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Cadaveric Donation in Northern India – Challenges and Solutions

By Dr. Anant Kumar in Urology

Aug 25 , 2022 | 3 min read

Contemporary India is undergoing rapid change. As the economy develops, its inhabitants' lifestyles and beliefs are transforming. With rapid Westernisation, lifestyle diseases like kidney, liver and heart failure are increasing. These unfortunate patients need organ replacement therapy to save their life. It is beyond doubt that transplantation is the best treatment for such patients.

India stands next to the United States and China in the number of kidney transplants done annually. Contrary to many other countries, ours is mainly a live donor organ transplant programme. However, there are several challenges – especially the very high demand and limited supply, and this gap is increasing every year as more patients are added to this waiting pool.

As per the national data, around 2,00,000 people suffer from renal failure every year, and about 10,000 renal transplants are done annually. Approximately 1000-1200 are done from deceased donors, which should be around 50%. Some parts of our country have done more deceased donations, like south India, Gujrat and Maharashtra. In northern India, a minuscule proportion is by cadaveric donation, except in Chandigarh and Jaipur. Delhi has huge potential but lags in the deceased donor program. Like in our centre, we do more than 200 renal transplants annually, of which hardly 4-8 are from cadaveric donation. Although live donor organ transplantation is a good option, not everyone can find a living donor within the family. The prospective donor, if at all available, may be medically unfit or maybe a marginal one. Without a suitable donor, most ESRD patients are condemned to a life dependent on dialysis and poorer outcomes than organ transplantation.
With the enactment of The Human Organ and Tissue Transplantation Act (THOTA), the government of India is actively trying to promote ethical organ transplantation. However, many challenges are still ahead of us.
 

The main issues/challenges are

  • Lack of awareness amongst the public and medical professionals regarding brain stem death
  • Poor rate of brain death identification and certification in hospitals 
  • Poor infrastructure and no fund for organ donation in government hospitals
  • Poor/uninformed attitude amongst the public regarding organ donation
  • Indifferent attitude and lack of motivation in medical and paramedical professionals
  • Lack of well-oiled organised system regarding organ procurement from deceased donors
Promoting cadaveric organ donation has multiple advantages, like reducing the demand-supply gap and avoiding the utilisation of marginal living donors. Ideally, no living person should donate any organ to save the life of his loved one. All organs should come from deceased donors. But such a utopian situation is non-existent.

How to increase cadaveric organ donation?

The only way to promote cadaveric organ donation is to increase public awareness regarding this noble gesture. Cadaveric donation is about gifting life, turning a tragedy into a new life for some patients. A life lost can never be brought back, but it can bring new life to as many as 8 patients and many others who may get tissue parts.

Teachings of other religions in India also promote organ donation. No religion is against donation.

The print and TV media can play a significant role in promoting cadaveric organ donation by disseminating knowledge, educating common people about the virtue of organ donation and enlightening other lives.

There is a major role to be played by government and non-government organisations, medical fraternity and corporate bodies. Government should make identification of brain death in hospitals mandatory and audits of such actions should be done regularly. Government should have dedicated funds for sustaining the life of a deceased person till organs are donated. Organ donation should be part of the medical and nursing curriculum, and regular training should be imparted at periodic intervals in each hospital and medical school. Transplant coordinators are the backbones of such programs, and there should be a national school of training for such professionals at regular intervals. Regular social functions should be organised where importance of organ donation should be highlighted. All personalities should come forward and pledge organ donation. At the back of all driving licenses should have the option of signing of consent for organ donation. In driving license class, a video of organ donation should be shown to all applicants and if they wish, they can opt for it at the back of their driving license. Many such activities will improve organ donations and save many lives. We don't need these organs in heaven, we should leave them here for others to live better. Be an organ donor.