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Transplant waiting list only gets longer

Image credit: Aleksandra Kuznecova / 123rf kidney transplant concept. transplant waiting list concept.
Image credit: Aleksandra Kuznecova / 123rf

For many, life continues to be hard as they wait on the organ donation transplant waiting list.

Not being able to access a life-saving organ transplant is not the case the entirety of the time. The family of a brain-dead man in Maharashtra gave doctors the go-ahead to donate his organs, offering hope to patients in desperate need. Fifty-year-old Vijay Rangari, the patient in question, experienced an intracranial haemmorhage. Despite treatment, his condition deteriorated and he was declared brain-dead on August 16th. His family, aware of the need India has for organ donation, agreed to donate his eyes, kidneys, and liver. “The patient’s wife as well as his daughter readily agreed to donate his organs which is praiseworthy,” said Dr Sanjay Kolte, honorary secretary of the Zonal Transplant Coordination Centre (ZTCC). “The organ donation week is under way and we are happy to see such people who understand the importance of the noble work.” 

Whilst this is an instance of indisputable tragedy nonetheless offering indisputable hope, many Indians continue to languish on a transplant waiting list that has widened during the COVID-19 pandemic. Low levels of organ donation, it should not be mistaken, is a pre-existing condition of India’s. As with many issues within the health system, it has only worsened since the coronavirus struck. 

“The number of organ donations in our country has been very low in comparison to the western countries,” said Vishwanath S., a transplant physician and consultant in neurology affiliated with Manipal Hospitals in Bengaluru, in remarks to IANS. “Furthermore, there is a significant drop since the start of the pandemic, the reason being COVID-recovered patients cannot donate immediately after recovering. Too much focus on COVID and the lack of awareness on organ donation are also the [reasons] why this number has dropped significantly.”

In one instance, the transplant waiting list for those in need of kidneys in Karnataka has grown considerably. “Kidney requirement has gone up in the region due to various factors, including lifestyle,” said N. G. Bhartheesha Reddy, vice president of the Mysuru (or Mysore) unit of Apollo. “In the last one year, we have conducted 26 kidney harvest and transplants. Among them, 22 were from live donations. Still, 65 are [on] the waiting list. Five liver transplants have been done, while fourteen are still waiting.” 

As previously reported by Health Issues India, “[there is a] need for greater awareness of kidney transplants and organ transplantation in general in India. According to Organ Donation India, India requires an estimated five lakh organs per annum but only two to three percent of this demand is met with an organ donation rate of 0.86 per million population. Consequently, many Indians die needlessly due to organ failure. End-stage organ failure affects roughly one million Indians, but just 3,500 organ transplants are carried out each year as of 2019 (although the Union Ministry of Health and Family Welfare estimated 5,000 procedures annually).

“Nonetheless, it is crucial to note India has a dual burden of organ failure and its organ transplant deficit. In the case of kidney transplants, in a country with a significant burden of chronic kidney disease but where many languish on the waiting list for a life-saving transplant, the dearth of organ donations is painfully apparent.” 

With the pandemic having elongated the transplant waiting list, it is crucial steps are taken. In 2019, a nine-member panel consisting of doctors from the Postgraduate Institute of Medical Education and Research (PGIMER) issued a slew of recommendations to address the ever-expanding transplant waiting list and encourage organ donation. They included

  • Making it mandatory for intensive care units (CUs) to provide daily information on potential organ donors
  • Employment of grief counsellors and transplant coordinators and establishment of a committee to certify brain death in every district, as well as district-level organ donation coordination offices in civil surgeons’ offices
  • Ensuring that such bodies provide continuous services and facilitate the safe transport of donors to retrieval or transplant centres
  • Creation of an ID number-based, centralised voluntary organ donor registry to enable donations from those who express willingness during their lifetimes to donate their organs
  • Involvement of NGOs and faith-based groups to raise awareness of the positive aspects of organ donation

Progress remains necessary. As a study published earlier this year argues, “bold policy changes are needed to meet the need for organ transplantation in India.” The authors write in the abstract that “twenty-five years after India passed legislation to legalise brain death, deceased donor transplantation remains underdeveloped while the country has established formidable capacity for living donor transplantation. 

“Because of a large number of potential deceased donors, there is hope that deceased donation could help meet India’s enormous need for organ transplantation. However, significant policy and practical barriers limit progress…In this viewpoint, we review the current status of organ transplantation in India and propose new policies to establish a national organisation to oversee deceased donor services in all states, to fund resources needed to support deceased donation, to leverage the existing living donor infrastructure to advance deceased donor transplantation, and call for establishment of government policy on funding for posttransplant care and immunosuppression.” 

In the public health context, 25 years is a long time. Many lives could have been saved if reforms had been put in place. Programmes whose efforts were stymied because of the pandemic must be restarted and there must be a conversation and, more importantly, action to implement reforms and raise awareness. The mound of cadavers that formed for want of organ transplants and the many who are still on the waiting list unclear from one day to the next if the lifeline they need will ever come are more than good enough reasons to work to do this. 

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