ recipient registration.
  • States, including Gujarat, Telangana, Maharashtra, and Kerala, no longer charge fees for patient registration.

NOTTO

• NOTTO is set up under the Directorate General of Health Services, Ministry of Health and Family Welfare, located in New Delhi.
• National Network division of NOTTO functions as the apex centre for all Indian activities for procurement, distribution, and registry of organs and tissues donation and transplantation in the country.

Organ donation in India is a crucial aspect of healthcare, offering a lifeline to individuals suffering from organ failure. Here’s an overview of organ donation in India:

1. Legal Framework:
   • India passed the Transplantation of Human Organs Act in 1994 to regulate organ donation and transplantation.
   • The law aims to prevent commercial dealings in organs and promote ethical practices in organ transplantation.
2. Types of Organ Donation:
   • India permits both living and deceased organ donations.
   • Living donors can donate organs like kidneys, segments of the liver, and parts of the lungs.
3. Deceased Organ Donation:
   • Brain-dead individuals can donate organs like heart, lungs, kidneys, liver, and pancreas.
   • Consent from the family is crucial for deceased organ donation, even if the individual has registered as an organ donor.
4. National Organ and Tissue Transplant Organization (NOTTO):
   • Established by the Government of India, NOTTO coordinates and regulates organ and tissue donation and transplantation activities.
   • It maintains a national registry of donors and recipients.
5. Challenges:
   • Shortage of organs for transplantation is a significant challenge.
   • Cultural and religious beliefs, lack of awareness, and concerns about medical malpractice can impact donation rates.
6. Initiatives and Awareness:
   • Various government and non-government organizations run campaigns to raise awareness about organ donation.
   • Transplant coordinators play a vital role in guiding families through the donation process.
7. Organ Transplant Centers:
   • India has several hospitals equipped for organ transplantation.
   • These centers follow strict protocols to ensure ethical practices and patient safety.
8. Living Organ Transplant:
   • Donors need to be emotionally related or genetically unrelated, and they require approval from an authorization committee.
9. Government Support:
   • The Indian government offers financial assistance for organ transplantation to those who can’t afford it.
10. Organ Trafficking:
    • India has faced challenges with illegal organ trafficking. Laws are in place to prevent such activities.

Remember, organ donation practices and regulations may evolve, so it’s essential to refer to the most up-to-date resources when studying this topic.