Increase Awareness, Save Lives

By GovernanceToday
In Interview
May 4, 2016
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Human Organ Transplantion is a boon for the medical industry as it has helped save lives of countless patients with dysfunctional organs. However, the ratio of donors to recipient has been very low which has left country with a long waiting list for transplants. Ritika Bisht of Governance Today in conversation with Dr. D.K Agarwal, Senior Consultant, Nephrology, Apollo Hospitals, asks him about the present, future and awareness issues related to organ donation in the country. Edited excerpts:

dkagarwal

Dr D K Agarwal | Senior Consultant, Nephrology, Apollo Hospitals

Can you brief us about the overall organ transplant scenario in the country?

Organ Transplantation has been one of the greatest advances of modern science which has provided new lease of life to many patients over the years. If we look back at cases dated 10 years back, then organ transplant scenario has definitely improved in India. But I still believe it is in primitive stage as cadaver transplant program is yet to gain any attention from general public and the critical shortage of donors make it impossible to meet the public demand for organ transplants. India lags behind in the implementation of a cadaveric donation program and unless you have donor pool of cadavers we won’t be able to meet the requirement.

Every year we get around 1.5 lakh patients of CKD (chronic kidney diseases). At the moment we are only able to treat around 5-10 percent cases of stage 5 CKD, either by transplant or by dialysis. Expensive cost of treatment is one of the issues for patients. The situation gets worse as lack of awareness among public poses another challenge. We still have lot of work to do; most importantly in the area of educating general public about organ transplant and benefits of being a donor.

Your views on our country’s system in organ donation and transplant.

India’s system for human organ donation involves lot of legal procedures which were not present earlier. Our government has framed different authorization committees to eliminate the unethical practices. As per our laws, sale of organs is banned, that means no money exchange between the donor and the recipient is allowed.

Thus, while conducting organ transplant the unrelated donor has to file an affidavit in the court of a magistrate stating that the organ is being donated out of affection. The donor has to undergo certain tests before the transplant and all the resultant medical reports are later checked by the authorization committee. The Human Organs Transplant Act has certainly kept a check on illegal organ transplant. In addition, the Act allows transplantation of human organs and tissues from living donors and cadavers. It has even permitted swap transplantation. Therefore, a lot of changes have taken place but certain glitches are still there which can be eliminated by educating the masses and hospital administration.

But the underground organ market is still existent and thriving in India. Your views on this practice and what needs to be done to eliminate it.

Despite the Act of 1994, we are still coming across reports of illegal organ trade. We need to understand that doctors, social workers, transplant coordinators and government are trying their best to root out this practice but the change does not happen overnight. As a result of continuous efforts many illegal transplant centers have been identified across India and shut down immediately. Penalties for removal of organ without authority have been made very stringent in order to serve as a deterrent for such activities. Educating general public, especially people from rural or remote areas, about the laws can help put a full stop to this practice but it would take time.

Though the Act of 1994 has helped support the overall transplant scenario, the endless documentation and requirements have left patients waiting for more than necessary. What can be done to ease the overall legal procedure?

Yes, I agree this is an issue when it comes to fulfilling the requirements in order to get a green signal for the transplant. We understand that laws were enacted to stop the unethical practices but if a donor is a friend and he/she willingly comes to donate then the donor should not be harassed in the name of endless legal documentation. This practice prevents people from donating. It is the duty of the authority in-charge to understand the situation of patients and family members and ease the procedure. Government has the power to change the rules and it is their responsibility to make sure that genuine person/donor is not harassed.

Could you comment on the infrastructure of organ transplantation in the country, especially in smaller cities and town- level hospitals?

Adequate hospital infrastructure for conducting organ transplant is missing in rural areas at the moment. Patients have been coming to metropolitan cities like New Delhi and Kolkata to get the treatment but with added efforts some areas are getting the benefits of programs. Our students are travelling to places in Odisha and Indore for these programs and are conducting organ transplants successfully.

When it comes to remote areas the absence of infrastructure is accompanied by lack of knowledge among masses about organ transplant. In my experience, doctors in remote places need to come for training so that they can know how the patient of organ failure is different from regular patients. I have spent a lot of time in social services and given lectures to other doctors as well which has helped a great deal in informing people about the transplant surgeries.  Thus, we need to educate not only people but doctors as well.

What needs to be done to encourage people to donate organs?

When it comes to cadaver donation the practice would take time as our population is not educated enough or informed enough as compared to people in European countries. We need proactive attitude towards cadaveric organ donation and most importantly implement counseling for relatives for organ donation in the event of brain death.

Even though our law authorizes organ donation after brain death it does not serve any purpose unless our population is informed about the procedure and how a brain dead patient can help others patients in critical stages live a normal life.

Indian society is not very welcoming to the idea of cadaver organ transplants as they prefer to conduct last rites without the removal of essential organs. In a sensitive case like this awareness is required not only for general public but also for hospital administration. A good motivator is needed to encourage family members to donate organs and explain them the futility of keeping a brain dead accident victim alive. All these measures need equal assistance from government and only then we would be able to increase our pool of donors to help patients live a new life.