KOCHI: March 14 was celebrated as ‘World Kidney Day’. This year, the focus was to promote educational awareness programmes on kidney diseases, its disastrous consequences, especially End Stage Renal Disease (ESRD), among others. In various hospitals, congregations of living donors and recipients were arranged to prove the safety of organ donation and the need to propagate the same through social, visual and print media.
The longest surviving transplant patient is reported to be Johanan Ramphel, 69 years, from Canada. Other longest living recipients are from the USA and South Africa. This raises a very prominent question. In India, why is kidney transplantation rare and not progressing effectively?
In the past, high financial burden, kidneys could only be bought by rich people, especially those from the Gulf. Now as per revised rules, foreigners are given least priority for organ transplantation in India. The next alternative is cadaver transplantation, although the survival rate is more in living donor transplantation (14-16 yrs) as compared to cadaver transplantation (10-12 yrs.). However, the rate of cadaver donation has come down, due to negative response from relatives.
A living donor also has to face several hurdles. For example, consent from donor relatives (parents, siblings, spouses, children etc.) and providing revenue documents.
‘Chain donations’ and ‘swapping donations’ are also encouraged now but with poor results. The donor has to be perfectly healthy and to be examined by almost all medical specialists including psychiatrists for surgical clearance. Patients with cancer, acute infections, HIV, above 70 yrs, other chronic diseases like diabetes mellitus and atherosclerotic heart diseases will not be accepted for organ donation. If no donor is available, another alternative treatment for End Stage Renal Disease is peritoneal dialysis which is cheaper. About 2-3 litres of special fluid is inserted into the abdominal cavity for three to four hours. The fluid is drained gradually at the same time through the other side of the abdomen. Although this procedure can be done repeatedly two-three times a day at home with better patient mobility, it is time consuming and the patient is vulnerable to bowel perforation and abdominal infections.
According to the latest reports in India, 2.2 lakhs renal patients in India are waiting for donors for transplantation. In India only 3,500 kidney transplantations are being done every year in about 250 hospitals. Among the live organ transplantation in India between 2011-2017, 50 cases of donors were related and majority of the donors were women (74% for kidney, 70% for liver) and only 19% of the kidney recipients and 20% of the liver recipients were women.
In Kerala alone, 3,480 people are dying per year in road accidents. If a small majority of dying patients’ relatives agree to donate their wards’ organs, our transplantation project would have been a great success. We promote signing pledges for organ donation in schools, colleges, NGOs and other charity and welfare organisations, but the outcome is pathetically disappointing.
Dr K P Poulose is the principal consultant and HOD in Medicine Department SUT Hospital, Pattom.
(The views expressed by the author are his own.)