06-August-2024-Special-Article

ORGAN DONATION AND TRANSPLANTATION IN INDIA

Organ donation and transplantation play a crucial role in saving lives and improving the quality of life for patients suffering from organ failure. India has made significant strides in this field, achieving new milestones and addressing challenges.

Key Highlights from the Annual Report 2023-24

• Milestone Achievement: In 2023, India surpassed 1,000 deceased organ donors in a single year for the first time, setting a new record.
• Indian Organ Donation Day (IODD): Observed annually on August 3 since 2010 to increase awareness about brain stem death and organ donation, dispel myths, and encourage citizens to donate organs and tissues.
• Awareness Campaign: In 2024, the “Angdaan Jan Jagrukta Abhiyaan” was launched, with July observed as Organ Donation Month to promote donation awareness.
• Impact of Donation: A single donor can potentially save up to 8 lives through organ donations (Kidney, Liver, Lung, Heart, Pancreas, and Intestine) and improve the lives of many more through tissue donations (cornea, skin, bone, heart valve).

Key Findings of the Report

Gender Distribution:

• 63% of living donors were women.
• 77% of deceased donors were men.

Regional Transplants:

• Delhi-NCR: Nearly 78% of transplants involved foreign nationals.
• Delhi: 4,426 total transplants, with over 32% to foreign nationals.
• Rajasthan and West Bengal: 116 and 88 transplants to foreign nationals, respectively.

Deceased Donor Milestone:

• The number of deceased-donor transplants increased from 837 in 2013 to 2,935 in 2023.

Organ Donation Rate:

• Currently less than 1 per million population, compared to the need for 65 organs per million.

Foreign Allocation Rule:

• Organs are allocated to foreigners only if no matching Indian patients are available.

Regulatory Framework

Transplantation of Human Organs and Tissues Act (THOTA), 1994:

• Regulates organ donation and transplantation, allowing donations from deceased or living donors known to the recipient.
• Altruistic donations from distant relatives or long-term friends are allowed but require verification to prevent financial transactions.
• Violations, such as organ trading or falsifying documents, are punishable by up to 10 years in prison and fines up to Rs 1 crore.
• Brain stem death is legally recognized as death.

Transplantation of Human Organs and Tissues Rules, 2014:

• Promotes organ donation from deceased donors.

National Organ and Tissue Transplant Organisation (NOTTO):

• Provides a national system for organ procurement and distribution.

National Organ Transplantation Guidelines:

• Removed age limits for receiving organs and eliminated domicile requirements for registration.
• Discontinued registration fees for organ recipients.

Organ Transport Policy:

• Created a uniform policy for efficient organ transportation between hospitals or cities.

Ethical Concerns

Living Donors:

• Medical Risks: Donors, especially for kidney transplants, may face health issues, conflicting with the principle of “do no harm.”
• Trafficking Risks: Organ donation can be vulnerable to illegal activities and trafficking, especially for unrelated living donors.
• Emotional Coercion: Living donors may feel pressured by family or emotional bonds, raising concerns about consent and undue influence.

Deceased Donors:

• Consent and Autonomy: Ethical issues arise in the absence of prior consent from the deceased regarding organ donation.
• Allocation and Fairness: Concerns exist about equitable access to organs based on socio-economic status or location.
• Transparency: The need for clear disclosure and ethical management of organ donation processes.

Challenges in Organ Transplantation

Donor Organ Supply:

• The number of organ donations is significantly lower than the demand, with a donation rate below 1 per million people.
• Around 1.8 lakh individuals suffer from renal failure annually, but only about 6,000 renal transplants are performed each year.

Peri-Transplant Tissue Damage:

• Aging and disease can degrade organ quality, leading to ischemia-reperfusion injury (IRI) and affecting transplant success.

Preservation Techniques:

• Many hospitals use outdated preservation methods. Advanced techniques like hypothermic and normothermic machine perfusion are not universally available.

Chronic Rejection:

• Long-term survival rates for transplanted organs have not improved significantly, with limited advancements in anti-rejection therapies.

Lack of Awareness:

• There is a general lack of awareness about organ donation, including the concept of brain stem death.

Way Forward

Strengthen Awareness Programs:

• Launch public campaigns and integrate organ donation education into school curricula to foster a culture of donation from a young age.

Enhance Infrastructure:

• Adopt advanced preservation techniques and standardize organ procurement, preservation, and transport protocols.

Advance Research and Innovation:

• Explore and implement new technologies like bioengineered organs and xenotransplantation.

Foster Ethical Frameworks:

• Develop clear ethical guidelines to address issues such as consent, fairness, and transparency in organ donation and transplantation.

Conclusion

India’s progress in organ donation and transplantation is notable, but challenges remain. Addressing these issues through enhanced regulatory frameworks, public awareness, and advanced technologies will be crucial for improving the system and saving more lives.

Mains Question:

1. “Critically analyze the current state of organ donation and transplantation in India, highlighting the key challenges and suggesting measures to enhance the effectiveness of the existing regulatory and ethical frameworks.”(150 WORDS)