Organ donations, transplants: India
This is a collection of articles archived for the excellence of their content. |
Contents |
Donors’ profile
Gender, relationship: 1995- 2021
Steffy.Thevar, Nov 13, 2023: The Times of India
4 out of 5 living organ donors in country are women, 4 of 5 recipients men: Study
Pune : For every woman who received an organ, four men got transplants in the country. Data from 1995 to 2021, indicates that 36,640 transplantations were carried out, of which over 29,000 were for men and 6,945 were for women. The stark difference, experts said, was because of economic and financial responsibilities, societal pressures and ingrained preferences.
Director of NOTTO Dr Anil Kumar said more men are cadaver donors but more women are living donors, but the difference when the numbers are added are so high that women outperform men in organ donation. “Of the total organ donations in the country, 93% were living donors. This by itself is a statement that many organ do nors in the country are women donors,” he said. As per a paper published in Experimental and Clinical Transplantation Journal in 2021, it was found that a huge gender disparity prevails in the country when it comes to living organ transplantation.
The data analyzed the organ transplants that took place in 2019 and found that 80% of the living organ donors are women, mainly the wife or the mother while 80% of the recipients are men.
The study also found that the primary reasons for more women donors are the socio-economic pressure on them to be the caretakers and givers in the family and as men are the bread earners in most cases, they hesitate from undergoing any surgery.
Mayuri Barve, an organ transplant coordinator from DY Patil Medical College, Hospital and Research Centre in Pune, said that in the last 15 years that she has been working in this field, only once did a husband come forward to donate his organ to his wife. Usually, wives, mothers and even fathers donate, she added.
In spousal donors, over 90% are wives
Mayuri Barve, an organ transplant coordinator from DY Patil Medical College, Hospital and Research Centre in Pune, said mothers and fathers are happy donors to their children.
When both are unavailable, wives come forward. Often, if the daughter is unmarried, she becomes the donor. However, if a wife needs an organ, then it is most likely that she would be put on a waiting list.
“If the recipient is a man and the bread earner, then the wife or the parents feel the responsibility of donating the organ. Women who are recipients feel guilty if their family members have to donate their organs and they refuse to take them from their families. Financial responsibilities on the male members and cultural upbringing wherein a woman is taught to take care of her family is the cause why more women tend to donate while more men are likely to be recipients.”
Dr Arpita Chaudhary, joint director of regional organ tissue transplant organization (East Region) which covers the states of West Bengal, Bihar, Odisha, Jharkhand, Sikkim said as per the data collected from several government hospitals, when it comes to live donors and spousal donors, over 90% are wives while only 10% of the donors are husbands.
Also, in the case of a parent’s organ donation, over 70% of the live donors are mothers. In addition to more women donating organs, female recipients are less compared to male recipients.
“Female literacy rate helps spread progressive ideas. Women donate their organs out of a sense of responsibility as caretakers. Our social structure is such that women feel they must give their time, energy and if required their organs for family members. In villages, where the woman works physically harder than the man, the mother would not let the father donate, the wife would not let the husband donate. However, such donation is not dependent on female literacy and somewhere male dominance plays a pivotal role. In all my 20 years, I have hardly seen a woman refusing to donate,” she said. Full report on www.toi.in
The legal position
Minors can donate organ/ tissue in rare situations: HC
NEW DELHI: A minor can donate an organ or tissue in a rare situation unless there is a risk to her life in the procedure, Delhi high court has said.
Justice Sanjeev Sachdeva on Wednesday set up an expert medical board to assess any risk to the life of a girl, who wishes to donate part of her liver to her ailing father, if she undergoes the procedure.
The court noted that “there is no complete prohibition in a minor donating an organ or tissue prior to attaining majority. Donation is permissible but in exceptional circumstances and in accordance with the rules.” The observations came after it was informed that a committee set up by Delhi government had refused permission to the girl to donate her liver merely on the ground that she is a minor.
“There is no medical opinion in the present case to suggest that there is a potential risk to the petitioner. The minor is aged over 17 years and 10 months. ...The decision of the committee of rejecting the representation of the petitioner solely on the ground that the petitioner is a minor is not sustainable,” Justice Sachdeva, who heard the matter via video-conferencing, noted.
