Organ Donation

With improvement in science and technology in medicine, life span of people is increasing and mortality is coming down in India. Due to changing lifestyle patterns and food habits, the percentage of people suffering from various organ failures have been increasing. Several patients with end stage problems are battling for life as there are not enough donor organs available. India has one of the worst organ donation statistics in the world. According to WHO only about 0.01 percent of people in India donate their organs after death as compared to western countries, where around 70-80 percent of people pledge their organs. The number of transplants done in the country every year, in case of major organs is less than a thousand. Every year, nearly 5 lakh people die due to non-availability of organs. Around two lakh people die due to liver disease, 50 thousand die due to heart disease. About 1.5 lakh people await a kidney transplant but only 5 thousand get one. Almost ten lakh people suffer from corneal blindness and await a transplant. The key barriers for organ donation being lack of awareness, complex laws and inadequate facilities. The world th) organ donation day (August 13^th is meant to create awareness among the people about the need to donate organs to save the lives of others or to improve the quality of life people. One organ donor can save upto 8 people and improve quality of life 50 people by donating his well-functioning organs.

The organs which can be successfully transplanted are Kidneys, Liver, Bone marrow, Heart, Lungs, Cornea, pancreas, Small bowels and Skin tissues. The need of organ transplantation can only be fulfilled by the process of organ donation after the brain death. There are cultural superstitions and wrong ideas that donations by living persons will adversely affect health in later life. In the recent past, organ donation has received greater attention. Now in India, many hospitals and trained doctors are available who can perform transplantation surgeries. Most of the organ donations in our country is happening between relatives (means a person donates his organ/s only to his relatives). They donate one th kidney and ¾^th of their liver (as it can regenerate to normal size after six weeks). The government of India expects to increase the number of donations to one per million population by 2020. Even that is a very modest target against the requirement. Both government and non government organizations should actively campaign to increase the awareness & number of people willing to donate, set-up rules and regulations by way of legislations and also develop uniformity in transplantation procedures followed. Better networking between hospitals, both public and private can facilitate transplantation of different organs in a better manner. Procedures for Swap transplantation of organs also need to be simplified. The concept of METHOD i.e., Management of Transplantation & Harvesting of Organ Donation needs to be driven by government agencies, civil society organizations, medical colleges & hospitals. Although cadaver donation of organs is increasing in recent days in our state, the case is not the same in swap transplantation of organs (ie, swapping of organs between 2 pairs of donor & recipient whose organs are incompatible betweenthemselves). Institutionalization of organ donation and harvesting of organs in at least 30% of death-bed patients, if made possible, will increase the organ donation rates. All this is possible with effective community awareness, right approach, integrated & intersectoral co-ordination & strict, uniform legislations.

As per Transplantation of Human Organ Act 1994,the authority of the hospital performing the organ transplant should obtain a license. No hospital shall commence any activity relating to removal or transplantation of any human organs for therapeutic purpose after the commencement of this act, unless such hospital is duly registered. If Live organ donation by near relative is to be done, the hospital has to obtain permission from local committee and if organ donation is by other than relative/ foreigner then permission has to be obtained from state level authorization Committee before the transplant. The committee will look into the purpose of organ donation, no commercial transactions, documentary evidences for relationship between donor and recipients and also verifies the consent and cross matching between the donor and the recipient. Any person who render his services at any hospital for purpose of transplantation or helped in any manner in the removal of human organs without authority's permission shall be punishable under the act with imprisonment upto 10 years and fine. Transplant of organ/s between relatives means-between Grandfather, Grandmother, Father, Mother, brother, sister, son, daughter, grandson, grand daughter more than eighteen years old who are healthy and no criminal record. Documentary evidence of relationship, Identity, proof of residence and willingness are prerequisites. If the donor is a woman, special importance is given for identity and independent consent.

In our state we have two registries- Government and Private online organ transplant and organ donation registry. In case of any Braindeath declared patient, with the consent of near relatives the organs can be transplanted to the needy patients based on the online registry. Though we have Transplantation of Human Organ Act for the donor and recipients ,now a day's people are misusing the act by impersonation to claim as relatives of donors and land in trouble as human organ trafficking. If the government enforces more stringent guidelines for transplantation, due to poor awareness in our community, the needy /suffering patient may not get a donor. At the same time, if transplantation act is not strict, then the affordable /rich patients will exploit the poor people for organs. Creating awareness about organ transplant as “life can begin/continue after death” may be a viable solution for patients with organ failure, who are waiting for organ donors, than an Act. (Author is a Member of the State organ transplant authorization Committee.)