Sunayana Singh, CEO, Organ (Organ Receiving and Giving Awareness Network) India explains that setting up of transplant units/departments in hospitals in smaller cities and rural areas can be boosted by an experienced transplant center handholding another to start their transplant program. India has some of the best transplant surgeons in the country who can train others in retrieval and transplant through such partnerships
It is estimated that almost five lakh Indians face organ failure every year. Most of them will not live to have an organ transplant. For an estimated 2 lakh patients who suffer from renal failure annually, the number of kidney transplants are 6000-10000 every year. The story is similar in the case of other organ transplant such as liver, heart, and lungs. Only approximately 5 per cent of people waiting for a life-saving organ transplant will receive one.
Although in the last decade big strides have been made in transplantation and even organ donation in many states, most of the transplants are from living donors (around 80 per cent) and very few from deceased donors. Organs are not retrieved from thousands of brain-dead patients which could help a lot of critically ill patients hanging by a thread and fighting for their life. The crisis deepens with people get added on the waiting list of transplants daily.
One of the solutions to this imbalance in the demand and availability of human organs for transplantation, is the sensitisation of the medical fraternity across India. While bigger metros are doing well, there needs to be a systematic approach to tackle the problem in smaller cities and rural areas.
Ultimately what we need is for there to be more transplant centers across the country. For this to happen, the know-how in the medical fraternity is crucial. The deceased donation program suffers from a lack intensive care facilities in smaller cities, lack of infrastructure and manpower to run the program including intensivists to man the ICUs, fewer private & government hospitals carrying out transplants, lack of infrastructure to run the program, lack of trained personnel especially surgeons, and lack of confidence in declaring brain death and handling and approaching the deceased’s family.
These are all factors that contribute to the low or non-existent donation rate in these areas. Deceased organ donation depends on organs donated by brain-dead persons who have died of severe brain injuries. The entire process involves a huge effort from identification of brain-death, consent of next of kin, coordination with different teams including the police in the case of medico-legal cases, organ procurement and finally transplantation.
There needs to be proper coordination between authorities and the police if it is a medico-legal case. So, from procurement to transplant, the process is long needs to be tackled head-on by all state governments.
Setting up a transplant center takes time, training, and infrastructure. Until such a time as they get their processes in place, they can become retrieval centers so that organs can be retrieved there and transported to transplant centers in nearby cities. This process will require some retrieval training, good coordination between all medical teams and the nodal agencies in each state to ensure the retrieval. There also need to be a well-organised transport mechanism to transport the organs from retrieval centers to transplant centers.
Setting up of transplant units/departments in hospitals in smaller cities and rural areas can be boosted by an experienced transplant center handholding another to start their transplant program. India has some of the best transplant surgeons in the country who can train others in retrieval and transplant through such partnerships. This will enable both local private and government hospitals to receive the know-how and benefit from experience hospitals and surgeons. This can go a long way in capacity building for organ retrieval and utilization organ.
An example of one such successful collaboration is between an experienced transplant center PGI Chandigarh, and Dr Rajendra Prasad Government Medical College (RPGMC) Tanda, Himachal Pradesh. The team at PGI Chandigarh for the past 3 years has been sensitising the Himachal Pradesh Government regarding need for setting up a transplant program. (There was none in private or public hospitals). The a surgeon from Tanda who trained for 3 years with PGI Chandigarh. Training modules and training courses with intensivists, neurosurgeons, anaesthetists were carried out over the course of the 3 years and all required clearances were taken for retrieval of organs. Extensive organ donation awareness campaigns are at their campus regularly.
The results are encouraging. Himachal Pradesh this year saw its first deceased donation in March 2022, and several more have taken place since then.
Organ donation and transplantation in India is growing, and the involvement of public and private sector in smaller cities and districts will increase the rate of organ donation and make transplantation more accessible to the public. Awareness in the public and medical fraternity is key. Brain-death committees need to be set up and there needs to be an ecosystem that moves along the retrieval process. Besides this, training and collaboration between hospitals are key in making this an affordable and inclusive process.