The girl wants to donate part of her liver to her father as he is suffering from a severe case of liver cirrhosis and urgently requires a transplant to survive.
The court directed the hospital, where the father is admitted, to set up the panel to examine if there is any potential risk to the girl’s life. It said the panel’s decision will be communicated to the government which shall “forthwith” take a decision on the girl’s representation for approval to donate part of her liver to her father, and listed the matter for hearing on April 3.
In her plea through her mother, the girl informed the court that she will turn 18 in last week of May, but her father needs urgent organ transplant.
Spousal consent not must for organ donation: MP HC
Spousal consent not must for organ donation: MP HC
Spousal consent is not required for organ donation, Madhya Pradesh HC has said, and ordered a Bhopal hospital to process papers for kidney donation by a woman to her brother, reports Ashutosh Shukla. HC held that there is no such provision in Transplantation of Human Organs & Tissues Act, 1994. A hospital cannot insist upon an NOC/affidavit of husband of donor. Any other close relative of a woman donor, except the recipient, may execute the document as required by the checklist, it said.
Organ failures
2013-17, an increase
Organ donation up 4-fold in India, but still a long way to go, Aug 01 2017: The Times of India
Over 2.5 Lakh Die In The Country Due To Organ Failure Annually While Cadaver Donations Are Marginal In Comparison. Some States Are Yet To Make A Debut
Of the 85,000 liver failure patients who join the country's waitlist annually , less than 3% get an organ. Also, of the two lakh fresh annual registrations for kidneys, 8,000 manage a transplant. Thousands waiting for heart or lungs face bigger odds as barely 1% get an organ before time runs out.
Despite cadaveric organ donations witnessing a near fourfold increase in the last five years, the demand-supply disparity in the country remains grave.Over 2.5 lakh deaths in India are attributed to organ failure annually , while cadaver donations are still very few in comparison.India's organ donation rate in 2016 stood at an abysmal 0.8 persons per million population compared to Spain's 36 per million, Croatia's 32 per million or US's 26 per million.
Experts say the gap exists because only ten states and two UTs have an active donation and transplant programme.States such as UP , Chhattisgarh, Himachal Pradesh, Goa and the North-East are yet to make a debut. Stakeholders blame lack of awareness, infra and political will as well as myths and misconceptions for the sluggish pace of cadaver donation.
“Even after decades, the programme is a non-starter because of systemic complexities.The problem lies within hospitals and is not so much about people's acceptance any more. Police formalities remain difficult and time-consuming, discouraging people from donating,“ says Dr Sunil Shroff of Chennaibased Mohan Foundation. “There have been cases where people have approached us wanting to donate organs but either the hospital or the city lacked the infrastructure to retrieve organs,“ he says, underlining how in a country with an acute shortage, organs get wasted.
Tamil Nadu, Maharashtra, Kerala, Karnataka, Telengana and Gujarat currently lead the way . Delhi and Chandigarh too managed 30 donations in 2016.
Dr Vimal Bhandari, director of the National Organ and Tissue Transplant Organisation, says the government is aware of the crisis. “We have signed an MoU with Spain which has the world's highest donation rate. About 100 countries are learning their model. Their experts will train five of our regional coordination centres,“ he says, adding that Spain took 30 years to build its programme.Unlike Spain, where majority of brain deaths occur due to haemorrhage, in India, road accidents are the main killer.
India's infrastructure too is growing. The national network facilitated 136 instances of organ sharing between cities and states. “Last year, we even saved the lives of two foreigners who underwent heart transplants here,“ Dr Bhandari says.
Tamil Nadu runs India's most successful programme by taking a slew of decisions to ease donations about a decade back; families donating organs don't have to move for NOCs or post-mortems. Also, the state offers free kidney , liver and heart transplants in government hospitals like developed nations.
Maharashtra, that crossed 100 cadaver donations last year despite one of Mumbai 's top hospitals being involved in a kid ney racket, has carried out 1,064 transplants in the last five years. Pune has suddenly emerged as a high-donation centre, surpassing Mumbai. “Till April 2017, 69 donations took place in Maharashtra,“ said Dr Gauri Rathod, Maharashtra's nodal officer for organ donation.
