On the Way to Self-sufficiency: Improving Deceased Organ Donation in India

Abstract

HEALTHCARE STRUCTURE AND ECONOMICSOrgan transplantation in India to date relies predominantly (80.3%) on living donor procedures for kidney and liver transplantation. Heart, lung, pancreas, and small bowel transplants are therefore less frequent. [1][2][3][4] There is also a pronounced gender inequality with a majority of male transplant recipients (81%), whereas most donors (78%) are female. At this time, there are limited living donor follow-up and variable recipient results. Most transplants take place in private sector hospitals with costs that nearly twice compared with those in the public sector.India ranks 184 of 191 countries for the gross domestic product (GDP) spent on healthcare. Based on the World Health Organization National Health Profile, India spent only 1.3%-1.4% of its GDP for public health expenditures (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019)(2020). In comparison, health expenditures (% GDP) are significantly higher in developed countries, ranging from 17% in the United States to 9.2% in Australia. Approximately 30% of healthcare in India is funded by the government, whereas 70% is funded outof-pocket; 50% of healthcare in the country is provided by private institutions. Ayushman Bharat Mission-National Health Protection Mission or Pradhan Mantri Jan Arogya Yojana has been launched in 2018, the Around the World T1-T3,F1

India: Gender Disparities in Organ Donation and Transplantation

“…Eighty percent of all transplant programs in India focus on living donor kidney transplants (LDKTs). 1,8,9…”

Current Status, Challenges, and Opportunities of Organ Donation and Transplantation in India

“…Currently, India performs the third largest volume of organ transplants after the United States and China. [1][2][3] Notably, <10% of patients with organ failure have access to SOT worldwide. The Indian Ministry of Health estimates a gap of approximately 175 000 kidneys, 50 000 livers, hearts, and lungs in addition to 2500 pancreas.…”

Why Are So Few Liver Transplants Done in the Public Sector in India and How Can We Improve the Numbers?

“…Of the total of 2592 liver transplants done in 2019 (before COVID), > 95% were done in 175 private sector hospitals and only <5% were done in 5 hospitals in the public sector. 1,2 Private hospitals perform 90% of all solid organ transplants and 98% of all liver transplants at a cost that is relatively low by international standards, approximately $ 7,500 US dollars for a kidney transplant and $25-30,000 for a liver transplant, but still well beyond the reach of most Indians who have an average annual income of less than $2000 US dollars. 2 Why is this so and what can be done about it?…”

“…1,2 Private hospitals perform 90% of all solid organ transplants and 98% of all liver transplants at a cost that is relatively low by international standards, approximately $ 7,500 US dollars for a kidney transplant and $25-30,000 for a liver transplant, but still well beyond the reach of most Indians who have an average annual income of less than $2000 US dollars. 2 Why is this so and what can be done about it? In this editorial, we will try and analyse the reasons why the public sector is unable to cope with the demand for equitable, subsidized, and accessible transplantation based on an altruistic organ donation registry.…”

“…The donor family should be recognised publicly for their generosity and the recipient's family receive a government subsidy (Umbrella Rashtriya Arogya Nidhi scheme, PM JAY insurance, state/ESI insurance) towards their treatment costs. 2,4 In addition, the next of kin of the donors should be incentivized by government health insurance cover. Those who pledge donations may also be rewarded by allocation priority in case they themselves end up with organ failure (a model which has been implemented in Israel).…”