HEALTH MATTERS. Shed the taboo around organ donation

The gift of life has always been perceived as one of the biggest acts of divinity and is a true miracle of medical science. It has been the endeavour of the healthcare collective, over generations, to enable this great mission. I believe that organ donation is a vital building block in this noble goal. Organ donation enables the recipient to get a second lease of life while it immortalises the donor’s act of exemplary humanism.

We often read or hear of touching stories of organ donation, and the transformation it brings to the lives of recipients and their families. Each of these stories is an inspiration to all of us and also serves as a clarion call for developing a national ethos around organ donation. Having said that, the sad reality is that India has one of the lowest organ donation rates among developed and developing nations.

Social inertia has played its part in this scenario, but equally important is the lack of knowledge. Even the reasonably educated are not aware of the fact that that apart from kidney, liver, heart, lungs and eyes, other organs such as pancreas, bone marrow, blood vessels, heart valves, middle ear, connective tissues, bones and skins can be harvested from a single cadaver. And this can literally mean a new life and improved quality of life for several individuals.

We cannot ignore the adverse effect of superstition. It fuels the reluctance to donate organs, and the result is a continuously widening gap between the number of organs required and those donated. I can only urge everyone to imbibe the oft-repeated quote: “Don’t take your organs to heaven; God knows we need them on this earth.”

The single biggest challenge facing us today is making organs for transplantation available. Though we have a population of almost 1.3 billion people, the statistic stands at 0.08 persons as organ donors per million population or PMP. This is an incredibly small and insignificant number compared to the statistics from around the world.

By conservative estimates, 1,75,000 Indians suffer from end stage renal disease requiring a transplant, while only 6,000 odd receive one in a year. Similarly, 50,000 Indians require a heart transplant while only 10-15 surgeries are performed each year. Some 50,000 Indians require a liver transplant, while only 700 procedures are carried out each year. While the number of eye donations has increased due to awareness, it is estimated that 4.6 million Indians suffer from corneal blindness.

This uphill challenge calls for a concerted effort to pick up the volume in our donor registries. Education and endorsements by key opinion leaders may need to be supplemented through strategic legislation to reverse this disturbing lack of organ donors in the country.

India currently follows a very loose version of the ‘opt-in’ framework. Under this framework, harvesting of organs is only done after the donor explicitly agrees to it. Countries such as the US, UK, Germany, and Netherlands have a ‘family consent’ system in place which helps raise the number of donors. These countries are seeing donations averaging between 10 and 30 PMP.

Then there are countries like Singapore, Belgium, and Spain which have a more aggressive approach of ‘presumed consent’, which permits organ donation by default unless the donor has explicitly opposed it, during his/her lifetime. This is often referred to as the ‘opt-out’ framework; these countries have seen the rate of donations double, averaging between 20 and 40 PMP.

Singapore, Israel, and more recently, Chile, have taken this a step further. Their ‘opt-out’ rules have been made stricter with reciprocity clauses. This means that certified organ donors will get priority in waiting lists, over people who have opted out of the organ donation programme. This framework has achieved results in both Israel and Singapore. The Chilean experiment just started in 2013.

In the Indian context the most basic challenge is to transform the mindset. The poor status of cadaver transplantation may be attributed to the moral, emotional and religious beliefs and taboos that inhibit the relatives of the deceased to donate the organ(s) of a brain dead person. Yet, some days bring forth miracles. On May 5, 2015, five families in Tamil Nadu consented to donate the organs of their deceased loved one and gave 23 individuals the priceless gift of life and vision. It was a dark night for five families and but each of them rose above their grief and chose large-heartedness.

A multi-disciplinary team of Apollo’s doctors and support staff worked round the clock to help realise this remarkable feat. Our hospital in Chennai has done the most number of combined heart and double lung transplants and also successfully performed this procedure on a 67-year-old (the second oldest such patient in the world; the oldest was 68).

Over the last few years, Tamil Nadu, and in particular Chennai, have witnessed a lot of transplants, and a significant rise in the number of donors. I am hopeful this will spread to all corners of the country soon.

Several new initiatives have come up to facilitate smoother and better transplants, and hasten the process of organ retrieval. The Green Corridor concept is a great idea — it involves the unhindered transport of an organ to the hospital, through a series of alerts at traffic junctions, airports and so on. I propose a formalisation of the Green Corridor by creating a new code, akin to those used in natural disasters, to be used for any organ retrieval or transport, which will ensure that all stakeholders — civic bodies, traffic police, ambulance operators and doctors — align to ensure the timely movement of organs. A national code will ensure better preparedness and improve the availability of organs. Corporate leaders can play a major part as they are often the role models, whom their employees consider worth emulating.

The global experience stands testimony to the fact that the availability and optimal utilisation of organs can be enhanced through a national declaration on cadaveric donation that puts forth an ‘opt-out’ framework in place. Such a framework, through the use of IT, will ensure that only those who opt out willingly will not be used as organ donors. This declaration will give India the unique position of having taken up a visionary public health initiative on such a large scale.

Our huge young population will be the moving force behind our mission to ensure that no person in India dies for want of an organ.

The writer is the chairman of Apollo Hospitals Group. Today is World Organ Donation Day