Hyderabad and other dis tricts of Telangana have crossed over 1,000 organ donations since 2013. From less than 1 per million population, the donation rate has now reached 4.4.From just 41 being recorded in 2013 to 106 organ donations in 2016. In 2017, over 80 organ dona tions have already been reported. “But there is an urgent need for education among doctors. In many cases, doctors are uncomfortable in declaring brain death. This is true of government hospitals,“ says Dr G Swarnalatha, in-charge Jeevandan.
Karnataka, too, is charting its own success story with donations taking a leap from 18 in 2013 to 70 in 2016. Dr Kishore Phadke, convener at Jeevasarthakathe--the state organ transplant authority--attributes this to linked Aadhaar cards with pledging organs. “ Anyone who enrols for Aadhaar will be directed to the website of Jeevasarthakathe where they can pledge organs,“ he says.
However, many states face unique problems. Consider Kerala which has recorded only 11 donations after 73 in 2016. “ A doctor filed a PIL in the high court alleging hospitals are falsely declaring brain deaths to procure organs. It led to negative propaganda in the social media.Even government authorities didn't stand by the transplant doctors,“ says Dr Jose Chacko Periappuram of Lisie Hospital in Kochi. Kerala, however, has to its credit some of the unique organ transplants that include larynx, pancreas, small intestine and hand transplants.
Eastern India is the worst, with most states not having conducted cadaver donations at all.Only seven cadaver donations, including five in 2016, took place in West Bengal since 2012. According to Aditi Kishore Sarkar, state's nodal officer for cadaver donation, “The drive to popularize organ donation through donor card distribution has failed.In 2017, there has not been a single cadaver organ transplant so far. The state plans to introduce new laws to improve brain death screening.
Even states like Karnataka show a unhealthy skew . As Dr H Sudarshan Ballal, senior nephrologist and chairman at Manipal Hospitals, Bengaluru, says, “Of more than 300 transplants conducted by private hospitals, only 20% are cadaver organ transplants. He says India needs more retrieval centres. “India's largest centre of neuroscience, NIMHANS, is still not recognized as a retrieval centre.“
Illegal organ donations
2008:Ayurvedic Dr Amit Kumar
The Times of India, Jun 04 2016
Rajshekhar Jha The kidney racket busted by Delhi Police recalls the unearthing of a similar racket in 2008. The earlier gang was headed by an ayurvedic practitioner, Dr Amit Kumar, and involved the transplants of a staggering 600 kidneys across the country.
The regulatory framework under which Kumar was found guilty and sentenced to seven years' of rigorous imprisonment and fined Rs 60 lakh by a CBI court in 2013 now appears to have so many lacunae as to allow another racket of similar magnitude. The latest case only highlights the need for a fresh evaluation of the norms to curb illegal organ donation. For over a decade, Kumar and his associates in the Rs 100crore business dodged the police with ease, with bribes being their main weapon. Even minutes before his arrest from a wildlife resort close to the India-Nepal border in 2008, Kumar had made an abortive bid to bribe a Nepalese cop. Arrested four times including by Delhi Police, Kumar had become the most wanted man for offences of this sort Jaipur, Guntur, Hyderabad and Mumbai.
While Kumar claimed to be a saviour of those battling kidney disease, including foreigners and NRIs from Greece, Canada, Saudi Arabia, UAE and the US, the so-called donors narrated a tale of being picked up by the doctor's henchmen and being confined to a secret location guarded by gun-toting men. The gang had a car converted into a mini lab where the victims were first brought and their blood samples matched with the clients' before any negotiations on money began.
Kumar used to insert advertisements in international medical journals offering overseas clients a full medical tou rism package that included return airfares, airport transfers, accommodation and cost of surgery . Like in the current case, the members aiding and abetting Kumar stayed in hotels and an upscale guesthouse in DLF-I in Gurgaon to impress wealthy clients.
The 2008 scam was exposed when a deal fell through and the potential donor, a UP labourer, filed a complaint of harassment against Dr Upendra, an aide of Kumar. This time it was a quarrel between a husbandwife duo that alerted the police.
While Delhi Police has been able to unearth a few cases till now, sources said this was only the tip of the iceberg. Once the mastermind and the big fish are in the net, bigger revelations are likely to follow.
