With over 200,000 people needing organ transplants each year and supply falling significantly short of this demand, organ donation in India faces major challenges. While the primary issue is this substantial demand-supply gap, the country also grapples with several other hurdles, including low awareness, misconceptions about organ donation, and hesitance due to cultural beliefs or fear.
The demand for organs far exceeds the supply. For instance, there are approximately 180,000 patients waiting for kidney transplants—the most required organ in India—each year, while only 17,000 to 18,000 transplants occur annually. Similarly, the demand for liver, heart, and cornea transplants further underscores this stark disparity.
While lack of awareness and cultural factors affect the donor supply to a great extent, much more efforts are needed to change public perception.
Here comes the importance of states like Tamil Nadu that continues to serve as an exemplar in promoting the cause of organ donation. Over the years, the State has developed an efficient structure with the combined efforts of the government, medical community, NGOs, media and the public.
The State witnessed an 18 per cent surge in organ donation this year. It also achieved a record number of deceased organ donations in a single month this January with 30 donors, marking it to be the first time since the launch of the Cadaver Transplant Program in 2008.
In just the first 130 days of 2024, over 100 cadaver donations took place.
CM Stalin's announcement on September 23, 2023, that the mortal remains of the organ donors will be accorded state honours is said to be a prominent reason behind the new filip.
Prompt political dispensation has always played a major role in etching Tamil Nadu's success story. In fact, the State Organ Donation Day is being observed since 2008 in remembrance of Hitendran, an organ donor.
Hitendran, a teenager, was declared brain dead in a tragic road accident near Chennai. His parents, also a doctor couple, came forward to donate his organs, including the heart, kidneys, liver, corneas, and bone marrow. His heart was transplanted to a 9-year-old girl, Abhirami, on September 23, 2008.
His parents' gesture was widely appreciated and sparked discussion on what brain death is and how important it is to take a call on deceased organ donation.
It also triggered a wave of people pledging for organ donation, in what was called the 'Hitendran Effect'.
Then Chief Minister M Karunanidhi declared that September 23 will be observed as State Organ Donation Day to promote such acts.
Transparency has been a key reason for the high organ donation rate in the State. The organ allocation process remains digital and centralised. Waitlisted patients are allocated deceased donor organs as per seniority in the TRANSTAN (Transplant Authority of Tamil Nadu) registry, strictly adhering to rules and protocols.
Dr N Gopalakrishnan, Member Secretary of TRANSTAN, highlighted that the inclusive approach and progressive nature of the State are enabling the efficient implementation of the Cadaver Transplant program.
Elaborating on it, he said, "Unlike many states, there is no tilt towards the capital city in Tamil Nadu. There is an evenness in the availability of facilities across all the districts and it is unique to the State."
Sharing about the recent initiative taken, he said that TRANSTAN, along with Madras Medical College, is conducting a structured program at regular intervals on the identification of brain death, maintaining the deceased organ donor, medico-legal procedures involved and grief counselling in which medical professionals from 25 to 30 medical colleges participate.
Talking about the prevailing awareness, he says that the consent rate for deceased organ donation is increasing and it is cutting across all social-economic backgrounds.
However, sources in the field press on the fact that there are still many gaps to be bridged in the understanding of organ harvesting, donation and transplantation among the general public.
"Instances where kins of deceased organ donors come back for jobs and money in favour are taking place too. Relatives even request for harvested organs to be transplanted to persons in need, often belonging to their family circle," they inform.
While a fair awareness can be attained in many possible ways and is already being addressed by the government, the demand-supply gap resulting in an increase in the waiting list and extended waiting period remains to be a major cause of worry.
Switching to an opt-out system that promotes a donation policy that presumes all individuals residing in a country/state to be willing deceased organ donor unless they specifically 'opt-out' remains a farsighted yet viable solution.
The Opt-In vs. Opt-Out system has been widely contemplated among the international medicine community for a long time, and the potential of the 'Opt-Out' system to provide a breakthrough in fixing the demand-supply stands to be evaluated.
A paper by Harriet Rosanne Etheredge titled 'Assessing Global Organ Donation Policies: Opt-In vs Opt-Out' argues, "There is little difference between opt-in and opt-out organ donation systems for increasing donor numbers when used in isolation. Independently diverting to an opt-out system confers no obvious advantage and can harm efforts to bolster donations. Rather, it is essential to address barriers to organ donation on several levels along with a switch in the system."
However, short-term solutions like improving the organ utilisation rate and conducting 'pledge drives' in all educational institutions and workplaces throughout the year should be looked out for. Moreover, it's the need of the hour.
With a robust infrastructure already in place and with a highly receptive community, a considerable leap in addressing the demand-supply gap will not be a long shot, likely.