Bangalore: Fifteen years after India passed the Transplantation of Human Organs Act, allowing organ retrieval from the brain-dead patients, kidney donations by live donors remain very much in vogue and, according to a recent study, the country sees more such transplants than any other country in the world barring the US.
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India, however, slips to the 40th rank in the study of 69 countries in terms of number of transplants per million population, with only three in a million getting the kidney in case of a renal failure.
According to a new report in Thursday’s issue of the Kidney International—the journal of the International Society of Nephrology—about 27,000 related and unrelated living kidney donor (LKD) transplants occur worldwide every year, of which 6,435 take place in the US and 1,768 in Brazil with India figuring in between with about 3,200 transplants, a number which the authors said, doesn’t represent “reliable national data”.
“It’s true, we don’t have any national registry and nobody knows how many kidney transplants occur in India,” said Sunil Shroff, managing trustee of the support group Multi Organ Harvesting Aid Network Foundation in Chennai. He estimates the number of transplants per year to be in the range of 3,000-3,500, with barely 5% coming from the brain-dead. The annual requirement is about 150,000.
The LKD rates in two-thirds of the 69 nations?surveyed have been growing at 50% over the last decade, but India remains stuck at the same level, which Shroff attributes to lack of health insurance, and institutional and financial support. A kidney transplant costs about Rs3-4 lakh, with a lifetime monthly post-operative care costing at least Rs10,000.
Tracking the rate of LKD is important as the worldwide prevalence of end-stage renal disease is increasing and a global trend can help countries evaluate their performance, said authors Lucy Diane Horvat, Amit Garg and colleagues from the University of Western Ontario in Canada.
India is in an unenviable position when it comes to the disease burden, implementation of the organs Act and preventing kidney rackets that frequently rock the nation.
At present, brain-dead transplant, also called disease donation, amounts to 0.7 per million population, but if this is increased to one, then there would be 1,100 donors and 2,200 kidneys for transplants, said Shroff. If pushed further, to two per million population, then 4,400 kidneys could be retrieved, dramatically reducing the burden on living donors.
“We (surgeons) have a problem in LKD…operating on healthy people, who in many cases die or develop complications,” said Sandeep Guleria, a transplant surgeon at All India Institute of Medical Sciences. He said unlike the West, which started with cadaver transplants and took to living donors to bridge the gap, India started with living donors and even 15 years after the Act, has failed to adopt cadaver transplants in earnest.
Some of the ambiguities in the Act that led the kidney donor-broker-hospital nexus to thrive have now been cleared. The Act was amended with effect from 4 August, to make the procedure more transparent , said Harsh Jauhari, head of renal transplantation at Sir Ganga Ram Hospital in New Delhi.
But several problems remain and experts believe they can be addressed when the national organ transplant programme—ambitious but apparently hurriedly announced in November—on the lines of the National AIDS Control Organization will eventually be launched. “It will bear fruit only four-five years down the road,” said Jauhari.
Graphics by Ahmed Raza Khan/Mint