Kidney donation
Spousal consent not needed: HC
Swati Deshpande, April 27, 2023: The Times of India
Mumbai: Bombay HC permitted a 64-year-old man suffering from renal issues since 2018 and on daily dialysis since 2021 to undergo kidney transplant with an organ donation from his wife’s brother.
The law does not require spousal consent for the donor, said the HC, setting aside orders by the approval committee and appellate body under Organ Transplantation Act that had rejected the donation on the grounds that the donor’s estranged wife and daughter had not given their consent. Abench of Justices Gautam Patel and Neela Gokhale said, “Neither of these orders can be sustained. They are contrary to the Act, clearly arbitrary and do not take into account the only relevant factor, but take into account something unnecessary not mandated under the statute. ” The HC said the “essence of the Act is that donation is voluntary”.
Justice Patel said the wife may say she is concerned about her finances but once the donor “says he has provided for wife and daughter we don’t think it is open to (the wife) to defeat the entire process by staying away from the process and staying silent and getting the authorities to believe her affirmative consent is required”.
The proposed recipient and donor (55) from Pune had filed a joint petition before the HC to quash the appeal order dated March 15, 2023, of the state government through secretary, medical education and drugs department, which upheld the regional authorisation committee’s February denial of transplant permission.
Organ-donation, statistics
2015: shortage of donors
See graphic, 'Number of donors found in transplants, organ-wise, 2015'
2016-17: increase from 9,000 to 15 lakh
From: No. of Indians who have pledged their organs jumps from 9k to 15L in 2 years, April 27, 2018: The Times of India
Statistics show Spain records 36 donors for every million population, but India has less than one organ donor for every million citizens. Doctors and experts, however, believe India’s youth can help change this abysmal organ donation rate.
The reason for their optimism is the increased awareness about organ donation among the young. Unlike ageing India that still looks at organ donation with suspicion, the youth seem to have adopted it. A recently published study that looked at the attitudes towards organ donation of final-year students of medical, dental, engineering, and arts and science students in Chennai and Thiruvallur found an overwhelming 94% of those interviewed knew about organ donation. Only 31 out of the 486 students hadn’t heard about it.
The study published in the Indian Journal of Transplantation said that 54% of the interviewed students were aware about the “organ transplantation act”. Indeed, when TOI spoke to youngsters across the country, their empathy for the cause was apparent. Eighteen-year-old Siddharth R Chaube from Somaiya College, Vidyavihar in Mumbai, believes organ donation is a “divine concept” as it forges a lasting bond between two, often unrelated, people. “Science has remarkably progressed over the last couple of years, but it still hasn’t found a way to create new organs out of scratch. This is where organ donation steps in,” said Chaube.
Social media marketing executive Kruthika Ravindran (23) signed a pledge to donate her organs after attending a seminar last year. “People do not know what organ donation is. Hence, we need to make people aware of the what, where, when, why and how,” Ravindran said, adding that educating people is the only way ahead.
Freelance photographer Nihar Salvekar (23) wants schools to start talking about organ donation. “The youth would then be able to understand it and decide accordingly,” he said. Signing donor cards, too, would fasten the organ donation process in case of untimely death.
In fact, National Organ and Tissue Transplant Organisation (NOTTO) director Dr Vimal Bhandari advocates pledging as the instrument of change. Pledging doesn’t have a legal standing, it is one of the most effective tools to spread awareness of cadaver donation in a country where people know little about the concept.
“In merely two years, the number of Indians who have pledged organs has jumped from 9,000 to 15 lakh today,’’ said Dr Bhandari. Out of the lakhs, over 70,000 of the pledges have come from the young jawans serving the Border Security Force and other police forces.
Dr Bhandari said a lot of these pledges have come from medical and other educational institutions that NOTTO approached with its network of 60 NGOs. “If we want to witness a big shift, we have to start talking about organ donation early in schools and colleges,” he said.
He added that if young leaders speak of organ donation, it will find an appeal among the youth. “Pledging not just makes one aware, but also provides a window for individuals to discuss it with loved ones,” he said.
