Lack of cadaveric donors is affecting organ donation in the country, says Dr Arvinder Singh Soin, chief hepatobiliary and liver transplant surgeon at Medanta-The Medicity, Gurgaon. Dr Soin, who also offers consultation at Columbia Asia Hospital, Yeshwantpur, suggests ways to bring down the cost of a liver transplant. Excerpts from an interview:
Has the cost of liver transplants increased over the last few decades?
In the late 90s, when the first successful liver transplants were done in India, the procedure cost Rs.20 lakh. Now, a resection may cost anywhere between Rs.3 and 4 lakh and a transplant Rs.20-25 lakh in a private hospital. It has not changed much. We cannot increase the costs because the procedure will then be inaccessible to people. So, we have curtailed it. It is an intrinsically expensive procedure.
How many transplants are needed each year?
About 20 to 25 people per million need liver transplants. In India, the requirement is 20,000 to 30,000 per year. Karnataka needs more than 1,000 a year.
Why is the procedure expensive?
It takes Rs.20-25 crore to set up a liver transplant centre. You need people who are trained — experienced doctors, anaesthetists, hepatologists, intensive care specialists. Along with them, you also need nurses. The procedure involves high-end instruments, medicines and blood products and medicines alone cost Rs.10-12 lakh. The ICU set-up is also different and it all adds up to the cost.
Do people have less expensive alternatives where they can get the surgery done?
Unfortunately, not many government hospitals are doing this procedure. But there is a way out. The government should divide the country into 10 to 15 regions and have a Centre of Excellence in each region where liver transplant surgery is done at a lower cost so that that people from lower socio-economic strata can also get it done.
How can the cost be brought down?
The main thing is to cut duties on importing life-saving essential medicines and instruments. Surgical instruments are very expensive and most of them are imported. Medicines should be manufactured locally and generic medicines should be developed and used, which cost only 20 to 50 per cent of the price of branded products. Also, increasing medical insurance cover for patients will bring down costs.
It is said that there is a shortage of liver donors. What is causing this shortage and how is it being addressed?
At present, 80 pc are live donors and the rest are cadaveric. Anywhere between 20,000 and 30,000 people need liver transplants each year, but we get only 400 to 450 cadaveric donors. Donation rates need to go up 100 times to fulfill the need which is being bridged by live donors. But no healthy person will have to undergo liver surgery if there were enough cadaveric donors.
Why are there very few cadaveric donors?
A lot of myths surround cadaveric donations which is preventing families from coming forward to give consent. They should know that if a person or relative is brain dead and being kept on life support, their liver can be donated to save another person’s life. Nothing will happen to the donor in their next life if they give their liver away. The government has to pitch in and create a national programme to create more awareness on cadaveric donations.
Among live donors, are men more willing to donate, or women?
Surprisingly, more women come forward to donate than men, so there is clearly gender bias. The ratio is 60:40. Live donors should ideally be within the recipient’s family and it could be said that more women come forward due to emotional coercion.