New organ donation rules: Why they may not go far enough

Gloves find wide use in the health sector as well as in industry. (Representative image)

The Union government recently announced that it was considering a “one nation, one policy” for organ donation and transportation.

According to the proposed rules, now patients can register themselves in any state for an organ transplant. So far, an organ recipient could only do so in their state of domicile.

A unique identity number will tag the patient across hospitals in various states, said the Union health ministry. It also announced that a clause in the Transplantation of Human Organs and Tissues Act, 1994, which barred people above 65 years from receiving organs for a transplant is going to be removed.

These announcements came on the back of the recently released data on organ transplants, which showed that in 2022, 15,561 such procedures had been carried out in India — the highest ever for a year and 27 percent more compared to 2021.

Although India ranks third among countries conducting organ transplants, it has been estimated that only 4 percent of those who need the lifesaving medical intervention actually receive it.

But are these new changes announced by the government capable of raising the country’s dismally inadequate transplant numbers? There remain serious doubts.

Who needs a transplant and why

Organ transplantation is required for those patients, who have damaged their own beyond repair. It means that despite medicines and devices, the damaged organs have to be replaced by healthy organs.

In some transplants, close family members can offer their organs to the needy if found compatible, but in some other cases, such as a heart transplant, only a brain-dead person, within a stipulated time, can be the donor.

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The changes proposed by the government are good steps in the right direction, but may not be sufficient, experts said.

Dr Sanjay Aggarwal, Head of Nephrology Department at the All India Institute of Medical Sciences, New Delhi, said the major hurdles were a shortage of organs, societal attitudes towards agreeing to donate organs and poor coordination at every level, resulting in a potential donor’s refusal to donate an organ at the time of a patient’s brain stem death.

Then there are issues such as financial constraints on the part of patients and lack of adequate facilities in many parts of the country apart from a shortage of expertise.

Aggarwal said that the new rules are unlikely to improve the organ transplantation scenario as the change may shift younger recipients to older recipients but it may reduce good outcomes.

“The one nation, one transplant also may smoothen the transplant experience for some, but is unlikely to raise the overall numbers due to various factors,” said the nephrologist.

These are good rules and guidelines, but the larger problem is of implementing them, Aggarwal said, citing the example of a possible donor from Odisha, who may register in Delhi but may not get a very good outcome due to issues such as delays in performing the procedure and the logistics of a long stay in a faraway place.

Where are the donors?

Dr K Mahesh Prasad, a consultant nephrologist with the P D Hinduja Hospital in Mumbai, said the main reason behind the poor transplant rate was the non-availability of donors.

“Until and unless the core issue related to organ availability is addressed, no changes in the existing law will have any significant impact on the transplant programme,” he said.

The situation on the ground is saddening, Prasad said. Most of the time, a donor is either the wife or mother and in some cases husband or father of the patient.

“Other relatives are generally reluctant and do not come forward and more than half of the patients have either too-old parents or medically unfit spouses,” Prasad added. “So waiting endlessly for the cadaver organ or meeting unfortunate events are the options left with.”

According to him, donors’ pools can be increased by allowing transplants from friends and acquaintances, like in many other countries.

“We should come up with some guidelines for unrelated transplants and streamline them in order to increase the transplant rate,” Prasad added.

He said strict laws should be put in place for inherent issues in unrelated transplants like donor exploitation and organs being sold for money.

But making unrelated transplants a crime is not going to solve the misery of kidney patients and a well-supervised, regulated, and incentive-based unrelated donor program is the need of the hour, he insisted.

Heart transplants: few and far between

In the case of kidney and liver transplants, in which the donors can be both living or deceased, the numbers are far from sufficient. One can only imagine the status in the case of heart transplants, where the donor can only be a brain-dead person.

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While an estimated 10,000 patients may be needing a heart transplant every year, just 250 got it last year.

Dr Vishal Rastogi, Director of Interventional Cardiology and head of the advanced heart failure programme with Fortis Escorts in New Delhi, said the biggest problem is that a lot of patients cannot afford a heart transplant.

Many don’t even know that they need a transplant, which can potentially save their lives, he says.

“There is a major lack of awareness while the centres for performing transplants are very, very limited in number,” he said.

It is for these reasons that despite a high number of patients dying in accidents and due to trauma every year in India, only a few heart transplants are carried out.

The moves by the government may be well-intentioned, but may produce few results until a lot more is done, Rastogi said.