2023: South leads
Hemali.Chhapia, Nov 13, 2023: The Times of India
4 IITs in south shine in gender ratio as girls make up 26% of new entrants
Mumbai : The Indian Institute of Technology (IIT) Hyderabad zone has the best gender ratio among all IIT campuses with close to 1,200 girls joining tech colleges this year. While the average percentage of females who joined the IITs stands at 19%, the southern zone has 26% young women.
Their journey begins early. Not only have as many bagged a seat, the proportion of girls who register from this zone are almost 50% of the total aspirants. This zone comprises Andhra Pradesh, Telangana, Tamil Nadu, Kerala and Puducherry. Five years after the supernumerary female quota was introduced in the IITs, almost every campus has an average of 19.7% girls. In the latest batch of 2023, there are 3,411 girls, more than triple compared to 995 in 2017, ayear before supernumerary seats were created for women. And, of those, a third is in IIT Hyderabad zone.
In 2018, the quota for women was 14%, which was increased to 17% the next year and 20% thereafter. IIT Delhi now aims to move towards a 50:50 gender ratio on its campus. “Women are performing well academically. As we are moving towards becoming multi-disciplinary and opening more programmes like design and public policy, we are seeing that a good diverse mix adds so much to the richness of the educational experience,” said IIT Delhi director Rangan Banerjee. “While there is already an ecosystem to make everyone comfortable, we want to change the mindset towards science and engineering in a way that our campus’s gender ratio is reflective of India’s population numbers. The ultimate goal is that gender becomes a non-issue,” added Banerjee.
Supernumerary quota lauded for IITs’ better gender ratio
A senior professor from IIT Madras said, “The gender mix has improved. Importantly, it has become better course-wise too. There used to be just about one or two girls in CS (computer science), but with the horizontal reservation (in every course), we have over 20 girls and about 70 boys.”
The supernumerary quota is hailed as an experiment that has brought much positivity on the IIT campuses that has distressingly low number of women. “Socially, this is going to have a long-term profound impact. IITs are creating leaders of tomorrow. So, a lot of these women who will graduate from the IITs will go on to occupy the top echelons — the country will see many women CEOs, several top bankers will be women,” said IIT Bombay director Subhasis Chaudhuri.
These additional reserved seats were the recommendation of a committee headed by Timothy A Gonsalves, former director, IIT Mandi. The institutes have come a long way from the 1990s, when the ratio was close to 10:1 in favour of boys, which decreased to 7:1 in the early 2000s, and then to 4:1 in the midand late-2000s. But later it deteriorated. In 2014, most IITs had anywhere between 5% and 12% of the girl student population on their campuses. A year before the supernumerary seats were allotted to females, the IITs admitted 995 girls and 9,883 boys.
Transplants
2023 data
DurgeshNandan Jha, August 4, 2024: The Times of India
New Delhi : Foreigners account for nearly one in every 10 persons undergoing organ transplant in India, govt data shows. In 2023, data shared by National Organ and Tissue Transplant Organisation reveals, India recorded 18,378 organ transplants with 42 recipients getting more than one organ. So, there were a total 18,336 organ recipients in the country of which 1,851 (10%) were foreign nationals.
Transplants involving foreign nationals were carried out in Delhi (1,445), Rajast- han (116), West Bengal (88), UP (76), Telangana (61), Maharashtra (35), Karnataka (15), Gujarat (11), Tamil Nadu (3) and Manipur (1).
Doctors say a majority of such patients come from ne- ighbouring nations where transplant facilities are not available or still in nascent stages, including Bangladesh, Nepal and Myanmar.
‘Foreigners mostly go for living donor transplants’
While the majority of foreigners receiving organ transplants in India come from neighbouring nations, some also come from developed nations like the US and UK for living donor transplants because the cost of the procedure is barely a tenth here compared with medical costs in their countries, Dr Subhash Gupta, liver transplant surgeon and chairman of Max Centre for Liver and Biliary Sciences, said. “Nearly 30% of patients undergoing liver transplant at our centre are foreigners,” he added.
An organ transplant involves removing an organ from a donor — living or deceased — and transplanting it into a needy patient.
The person who gives the organ is called the donor. The person who receives the organ is called the recipient. A living donor can donate kidney (as one kidney is capable of maintaining the body functions), a portion of pancreas (as half of the pancreas is adequate for sustaining pancreatic functions) and part of the liver (as the few segments that are donated will regenerate after a period of time). On the other hand, a deceased donor or person who is declared brain dead can donate multiple organs and tissues including the heart, lungs, liver, kidney, intestines and corneas.
