Bold policy changes are needed to meet the need for organ transplantation in India

Abstract

In 1994 Indians with end-stage heart, lung, and liver disease were doomed to die and only a few wealthy patients with kidney failure could obtain a living donor transplant. In response to embarrassing revelations about the black market in kidney transplants and the absence of extra-renal transplantation, the Indian government passed the Transplantation of Human Organs (THO) Act. [1][2][3][4] The THO Act legalized brain death and made the sale of organs a punishable offense. However, the passage of the THO Act was not accompanied by government-funded initiatives to advance development of deceased donor programs. Unsurprisingly, transplantation in India is predominantly based on living donation. Today, India performs the highest number of living donor kidney and liver transplants in the world but only a small number of deceased donor transplants. In 2019, 88% of 9751 kidney transplants and 77% of the 2590 liver transplants performed in India were from living donors. 5 In comparison, in 2018 only 36% of kidney and 19% of liver transplants performed globally were from living donors. 6 A quarter century after the THO Act, transplantation remains inaccessible for most Indians with end organ failure. An estimated 220,000 persons die of chronic kidney disease in India annually. 7 The burden of extra-renal end organ failure is also undoubtedly large. It is estimated that between 200,000 and 300,000 persons die of liver failure annually with about 25,000 of the deaths among patients who could have been transplant candidates. 8 In this perspective we review the current status and propose national policies to advance deceased organ donor transplantation in India. As the delivery of health-care services in India is complex, this viewpoint does not directly address implementation issues which will vary between individual states in the country.

Overcoming Challenges of Deceased Organ Donation in Indian Private Hospitals

“…Doctors in ICU are unsure of what to do when the relatives refuse DOD, as there is ambiguity on the legal position on switching off ventilators. 8 A uniform definition of death that encompasses both circulatory death and BD, delinking the declaration of BD declaration from DOD, is required. 9 A lack of clarity in law on the use of ancillary tests confirming BD in situations where apnea test is not feasible compounds the issue.…”