👍👍👍Much-needed easing | The Financial Express

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New organ donation guidelines will help, but to see a meaningful difference, India needs many more donors

Scrapping the domicile rule should improve access to donated organs for those in need and can prove life-saving. (Image: AP)

In a welcome move, the Union health and family welfare ministry announced on Thursday the government is doing away with the domicile requirement to register for receiving an organ. So far, the regime required any person, in need of organ transplant, to be domiciled in a state to be eligible to register on that state’s prospective recipients’ list. Also, seniors, a demographic that would have a greater need for transplants, can now register for receiving organs; earlier, the National Organ and Tissue Transplant Organisation guidelines debarred those above 65 years of age from receiving donated organs.

Scrapping the domicile rule should improve access to donated organs for those in need and can prove life-saving. A New Delhi, for instance, sees much fewer deceased-donor organ donations than a Tamil Nadu or a Telangana. Curiously,  at 3,623, the national capital territory saw the highest number of living-donor transplants in 2022. The new rules would enable a person from Delhi to avail of a transplant in time in a state that sees a lower demand. Moreover, with the productive life of Indians gradually getting extended, allowing those above 65 years of age to receive donated organs is a shot in the arm for improved health in the country. 

However, the real challenge is the massive gap between demand for organs and the supply thereof. As per data cited by Organ India, nearly five lakh people need organ transplants every year but only a small fraction receive transplants. For instance, in 2022, there were just 15,561 organ transplants.

Although this was certainly an improvement compared with the 4,990 transplants in 2013, it means the vast majority of those in need suffer, even die, because of the non-availability of donor organs. To illustrate, against 2,00,000 people needing corneal transplants in the country to treat related loss of vision, only 50,000 receive these. Similarly, against an estimated 2,00,000 cases needing kidney transplants in the country, there were just 11,423 cases of transplant in 2022. That the bulk of the kidney transplants were from a living donor shows how formidable a challenge it is to get people to pledge their organs or volunteer a deceased relative’s organs. There has been some progress as reflected in the growing number of deceased donor transplants in the last decade (2013-2022). There is also an improvement in the harvesting of organs from deceased donors, reflected in the average organ transplants per donor increasing from 2.43 in 2016 to 3.05 in 2022. But this is nowhere near enough, given just 250 patients received heart transplants, against the estimated need of 50,000.

It is clear that the dismal donation rate of 0.86 per million population needs to be pushed drastically upwards. The shortage of donated organs can be attributed to, among other factors, the lack of awareness among the masses regarding organ donation, the taboos stemming from religion, and infrastructural inadequacy. Crucially, not only is there a lack of awareness about brain stem death among the deceased person’s families and relatives, there are also some perceived tripwires emerging from healthcare industry protocols and the existing legal framework. Some experts point out how the difference between the protocols to declare a person “brain dead” can cause delays in harvesting, leading to wastage of organs. While brain-stem death is recognised by the Transplantation of Human Organs and Tissues Act 1994, there is no mention of it in the Registration of Births and Deaths Act, leading to uncertainty in some cases. Meanwhile, the donation deficit has spawned illegal trade in organs, worsening human trafficking in the country.