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Table of Contents
REVIEW ARTICLE
Year : 2018  |  Volume : 12  |  Issue : 3  |  Page : 174-176

Deceased organ donation in India – Current challenges and scenario


1 BJMC, Ahmedabad, Gujarat, India
2 Department of Nephrology, JNMC, Wardha, Maharashtra, India
3 Department of Nephrology, IKDRC/ITS, BJMC, Ahmedabad, Gujarat, India
4 Department of Medicine, Northern Railway Central Hospital, New Delhi, India

Date of Web Publication28-Sep-2018

Correspondence Address:
Dr. Manish Ramesh Balwani
Department of Nephrology, JNMC, Sawangi, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijot.ijot_26_18

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  Abstract 


Worldwide, organ transplantation has saved and enhanced the lives of thousands of recipients over the past five decades. Organ transplantation rates are still lower in developing countries including India. The cause of this low rate is attributable to many factors including unawareness about procedure and concerned laws, low education levels, inadequate trained workforce, low socioeconomic status, and costly immunosuppressive drugs. In the last few years, the government has tried positively to increase the organ transplantation by forming the National Organ and Tissue Transplant Organization. Now, the government needs to push for affordable transplantation by strengthening the public sector hospitals and by making the transplant medications more affordable. Moreover, the transplant community should strive to increase the organ donation awareness, improve the infrastructure for organ retrieval, storage, and allocation in an equitable way.

Keywords: Cadaver donation, hurdles, organ donation, policies


How to cite this article:
Patel AH, Balwani MR, Patel H, Pasari AS, Patel UR, Tolani P, Kute V. Deceased organ donation in India – Current challenges and scenario. Indian J Transplant 2018;12:174-6

How to cite this URL:
Patel AH, Balwani MR, Patel H, Pasari AS, Patel UR, Tolani P, Kute V. Deceased organ donation in India – Current challenges and scenario. Indian J Transplant [serial online] 2018 [cited 2018 Nov 21];12:174-6. Available from: http://www.ijtonline.in/text.asp?2018/12/3/174/242428




  Introduction Top


End-stage organ failure is becoming more prevalent due to increased life expectancy. Similarly, end-stage kidney disease is a common and rapidly increasing global public health problem, both in developed and developing countries. At present, there is no CKD registry which can show the exact prevalence of chronic kidney disease in India. Few studies in the recent past have shown a variable prevalence ranging from 4% to 17.2% with wide regional differences.[1],[2]

An Indian population-based study determined the crude- and age-adjusted end-stage renal diseases incidence rates at 151 and 232/million populations.[3] Kidney transplantation remains the treatment of choice for patients of end-stage kidney disease as it leads to longer survival and superior quality of life.[4]

In 2009, it was estimated that in India, 3500 patients undergo renal transplantation, 3000 new patients are treated with continuous ambulatory peritoneal dialysis, and more than 15,000 patients begin maintenance hemodialysis in a year.[5]

The present review tries to recognize the challenges encountered in organ donation and give possible solutions.


  Discussion Top


As per the Indian transplant registry maintained by the Indian Society of Organ Transplantation on their website http://www.transplantindia.com/, a total of 20,952 kidney transplants have been reported to them till first June 2018 from a total of 48 centers only. Still now, live-related transplants account for majority of kidney transplantation in India, whereas cadaver transplantation is still in infancy. Although in the last few years, cadaver organ donation has increased in India, it still remains a distant dream to cater the waiting list of end-stage organ failure.

In India, deceased organ donation program is largely restricted to big institutions and private sector which makes it less accessible for all. The deceased donation rate in 2013 was 0.26/million populations and this has gone up to 0.36/million population in 2014.[6]


  Socioeconomic Factors Top


Low socioeconomic status is a big hurdle for organ transplantation. Public hospitals need to pick up or start the transplant program so that it is accessible to all. Starting transplant program in public hospitals will give boost to organ donation drive as it will increase the credibility of organ allocation system.


  Cultural and Religious Aspects Top


Superstitions such as being born with a missing organ (that has been donated); and that tampering with the body will not free their dead relatives from the cycle of life–death–rebirth are some of the prevalent superstitions.[7]

This can be overcome by the widespread involvement of religious leaders in organ donation drive being conducted by government and nongovernment organizations. Religious leaders should be made familiar with the concept of brain death and organ allocation policies of the country. It will indirectly percolate within the community through the spiritual leaders and will in turn increase the faith in organ donation and allocation policies.


  Timely and Proper Communication Top


It is very important to effectively communicate with the family members of brain dead person about organ donation. Their decision should be respected in every possible manner. Many a times, people sign the donor card due to peer pressure and other factors without having complete knowledge about the issues involved. If willing for organ donation, it should be well ensured that the process of organ donation should be smooth and without hurdles until the body is handed over to relatives. Before proceeding for organ donation, relatives should be made well aware of the process of organ donation which will reduce the apprehensions of the concerned family. Discussion about organ donation should be a part of end-of-life care, when appropriate, and an early involvement of transplant coordinators and counselors should be ensured.


  Organizational Support Top


The lack of an adequate number of transplant centers with staff as well as transplant coordinators who are adequately educated and well versed with the procedures required to conduct an organ donation program is acting as a significant roadblock to the deceased organ donation program.

