Many Indians have pledged to donate their organs after their demise. The picture from the prism of activities undertaken and pledge forms filled appear to be rosy. The statistics look fabulous. But there’s a hitch in the rate of conversion — from filling a form to actual donation. Find out why.
Death never comes by appointment. It’s cruel when someone’s life comes to an abrupt end. Take the case of Sachin Nehete — a 19-year-old engineering student in Mumbai. He met with an accident while riding a bike and was declared brain dead by doctors two days after the accident. Holding back their tears, Bharati and Purshottam Nehete, Sachin’s parents decided to give his organs for donation after he was put off the ventilator.
“We were reluctant at first but then decided that our son may not be in this world anymore; if someone else can get a life with his organs we should go ahead with it. It was like giving an opportunity to our son to live forever,” narrated the parents in a digital forum that advocates organ donation.
Donating one’s organ serves a valuable need. “A meaningful life can go beyond one’s death,” remarked actress Nandita Das sometime ago, while pledging her organs, adding, “when we are dead and gone, if our organs could save anyone’s life or be used for any medical research, then why wouldn’t we do it.”
The successful stories of transplants have given hope to many patients ailing with diseases associated with eyes, kidney and heart. In India, the medical infrastructure too has matured over the years to undertake such cases. In that case, what we need is more people pledging to donate their organs after life.
The number of people requiring transplant has grown because of two reasons — India’s aging population and rise in organ failure. But the barriers too are not insignificant. Although road traffic accidents are primary cause of death in India, only a small number of them are able to donate their organs.
As organs need to be transplanted as soon as possible following the donor’s death, they can only be donated by someone who has died in the hospital. Usually, organs come from people who are certified as dead while on a ventilator in a hospital’s intensive care unit, which can be as a result of a hemorrhage, major accident like a car crash or stroke.
Dr Avnish Seth, director FORT (Fortis Organ Retrieval and Transplant) stated in an interview to a leading paper, “Once the heart stops beating for five minutes, there is no possibility of a person coming back to life, but his organs such as kidneys, liver, pancreas, lungs and even heart can be retrieved and transplanted. Unfortunately, the concept is not very popular in India.”
Laws in India are unclear on organ donation after cardiac or circulatory death (DCD), unlike in the case of brain-dead people, when it is allowed. Experts estimate that the process of organ retrieval in 2014 could not be completed in several cases even after the families consented to donation, as organ donation after DCD is not allowed here. On the other hand, several countries have been doing it for the past two decades. Last year, doctors from Spain, the UK, Australia and India came together in India’s first DCD Summit at Fortis Gurgaon to take the issue forward in the country. Talking about the emergence of DCD in his country some two decades ago, Dr Marti Manyalich, president, TPM-DTI Foundation, Spain, stated how Spain started DCD in 1995 by making it mandatory for hospitals to have a designated team for organ donation.
In Western countries, mass media has been playing an important role for decades in educating people about organ donation. However, in India, media has picked it up recently. DCD will be possible if the government and private sector work together and there is more healthcare cooperation between India and countries that have been practicing it. Spain has the highest rate of organ donation totaling about 35.3 per million of its population.
The summit demystified laws that exist for DCD in India. Dr Kumud Dhital, who is credited with performing the first dead heart transplant in the world, said, “Laws in India don’t permit withdrawal of life support system. However, there is nothing in the law that doesn’t permit DCD in India. Lack of expertise and apprehension of doctors in performing DCD seems to be a major issue here. I think DCD needs to be considered in the country till there is more clarity on laws related to end of life care.”
Dhital had performed three transplants with donor hearts that had stopped beating for 20 minutes at St Vincent’s hospital health heart lung transplant unit in Sydney in 2014. The first patient to have the surgery was Michelle Gribilas. The 57-year-old was suffering from congenital heart failure and had surgery about two months ago. Gribilas acknowledged that the operation had transformed her life.
The donor hearts were placed in a portable console dubbed a “heart in a box” and submerged in a ground-breaking preservation solution jointly developed by the hospital and the Victor Chang Cardiac Research Institute. They were then connected to a sterile circuit where they were kept beating and warm.
Doctors said the result for organs If our organs could save someone’s life or used for research when we are dead, why wouldn’t we donate transplanted after cardiac death is almost similar to those for organs transplanted after someone who is brain dead (BD). “It has taken 20 years for us to make headway in organ donation after BD. It is time for the next logical step: DCD,” Dr Seth elaborated.
According to doctors, DCD can help bridge the large gap between demand and supply of organs, as it has the potential to save the lives of 30 per cent more heart transplant patients by increasing the supply of suitable donors.
In India, close to 5,000 kidney transplants are carried out annually against an estimated requirement of more than 1,75,000. Similarly, only 1,000 liver transplants are performed every year in a country where over 50,000 die due to endstage liver disease. The annual requirement of hearts is estimated at around 50,000 and lungs about 20,000. The rate of organ donation, on the other hand, is as low as 0.3 per million population.
Educating the people through creating awareness is vital. Many not-for-profit The annual requirement of hearts is estimated at around 50,000. The rate of organ donation is as low as 0.3 per million population organisations have crafted various events and information campaigns to reach the masses. The Internet and promotions by celebrities, especially movie stars, too have helped. Many Indians have pledged to donate their organs after their demise. The picture from the prism of activities undertaken and pledge forms filled appear to be rosy. The statistics look fabulous. But there’s a hitch in the rate of conversion— from filling a form to actual donation.
The reasons are obvious. “I will fill up a card. I will pledge my eyes. The pledge card shall go to the hospital, an NGO or the eye institute. And then it shall stay in that file in a dusty and rickety almirah for years. When I am dead, my dear ones would be in mourning. 90 per cent chance is that they wouldn’t remember my pledge. It’s going to be tough on them. Eventually I shall be turned to ashes and the donor pledge card shall only gather more dust in that rickety almirah,” explained C. Pallavi Rao Narvekar, Group Head, Radio Mirchi in one such event advocating donating organs.
Therefore, instead of pledging your eyes after your death ensure instead a donation while you are alive. Such an approach demands that we discuss the issue with everyone — from family, friends, colleagues to neighbours. Also, to spread the word around continuously to ensure no tragedy goes wasted.
But the next step is tedious. It requires the courage to translate a tragedy in one’s family, extended family or friends’ circle at that time of crisis and initiate the idea of organ donation in those crucial six hours that would benefit at least four to six people. It wouldn’t be easy. Experience tells that one should be ready to face the anger and wrath of the deceased’s family.
“I have personally mustered up courage to initiate the sensitive talk in two such tragedies over the last three years and was able to translate one such tragedy into a donation,” says Rao sharing her own experience — and an example for others to emulate. That’s the way to increase the rate of successful donation of organs in our country. It’s not impossible — a bit of will wrapped with empathy could do the trick.