On August 13, 2020, MOHAN Foundation organised its fifth panel discussion as part of its series, ‘Synchrony Dialogues,’ launched on June 12, 2020. This discussion titled ‘Building Partnerships for Organ Donation' was in association with SBI Foundation and in partnership with The Times of India. August 13 has been celebrated as 'Organ Donation Day' as part of an initiative by Times of India since the last 6 years.
Ms. Lalitha Raghuram, Country Director, MOHAN Foundation began the webinar by introducing Mr. P.W.C. Davidar, IAS Retd. Additional Chief Secretary, Govt. of Tamil Nadu as the moderator of the panel discussion. The other panelists were - Ms. Manjula Kalyanasundaram, Managing Director, SBI Foundation, Dr. Anil Kumar, Deputy Director General, DGHS, MoHFW, Govt. of India, Dr. Shubnum Singh, Advisor CII Healthcare, Policy & Governing Board Member, Healthcare Sector Skills Council, Dr. Arun Gupta, Executive Director, National Health Authority, Dr. Sonal Asthana, Senior HPB & Multiorgan Transplant Surgeon, Aster Integrated Liver Care Team, Dr. Rajesh Chandwani, Faculty, Centre for Management of Health Services (CMHS), IIM Ahmedabad, Dr. Santosh Shetty, Executive Director & CEO Kokilaben Dhirubhai Ambani Hospital, Mr. Sanjeev Bhargava, Brand Director, Times of India & Dr. Sunil Shroff, Managing Trustee, MOHAN Foundation.
Mr. Davidar began the discussion by putting the first discussion point to the forum – what is the way forward to increase organ transplants in our country and what are our training needs – who could identify them and how will the training be administered. He then invited Dr. Sonal Asthana to share his viewpoint.
Dr. Asthana said that in a short span of 9 years India had come a long way. The organ donation rate of India has increased 11-fold from 0.08 to 0.80 per million population. He said that we have made substantial progress in creating awareness amongst the population of the requirement of brain death and organ donation – the foundation stone has been laid but putting the processes in place is an on-going challenge and training of transplant coordinators who are the linchpins of the transplant programme. He further added that MOHAN Foundation has played a pivotal role in creating awareness among masses and training transplant coordinators across the country.
Dr. Santosh Shetty was of the belief that the foundation of anything lies in education and that education at all levels was absolutely critical. It is the cornerstone for every successful transplant programme. He further added that to increase organ transplantation we needed to sensitize the treating doctors, the hospital staff, the neurocritical care and everyone associated with it. He applauded the work of MOHAN Foundation in training transplant coordinators who play a great role in counseling the families of brain-dead patients for organ donation.
Dr. Sunil Shroff spoke about the challenges faced in the area of organ donation in different states. In some states the organ donation programme runs smoothly whereas in other states there are challenges like acceptance of brain death & organ donation particularly in government hospitals and engaging the doctors to identify and certify brain death. Dr. Anil Kumar spoke about the shortage of neurosurgeons in the government sector and the need to mobilize more donations both in the government as well as the private sector by upgrading the facilities and infrastructure as there is unequal distribution of these facilities in our country. He gave the example of the western and southern regions of our country where there is maximum organ donation and transplant activity as compared to the north-eastern region where it is still in its nascent stage.
Dr. Shroff, Dr. Santosh and Dr. Asthana were of the view that neurocritical care specialists were not being given any recognition and acknowledgement for their role in the deceased donation programme donation has been a very fulfilling experience. and the transplant team gets all the glory. It is actually a team effort but the neurocritical care team is left out.
Mr. Davidar put the second question to the forum as to the role of CSR (Corporate Social Responsibility) and Media in promoting organ donation and how to engage the corporates to promote the cause of organ donation.
Ms. Manjula Kalyanasundaram said health was SBI Foundation's focus area and the partnership with MOHAN Foundation to promote the cause of organ donation has been a very fulfilling experience. Taking a cue from her sharing, Mr. Sanjeev Bhargava addressed the question as to what corporates get out of the CSR initiative. He said that the consumers of today expect a brand to be ‘benevolent’ and corporates are realising that benevolent cause association is good for the business. CSR is not just a compulsory clause imposed by the government, but it is absolutely critical for the organisation if they want to build associations and connections. He further added that media has a sacred responsibility to society and if they don’t deliver, they will lose their integrity as a media entity and that responsibility is to bring bubbling up to the surface issues which otherwise are not part of the public discourse but are important for the society.
Dr. Shubnum Singh shared her views on the approach of top management in the corporate world who would actively promote organ donation even among their own employees, and took the example of SBI Foundation. She said, “In today’s corporate environment, they are acutely aware of their societal responsibilities. When you expand in a company, and you realize that you are not isolated, it is just not the balance sheet, but you have to look at the larger universe of your stakeholders which means that you have to actively engage with the community and that is the key”.
Mr. Davidar put the third question to the forum for discussion, “How can private hospitals participate in care of poorer patients? Can the trust deficit between government and private sector be reduced through such initiatives? He invited Dr. Arun Gupta to share his comments.
Dr. Arun Gupta shared with the forum that presently there is no package for organ transplantation under Ayushman Bharat Pradhan Mantri Arogya Yojana (ABPMJAY). Under this scheme health needs of approximately 40% of the population in the country is being looked after. And, a need has been felt to include organ transplantation under it. He also added that the quality of care given to the patients in a private hospital is phenomenal and people prefer to go to these institutions. National Health Authority has sponsored around Rs. 1 crore treatment under ABPMJAY and less than 0.5% complaints come into their system and in this the share of private hospitals is even less.
Dr. Rajesh Chandwani shared his viewpoint on funding for transplants for poor patients. He said that the ideal situation would be where the patient does not have to bear the cost at all but ultimately somebody has to bear. Many of the hospitals have not done a systematic study on the transplant costing. If the resources and the cost is allocated i.e. if the drivers are known only then can they be controlled. As organ donation is a complex process where there are different stakeholders with different perspectives, it is important to ensure that everybody is satisfied.
The fourth and the last question put forward by Mr Davidar to the forum was strengthening documentation - In non-transplant organ retrieval centres brain death declaration is being done. Could we make every ICU in the country as a deemed to be non-transplant organ retrieval centre?
Mr. Davidar invited Dr. Anil Kumar to share his comments. Dr. Kumar said that it was a very wishful and ambitious project. There are certain pre-requisites for a hospital to become a non-transplant retrieval centre as mandated by the law. The hospital should have a brain death committee that would identify and certify a brain-dead patient. The ICU should have the donor maintenance protocol in place to be instituted once a patient is declared brain dead. Mandatory placement of a Transplant Coordinator who would initiate counseling for organ donation. Even after fulfilling the criteria as mandated by the law for a hospital to become a retrieval centre, nursing homes/smaller hospitals can still face issues like for example; a brain death being wrongly diagnosed.
Mr. Davidar added to Dr. Anil Kumar’s points and summed it up by saying that not compromising on the procedural aspects of declaring a person brain dead or on the facilities and infrastructure needed for an organ harvesting exercise, the processes and procedures could be re-looked at exponentially so that many people who want to donate and are in a position to donate will have the ability to do so.