By Anurag Wasni and Rohan Kar
Organ transplantation has emerged as a critical approach for addressing acute organ failure worldwide thanks to improvements in surgical techniques, organ preservation, and pharmaco-immunologic treatment. organ donation contributes to medical science research by allowing researchers to seek breakthroughs in their fields through donated organs, particularly in disciplines such as biotechnology.
Despite advancements in the field, high burden, ie, the demand versus supply gap, poor infrastructure, poor awareness and attitude towards organ donation leads to poor deceased organ donation rate, lack of retrieval and tissue banking, prevention, and control of organ trading and finally the high cost of transplantation are critical challenges that are keeping the organ and
Tissue donations in India at backfoot. India continues to have one of the world’s lowest organ donation rates. In India, the rate of organ donation is relatively low, at 0.3/million, compared to other Western countries, where it may reach 36/million. According to the report of the standing committee, the total number of transplants performed in the nation has climbed from 4990 in 2013 to 12666 in 2019, putting India third in the world, trailing only the United States and China.
What is the current state of Organ/Tissue donation in India?
The Transplantation of Human Organs Act (THOA) of 1994 developed a framework for the removal, storage, and transplantation of human organs for therapeutic purposes, as well as the restriction on commercial deals in human organs in India. There is a dire need to increase the deceased body’s organ donation rate since the contributions from living people are insufficient to fulfill the country’s spike in organ demand. Subsequently, the Transplantation of Human Organs (Amendment) Act 2011 was enacted to streamline the organ transplantation process and curb illegal dealings.
The THOA Act encourages deceased organ donations, permits donations from living people near relatives, and swaps donations. Directorate General of Health Services, Government of India is implementing National Organ Transplant Program (NOTP) to carry out the activities per the amendment Act. The NOTP initiative seeks to safeguard vulnerable, underprivileged individuals from organ trafficking while increasing deceased organ and tissue donation. Furthermore, NOTP intends to establish a system for timely obtaining and distributing organs for transplant. It aims to monitor services, train the medical and support staff, and correct/change policies and programs whenever required to improve the state of organ donations in the country. The National Organ and Tissue Transplant Organization (NOTTO), an apex-level body, has been formed as the focal point for all coordination and networking for organ and tissue procurement and distribution and organ and tissue donation registration in the country. Around 14 lakh persons registered with NOTTO have pledged to donate organs and tissues. In contrast, the country’s organ donation rate (the number of dead donors per million people) has increased from 0.27 in 2013 to 0.65 in 2018. This reveals a considerable rise in public understanding of organ donation and the prospect of creating a robust organ donation ecosystem. to.
Since the program’s inception at the turn of the century, the number of organ donations and transplants in India has grown significantly. The Indian Government’s 1994 transplantation act, the availability of appropriate facilities, technological advancements, trained and skilled experts in the private sector for heart and liver transplants, well-established kidney transplant units in government hospitals, and contributions from numerous non-governmental organizations (NGOs ) towards organ donation awareness and transplantation have all contributed to the improvement in organ donation and transplantation.
Government hospitals, particularly those in smaller cities, sometimes need more competent specialists capable of performing transplants and rely on larger hospitals for assistance. The knowledge-sharing model would promote the expansion of transplant programs to tier II cities through personnel deployment at smaller towns/centres where they cannot recruit transplant specialists due to disparities in compensation scales. These professionals can regularly spend time in these centers in smaller cities and towns and facilitate donations and transplantations operations. Similarly, private hospitals and organizations’ CSR funds may be prioritized for establishing and expanding transplant facilities at government hospitals. With the public-private partnership, these services will be able to reach even the most rural parts of India, where many sick individuals may benefit from organs retrieved from thousands of brain-dead victims. With air ambulances, airline and police collaboration, organ transport technology, and other resources, a public-private partnership can deliver these services in even India’s most remote places.
Organ transplants are costly procedures that need post-operative care. Transplants can be offered at reasonable rates to a broader patient group that would otherwise be excluded by integrating the public and private sectors. Furthermore, effective transportation links between cities and states encourage organ donation and increase the possibility of a successful transplant. National and sub-national level cooperation between the Ministries of Road, Railway, and Aviation is essential to promote the creation of green corridors for speedier organ transfer.
A Public-Private Partnership (PPP) model can significantly assist the shift in the country’s approach toward organ donation and transplantation. Combining the resources of the public and private sectors will increase the rate of organ donation and ensure a smooth process. Although most government hospitals have adequate beds, strong neurology and neurosurgery departments, and excellent trauma treatment, funding restrictions may push them to prioritize therapeutic services over organ donation and transplantation.
The transplant hospital can link with smaller non-transplant hospitals, regional government entities, and other healthcare providers under this approach. Transplant coordinators at the transplant hospital can support these hospitals with organ donation counselling, planning, and understanding. Furthermore, privately operated hospitals may aid smaller units in expanding organ donation and retrieval capability by establishing on-site authorization committees, brain death committees, and technical know-how in organ donation and transplantation. Training activities for government hospital surgeons and workers at private institutions will also aid in the hospital’s retrieval and transplant specialist shortage. The altruistic nature of Indians necessitates better knowledge about organ transplantation to increase donor registration in the country.
Anurag Wasni, Innovation Lead, Atal Innovation Mission (AIM), NITI Aayog & Rohan Kar, PhD candidate, Healthcare Marketing, IIM-Ahmedabad
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