Hospitals should have a clear protocol for declaring brain death and intensive care staff including paramedics should be well aware of the protocols. Regular reinforcement regarding brain death declaration protocols of the new and old staff should be conducted at timely intervals.

Trained transplant coordinators who have sympathetic approach toward the family members of the brain dead should be appointed.


  Medical and Paramedical Fraternity Top


Even the medical community has very little knowledge regarding organ donation policies and the concerned national and international laws. This can be circumvented by having dedicated chapters on organ donation and related policies in the undergraduate study curriculum. Sensitization at earlier age will increase the understanding about the subject among medical and paramedical students. The chapters should also clearly specify the roles and responsibilities of medical and paramedical staff.


  Media Top


The entire concept of deceased organ donation is built upon the trust into the system of organ donation and allocation. Any negative idea, which breaks this trust, acts as an impediment to the whole process of organ donation.

Media should be actively involved to increase the awareness regarding the concept of brain death among the general population.


  Organ Allocation Top


In a study, about 59% of the study participants believed that there was a potential danger of donated organs being misused, abused, or misappropriated.[8]

Hence, it is very important to have a transparent system of organ allocation. Every detail should be made available to the society online which will increase the trust in the system and boost the organ donation drive. The society should be made aware of the fact that organ allocation is immune to all kind of pressures which can influence the allocation system.


  National Organ and Tissue Transplant Organization Top


This is a national level organization set up under the Directorate General of Health Services, Ministry of Health and Family Welfare. It functions as an apex center for conducting all India activities related to coordination and networking, for the procurement and distribution of organs and tissues, for maintaining the registry of organs, and for facilitating tissue donation and the transplantation of the harvested organs across the country. This organization is proving to be a major boost for organ donation, and especially organ distribution at the regional and state members. It has thus decreased the chances of wastage of organs with proper distribution among members. The system needs to be penetrated to the grass root level for better results.


  Organ Transport Top


Sometimes, organs are transported from the donor hospital to the transplant center where the recipient is located. In India, mostly road transport is being used for shipment of organs. Green corridors have been particularly helpful in reducing cold ischemia time and improving the quality of organ transplant. When the distance is more, the organs are transported through commercial airlines. There have been many instances where valuable organs have been wasted due to delay in the transportation process. Green corridor concept should be taught in the school curriculum to make the next generation aware of the process. The government can help by providing financial help by collaborating with air carriers to help in mobilizing the donated organ to different parts of the country and thereby preventing organ wastage.


  Handover of Body Top


The delay in funeral is a major factor for families to refuse organ donation. Thus, every effort should be made to ensure a quick release of the dead body for disposal. The relatives should be explained in detail about the procedure of organ donation and the time needed for the same.


  Recognition of Donor Families Top


Donor families should be honored and recognized in social and government functions to appreciate their noble gesture of organ donation.


  Conclusion Top


There is a great disparity between the number of potential donors and actual cadaveric donors. Public awareness is the major and foremost factor that can lead to improved rates of deceased organ donation in India. Effective communication is a very important factor and discussions about organ donation should be a part of end-of-life care. Involvement of mass media, religious, and political leaders in organ donation drive with transparent organ allocation system will provide the necessary boost for organ donation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Singh AK, Farag YM, Mittal BV, Subramanian KK, Reddy SR, Acharya VN, et al. Epidemiology and risk factors of chronic kidney disease in India – Results from the SEEK (Screening and early evaluation of kidney disease) study. BMC Nephrol 2013;14:114.  Back to cited text no. 1
    
2.
Singh NP, Ingle GK, Saini VK, Jami A, Beniwal P, Lal M, et al. Prevalence of low glomerular filtration rate, proteinuria and associated risk factors in North India using cockcroft-gault and modification of diet in renal disease equation: An observational, cross-sectional study. BMC Nephrol 2009;10:4.  Back to cited text no. 2
    
3.
Modi G, Jha V. Incidence of ESRD in India. Kidney Int 2011;79:573.  Back to cited text no. 3
    
4.
Garcia GG, Harden P, Chapman J, World Kidney Day Steering Committee 2012. The global role of kidney transplantation. Lancet 2012;379:e36-8.  Back to cited text no. 4
    
5.
Agarwal SK, Srivastava RK. Chronic kidney disease in India: Challenges and solutions. Nephron Clin Pract 2009;111:c197-203.  Back to cited text no. 5
    
6.
Shroff S. Deceased Donor Transplantation in India. ISOT Newsletter; April, 2015.  Back to cited text no. 6
    
7.
Singh P, Kumar A, Sharma RK. Factors influencing refusal by relatives of brain-dead patients to give consent for organ donation: Experience at a transplant centre. J Indian Med Assoc 2004;102:630, 632, 643.  Back to cited text no. 7
    
8.
Balwani MR, Gumber MR, Shah PR, Kute VB, Patel HV, Engineer DP, et al. Attitude and awareness towards organ donation in Western India. Ren Fail 2015;37:582-8.  Back to cited text no. 8
    




 

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  In this article
Abstract
Introduction
Discussion
Socioeconomic Fa...
Cultural and Rel...
Timely and Prope...
Organizational S...
Medical and Para...
Media
Organ Allocation
National Organ a...
Organ Transport
Handover of Body
Recognition of D...
Conclusion
References

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