Organ Donation and Transplantation - Tribulations and Triumphs - An Indian Perspective

Dr. Sunil Shroff,

Sri Ramachandra Medical College & Research Institute, Chennai  

From the realms of mythology to the futuristic pages of sci-fi books, transplantation of organs from one human being to another has always been written about, talked about and debated about - intensely. But, what is happening in the world of organ donation and transplantation today? A patient with kidney failure can at least live with dialysis till an organ becomes available but for a patient with liver or heart failure; the only hope of living maybe to have an immediate transplant. Are we doing enough to help these critically ill patients whose number is constantly on the increase? What is the current status of different transplants in India?

Organ donation is a gracious act; it reaffirms our faith in humanity.  However in India over the last 10 to 15 years the organ donation process is marred due to the stigma attached to kidney donation. The law of the land prohibits any commercial angle in organ donation. However the law is hood-winked and kidney trade continues to flourish.

However in the last 10 years, there is a very interesting advancement in the field of transplantation in India, this is seldom discussed or talked about. For the first time in our country organs have been donated and transplanted from patients who are brain dead. Brain death usually happens when there is bleeding within the brain and the brain tissue gets starved of oxygen and glucose and dies. The bleeding can happen due to a spontaneous rupture of a weak vessel within the brain or more commonly due to a severe head injury due to a road traffic accident. The diagnosis of this condition is clinical and most doctors in intensive care units are familiar with the condition. The brain is the master conductor that directly or indirectly controls the functioning of the body and once it dies everything is lost. Normally in death, the heart comes to a stop first and the brain-cells die within a few minutes due to lack of blood circulation but in brain death the reverse takes place.

A patient who is brain dead is in an irreversible state and is totally dependent on a breathing machine and has constant need for medications to keep their heart and circulation functioning. This condition was first recognized in an ICU in Paris and was called coma de pass.  In this very tragic situation before the machines are switched off the doctors can explore the possibility of organ donation with the relatives. Sometimes, if the patient was in a road traffic accident; a post-mortem examination is necessary before handing the body over to the relatives for the last rites. A post mortem in any case entails removal and examination of body parts and relatives may consider organ donation.

The emotional upheaval of death is the most difficult to overcome and in this condition accepting the notion of organ donation by the relatives can be understanbly very difficult. However, if the body is to be buried or cremated some of the organs can be donated to give a critically ill organ failure patients a second chance in life. Most people donate the belongings of their loved ones after their death, organ donation also should be considered in the same light and spirit. It is the noblest of all donations. The act is as holy as holy can be, as it gives a fellow human being a chance to live.

In our country since the law was passed in 1995, we have managed to do over 900 organs like kidneys, heart, liver, lungs and pancreas transplants. In the west approx. 25,000 transplants of various organs are under taken every year and approx. 85% of organs come from brain dead or cadaver patients. Let us briefly examine what has been achieved in the last 10 years

* The 900 odd cadaver organ transplants have shown that we in India are capable of organizing the chain of events that lead to cadaver transplants.

* The brain death certification is now widely accepted by clinicians and the protocols to certify it, have been uniformly accepted as laid down by the government,

* Few hospitals are now regularly doing such transplants and in this respect both Tamil Nadu and Maharastra have made some commendable efforts

* It is possible to not only do kidneys transplants but our hospitals and doctors can also perform complex transplants such as  liver and heart transplants.

Spain has the highest number of organ donation rate from brain dead patients 32 per million population. If we compare our current cadaver donor rate per million population and extrapolate its potential, we can make some interesting conclusion and not only help ourselves but also help with the global organ shortage.

* The current organ donation per million for cadaver in India is 0.05 per million (about 50 Cadaver donors per year).

* At 1 per million donation rate we would have 1100 organ donors

Or 2200 kidneys, 1000 hearts, 1100 Livers,1100 Pancreas and  2200 Eyes

      This should take care of almost all current demands for organs.   

* At 2 per million donation rate there would be 2200 organ donors and the above figures would double and there would be no necessity to undertake living kidney donations. 

* If we did 3 per million, we could take care of all SAARC countries demand for organs

* At 5 per million we would have 10,000 kidneys, 5000 hearts and 5000 livers  and we could start looking at the problem of organ short age in rest of Asia and other parts of the world. 

The cadaver programme needs to be given a priority and efforts should be made to encourage hospitals and state governments to promote the programme in India. We in India at present may not be able to compare our economic progress with some of the western counterparts but countries in the second league like Poland and Hungary are today able to do an organ donation rate of 6 per million. Even the conservative society of a country like Hong Kong does 3 per million. Transplant surgery is indeed cutting edge surgery and the capability of successfully doing multi-organ transplant surgery will help with important research developments and standardize our hospitals practices besides improving the image of our healthcare overseas. Transplant surgery is the platform that can give the jump to our healthcare and take it to a higher level of capability. India is today on the threshold of taking a jump from being a 'developing ' nation towards a 'developed' nation. This is the dream of many proud Indians including our President APJ Kalam and cadaver organ donation and transplant is part of this larger picture. Over the last ten years, the programme has slowly started rolling all it needs is a little momentum