Organ
donation and transplantation provides a second chance at life for thousands of
people each year. The growing disparity between the rich and poor, demand for
human organs and availability of technology in the country makes the trading of
organs a quick means to riches for some and a relief for others. Invariably
Organ trade leads to exploitation of the poverty-stricken people by tempting
them with financial gains to meet their immediate short-term financial needs.
Making
organs a commodity is fraught with erosion of social, moral, and ethical values
and is not an alternative that can be acceptable to meet organ requirements in
a civilized society. The World Health Organization (WHO) in its statement on
the sale of organs clearly states that it violates the Universal Declaration of
Human Rights as well as its own constitution: “The human body and its parts
cannot be the subject of commercial transactions. Accordingly, giving or
receiving payment… for organs should be prohibited.”
Each
year hundreds of Indians die while waiting for an organ transplant. The reason:
there is acute imbalance between the number of organs donated and the number of
people waiting for a transplant. While 2.1 lakh
Indians require kidney transplantation annually, but only 3000 – 4000 kidney transplants
are done. The situation is not very different in relation to heart transplants.
While annually around 4,000–5,000 patients in India require a heart transplant,
so far only 100 heart transplants have been conducted across the country.
According to the National Programme for Control of Blindness (NPCB) 2012-13
report, only 4,417 corneas were available in 2012-13 against a whopping
requirement of 80,000-1, 00,000 per year. There are currently over 120
transplant centres in India performing
approximately 3,500 to 4,000 kidney transplants annually. Out of these four
centres undertake approximately 150 to 200 liver transplants annually while
some do an occasional heart transplant.
Finding a donor is the main issue in the
country. Lack of awareness and improper infrastructure facilities are the main
reasons behind the existing scenario. Administrative hurdles and
conservative mindset further affect organ transplantation scenario in
India. There are a
lot of myths associated with organ donation which needs to be addressed to
solve this problem. Most Indians generally believe that it is against the
nature and religion that body parts are mutilated. Some are suspicious that the
hospital staff may not work hard to save their lives if they want organs. Others
believe that there might be a temptation to declare them dead before they are
actually dead. Lack of a centralised registry for organ
donation, acts as another major hurdle for the people to donate organs or get
data about donors. Also, there is a problem of certifying brain
deaths; if people are not aware of brain deaths, it
becomes difficult to convince the relatives of the patients for organ
donation.
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Kidney
transplants in India first started in the 1970s and since then India has been a
leading country in this field on the Asian sub-continent. The evolutionary
history of transplants in the last four decades has witnessed commerce in organ
donation becoming an integral part of the program. The Government passed the
Transplantation of Human Organ Act (THO) in 1994 which made unrelated
transplants illegal and deceased donation a legal option with the acceptance of
brain death. Overcoming organ shortage by tapping into the pool of brain-dead
patients was expected to curb the unrelated transplant activity. But, despite
the THO Act, neither has the commerce stopped nor have the number of deceased
donors increased to take care of organ shortage. The concept of brain death has
never been promoted or widely publicized. Most unrelated transplants currently
are being done with the approval from an Authorization committee.
Government
of India enacted the ‘Transplantation of Human Organs (Amendment) Act in 2011
which made provisions for simplifying the procedure for human organ donation.
The provisions included retrieval centres and their registration for retrieval
of organs from deceased donors, swap donation and a mandatory inquiry by the
registered medical practitioner of a hospital in consultation with transplant
coordinator (if available) from the near relative(s) of potential donor
admitted in Intensive Care Unit and informing them about the option to donate
and if they consent to donate, inform the retrieval centre for retrieval of
organs.
In
India, the potential for deceased donation is huge due to the high number of
fatal road traffic accidents and this pool is yet to be tapped. At any given
time, every major city would have 8 – 10 brain deaths in various ICUs. Some 4 –
6% of all hospital deaths are due to brain death. In India, road accidents
account for around 1.4 lakh deaths annually. Out of
these, almost 65% sustain severe head injuries as per an AIIMS, Delhi, study. This means there are almost 90,000 patients who may
be brain dead.
It is not that
people don’t want to donate, but that there are no mechanisms in hospitals to
identify and certify brain deaths. Plus, no one empowers the relatives of a
brain-dead person to save lives by donating his organs. Anyone from a child to
an elderly person can be a donor. Organ donation from the brain dead – also
referred to a cadaveric donation is still very low in India. While Spain has 35
organ donors per million people, Britain has 27 donors, US 26 and Australia 11,
India’s count stands at a mere 0.16 per million people.
Signing a donor
card is the first step in making your wishes about donation known. A donor card
is not a legal document but an expression of one’s willingness to donate. While
signing a donor card demonstrates one’s desire to donate organ after death,
letting the family or friends know about the decision is very important. That
is because family members will be asked to give consent for the donation. The
decision will be considered final when they give consent. Vital organs such as
heart, liver, lungs, kidneys, pancreas and intestines, and tissues such as
corneas, heart valves, skin, bones, ligaments, tendons, veins, etc. can be
donated in case of brain death.
The proposed Transplantation of Human Organs and Tissues Rules,
2013 has many provisions to remove the impediments to organ donation while
curbing misuse/misinterpretation of the rules. To mention a few;
·
When the
donor is unrelated and if donor and/or recipient belong to a State/ Union
Territory, other than the State/Union Territory where the transplantation is
proposed to be undertaken, “No Objection Certificate” from the State/Union
Territory of domicile of donor and/ or recipient is required. “No Objection
Certificate” will not be required for near relatives and Swap donation cases.
·
The quorum
of the Authorisation Committee should be minimum four and is not complete
without the participation of the Chairman, Secretary (Health) or nominee and
Director of Health Services or nominee.
·
Every
authorised transplantation centre must have its own website. The Authorisation
Committee is required to take final decision within twenty four hours of
holding the meeting for grant of permission or rejection for transplant and the
decision of the Authorisation Committee should be displayed on the notice board
of the hospital and the website within twenty four hours of taking the
decision. The website of transplantation centre shall be linked to
State/Regional/National Networks through online system for organ procurement,
sharing and transplantation.
·
There would
be an apex national networking organization at the centre. There would also be
regional and State level networking organizations where large of number of
transplantation of organ(s) or tissue (s) are performed. The State units would
be linked to hospitals, Organ/Tissue matching Labs and Tissue Banks within
their area and also to regional and national networking organisations. Such
networks shall coordinate procurement, storage, transportation, matching,
allocation and transplantation of organs/tissues and shall develop norms and
standard operating procedures.
·
A National
Registry on Donors and recipients of Human Organ and Tissue accessible on-line
through dedicated website having National, Regional and State level
specificities will come into force. National/Regional registry shall be compiled
based on similar registries at State level. The identity of the people in the
database shall not be in public domain.
Accordingly,
the Government is going to set up an online network under the National Organ
and Tissue Transplant Organisation (NOTTO). The online service will be able to
connect people directly to the donor. OTTO, an autonomous body under the Health
ministry, would be the nodal agency coordinating all organ transplants in the
country. All hospitals in the country, whether private, public or
district-level health centres, will be part of the network. Apart from NOTTO,
four regional centres would also be set up across the country.
To conclude, the emerging field of regenerative medicine may allow scientists and engineers to create organs to be
re-grown from the patient's own cells (stem cells,
or cells extracted from the failing organs).This would not only improve the
availability of compatible organs but also would address the socio-ethical
issues attached with it.
(PIB Features.)
*******
*Director
(M&C), Press Information Bureau, Kolkata.
SS-60/SF-60/02-08-2013
RTS/HSN
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