Agroup of non-profit organizations are banding together to try and improve organ donor policies, a move they hope will help save thousands of patients and reduce black market trade of organs.
The newly formed National Deceased Donor Transplantation Network plans recommendations to the public and private health sectors to streamline the process of retrieving hearts, livers and kidneys from those declared legally brain dead at hospitals and transplanting them successfully.
Though there have been examples of dramatic success stories in recent months, transplants done with organs donated by brain dead patients are rarely performed in India. While poor infrastructure at many hospitals across the country contributes, the main problem is a lack of donors, say observers.
“First and foremost, we need to have a massive pan-India awareness campaign,” said Vatsala Trivedi, coordinator of the Zonal Transplant Coordination Committee (ZTCC) in Mumbai.
Efforts must target the general public to educate them about the myths and realities regarding organ donation, said Dr Trivedi. Physicians in large government hospitals with intensive care units that see large numbers of accident victims rarely declare patients brain dead, meaning that person can’t legally donate their organs for transplant—even if they are willing.
“The major public hospitals and the doctors who are treating patients there are not treating this as an important issue,” said Dr K. Ravindranath, managing director and chairman of Global Hospitals and a surgeon who performs liver transplants in Hyderabad. “There is no proper system in place to not only declare, but to take proper care of brain dead patients.”
Often, in the rare instance that hospitals attempt to do this, the donor has “crashed” and the opportunity to retrieve the organs is lost, said Dr Ravindranath. In the vast majority of cases when an organ donor passes away at another hospital, the body must be shifted across the city to Global Hospitals not only for the surgery to retrieve the organs—but just to be declared brain dead. The process alone comes with red tape that drives many families away from donation, he explained.
“Not only do you face a lot of bureaucracy, but you risk losing them along the way,” he added.
For example, only 31 transplants where the organs were donated by a brain dead patient were performed in Hyderabad, India’s sixth largest city, between 2002 and the end of 2006, according to K. Raghuram, chief executive of the city’s chapter of the Multi-Organ Harvesting Aid Network (Mohan).
The group will also recommend that each state keep a registry to help match a patient waiting for a transplant with a compatible organ if it becomes available. Currently, the records are kept at the hospital level, say officials.
At least 100,000 people await a kidney transplant, 30,000 need new livers and about 10,000 need a heart here at any given time, estimate officials from the major transplant organizations.
High demand, coupled with foreigners seeking transplants in India they have been unable to obtain legally elsewhere, fuels a rampant illegal trade in organs here. Donors, often poor, are often promised payment in exchange for a kidney.
However, strengthening the national system of donations from brain-dead patients, who have previously indicated that they are willing to donate their organs, is one of the best ways to curb the illegal organ trade, though it will take time, according to those who track the international organ blackmarket.
In India and other developing nations, “not only is it not exceptional for someone to sell a kidney but it’s become routine,” said Nancy Scheper-Hughes, director of Organs Watch and a professor of anthropology at the University of California at Berkeley. “It’s hard to reverse that kind of system once it’s there.”
Resource-strapped doctors at large public hospitals sometimes “can’t see wasting the resources on the ‘living dead’,” said Scheper-Hughes, speaking from Boston, where she is spending the year as a Radcliffe fellow at Harvard University to write a book on the illegal organ trade. “Putting cadaveric donation in place requires a huge mobilization of political will, from the legislature on down to the doctors, hospital staff and public.”
The new association will register itself as a not-for-profit society and have its registered office in Mumbai, officials from several of the associations said. It includes representatives from the ZTCC in both Maharashtra and Karnataka, Gandarpan in Kolkata, the Chennai and Hyderabad chapters of Mohan, and the Delhi-based Organ Retrieval and Banking Organization, as well as the Chennai-based National Network for Organ Sharing.