Lack awareness a major hurdle in organ transplants

Issues related to logistics, infrastructure and legalities also play a major role in the organ donation process

Kamini Mehta, daughter of a retired army officer who was shot in Meerut in 2008, feels her father is still around. Mehta, who lives in Gurgaon, decided to donate her father’s organs as she was told by doctors that he was brain-dead and would never come out of coma. She and her husband, also a retired army officer, did some quick research and took a decision. “Because we were counselled well and because we took the decision without wasting time, my father’s liver, three heart valves, kidney and one eye could be used to save so many lives,” says Mehta, with a sense of relief.

However, statistics show that such instances are very few. Despite a huge unmet need for human organs and tissues, experts say around 20 per cent of donated organs are rejected or wasted due to reasons such as time lag, improper storage of organs and legal hurdles in the clockwise precision with which transplants must be carried out.

According to Sunil Shroff, managing trustee of the Mohan Foundation, a non-governmental organisation that focuses on organ donation, a major roadblock is in the first step itself — declaring a patient brain-dead. “The problem is not so much the public, they can be talked and converted to agree to donate. The primary reason for the huge disparity between demand and supply is lack of awareness and challenges in hospitals itself,” says Shroff. According to him, though two to four per cent of deaths in any hospital are due to brain death, they are not declared so in time to assist transplants.

Usually a donor’s organs are healthy to be explanted within 24-74 hours of brain death, after which the heart fails and the organs start becoming unhealthy. “Organs are natural resources and, therefore, run the risk of decaying and getting infected. The organs have to be, therefore, explanted and transplanted at the earliest possible to get best results,” says Avnish Seth, a gastroenterologist and director of Fortis Organ Retrieval & Transplantation.

In the case of eyes, the cornea has to be explanted within two to three hours of death, after which the cells start decaying, says Ajay Sharma, chief medical director and founder of Eye Q. According to Sharma, although eye donation is a very popular phenomenon, 50-60 per cent of the pledged eyes are wasted because the family of the deceased do not call an eye bank.

There are also other issues related to logistics, infrastructure and legalities involved that play a major role in the process of organ donation to transplant.

For instance, in the case of tissue transplant such as eyes, bones and skin, which can be done in the case of natural deaths as well, proximity of an eye bank or a transplant centre is very important.

Sharma points out there are merely 480 eye banks across India. In cases of cadaver donors, hospitals, mainly government hospitals, do not show enough initiative to declare a patient brain-dead, as there are logistics, legalities, infrastructure and financials involved, say experts.

According to Neelam Mohan, director, department of pediatric gastroenterology, hepatology and liver transplantation, Medanta-The Medicity Hospital, maintaining a donor after s/he is brain-dead is crucial and hospitals often shy away because they have to dedicate infrastructure such as intensive care units, a panel of doctors apart from taking care of the cost attached.

Contacting recipient patients and making them available for transplant in time is also a challenge as there are only a few states such as Tamil Nadu, Karnataka, Kerala, Maharashtra and Andhra Pradesh that maintain registries.

Seth says although police and other agencies involved are often accommodating in such issues, hospitals are also required to have precision in managing legal procedures such as autopsies and other formalities. “Hospitals should interact more with police to make them aware about the mechanism, so that in accident cases, they hand over the body to the hospital at the earliest possible,” says Shroff. He adds that although there are 140,000 road accidents every year, of which 90,000 are head injuries, only five to 10 per cent of total organs donated in India are from brain-dead people.

According to estimates, organs are available to just a 10th of the patients. According to doctors and experts, the healthcare sector currently generates around Rs 500 crore of annual revenue from organ transplants, against a potential of at least Rs 5,000 crore.