Pallavi Kumar of Mohan Foundation, an NGO working in the field of organ donation, said deceased donations are rare in India and preference is given to Indians for receiving organs retrieved from such donors. “Most transplants involving the foreigners are living donor transplants,” she said.
The NOTTO data also reflects this trend. It shows that of the 1,851 foreigner transplants that took place in India in 2023, only nine involved organ donation from a de- ceased donor. “For living donor organ transplants involving foreigners, there are strict protocols and vetting is done at multiple levels to ascertain that the donor is a blood relative of the patient before allowing transplant,” Dr A S Soin, liver transplant surgeon and chairman of the Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, said. Recently, there were reports of commercial dealings in organ transplants involving foreign citizens after which the Centre issued a directive asking states/UTs to create a NOTTO (National Organ and Tissue Transplantation Organisation)-ID of all organ recipients, both for living and deceased donor related organ transplants.
Aircraft carrying organs can seek priority takeoff & landing from ATC: New SOPs
Airlines carrying human cadaveric organs can request the ATC for priority take-off and landing for the aircraft, according to the first set of standard operating procedures released by health ministry. An in-flight announcement can be made about the carriage of a human organ onboard, the SOPs say. They call for airport and airline staff to arrange a trolley for carrying the organ box to ambulance on arrival. “In case the ambulance is allowed until the runway, airline crew to guide and assist the accompanying medical personnel carrying the organ box to disembark from the staircase onto the runway directly and into the waiting ambulance,” the SOPs add. TNN
Heart transplants: State-wise
DurgeshNandan Jha, Aug 13, 2024: The Times of India
From: DurgeshNandan Jha, Aug 13, 2024: The Times of India
New Delhi : Southern states lead in heart transplants, according to data shared by National Organ & Tissue Transplant Organisation (Notto).
In 2023, 221 heart transplants were carried out across India. Of these, Notto data show that a maximum of 70 were carried out in Tamil Nadu, followed by Karnataka (35), Maharashtra (33), Gujarat (29) and Telangana (15). Delhi-NCR witnessed only 14 transplants, according to the govt report. Officials attribute the higher number of heart transplants in South India to an increase in harvesting from the deceased.
India recorded a total of 1,099 deceased donations in 2023, with the highest number (252) reported in Telangana, followed by Tamil Nadu and Karnataka with 178 each, Maharashtra with 148, and Gujarat with 146, an official stated.
A heart transplant is a surgery to remove a damaged or diseased heart and replace it with a healthy donor heart. While the liver and kidney can be donated by living donors, the heart must be donated by someone who is brain-dead and is on life support, also referred to as a ‘deceased donor’.
According to Dr Y K Misra, head of cardiac sciences and chief cardiovascular surgeon at Manipal Hospitals, southern states get considerably more deceased donations hence most patients requiring a heart transplant go there and get enrolled. “Some of these states also provide free of cost medications to heart recipients,” he added.
The first successful heart transplant in India took place at AIIMS in 1994. Since then, number of such transplants have grown multi-fold but, doctors say, it remains a fraction of the actual requirement.
Nearly 10 % of total number of heart patients suffer from end-stage heart failure which may necessitate a transplant. But due to scarcity of do- nors, doctors say, few can undergo a heart transplant. Private hospitals charge anywhere between Rs 20 to 25 lakh for a transplant. Govt hospitals perform the life-saving procedure for a fraction of the cost, but the wait list is too long.
Dr Sudhir Gupta, assistant professor of forensic medicine at AIIMS, said, “In India, certain amendments to Human Organ Transplant Act, 1994 are required to enhance cadaver-heart-retrieval. This may include making it mandatory for hospital ICUs to declare all brain deaths and register them with an online central organ registry for better coordination of cadaver heart donation, retrieval and transplantation.”
TIMES VIEW: Data shows that while the number of deceased donations in the South and the West show a substantial uptick, other regions are lagging behind. Laggard states must find out what makes these states more successful in their endeavours and adopt those practices. An inter-state meet on the subject would help.
