Need to promote organ donation

After the enactment of the Transplantation of Human Organ Act, 1994, it appeared that the kidney bazaar had stopped at least in Maharashtra. However, 2004 started with exposes of kidney sale rackets (1). Organs that can be donated include kidneys, heart, liver, lungs and pancreas. Tissues that can be donated include corneas, skin, bones, bone marrow, connective tissue, and blood and blood vessels. The complete body also can be donated.

As per the Act, a person can donate by one’s free will to immediate blood relations (brother, sister, parents and children) OR to any person for whom donor possesses special affection, attachments, or some special reason. When alive, one can donate blood or bone marrow to any person and a part of the liver or skin or one of the two kidneys. Nothing else can be donated when one is alive.

Most deaths occur due to stopping of the heart–lung function. After such a death, the eyes and skin of the dead person can be donated even if she/he has not filled a pledge card. Eye donation should take place within four hours and skin donation within 12–24 hours after death.

Death also can occur from cessation of brain functioning. A brain-dead person whose heart is beating can also donate organs and tissues before the heart stops beating. For body donation, one has to fill the donation form before death. In the absence of such a declaration, the nearest kin will have to make an affidavit to that effect.

There are approximately 15,000 patients in Maharashtra with failure of both the kidneys. They depend on dialysis. Kidney transplantation is a better alternative for them. The annual number of transplants in Maharashtra since 1997 is just 320. Of these, only 20 come from brain-dead donors, 200 from immediate relatives, and 100 from unrelated donors. The need for a kidney bazaar arose due to the large difference between demand and supply for kidneys.

Unfortunately, few relatives of brain-dead persons give permission for organ retrieval. The Zonal Transplant Control Committee in Mumbai and Pune have 225 and 25 needy patients, respectively on the waiting list. Due to less number of donors in this category, one may have to wait for more than 5–10 years to get a kidney. This compels many of them to opt for live (related or unrelated) kidney donors.

There are 31 approved hospitals for declaration of brain death and for kidney transplant in Maharashtra. It is estimated that a total of 100 brain deaths are identified in all the 31 hospitals annually, making available 200 kidneys every year. If even half of these kidneys were available for donation, it would bring down the demand for unrelated live donation. Close relatives of brain-dead people learn of the concept of brain death for the first time in a tragic situation. They do not believe that the heart is beating only because of a respirator and will stop anyway within two days. Hence, they deny the permission for organ retrieval.

Though the Maharashtra government accepted the Act recognising brain death in 1995, the first kidney transplant from a brain-dead person took place two years later. The first liver transplant in Maharashtra from a brain-dead donor was carried out in 2002.

Accepting kidney from a brain-dead person is the best way to avoid the kidney bazaar, especially in the developed world where almost all transplants are now carried out in this fashion. However, the concept of brain death is not that widespread in India. The ways to increase awareness about the concept of brain death and to propagate the organ donation movement, are listed below.

The government does not keep information on the number of brain deaths, permissions for organ retrieval and number of organs retrieved. This would be useful for the organ donation movement.

Hospitals retrieving organs from brain-dead persons should give publicity to the event. Patients waiting for organs are the beneficiaries of this effort and should take responsibility for raising awareness about brain death and canvassing for organ donation. Hospitals where patients are enrolled for organs should form support groups which should not leave any opportunity of canvassing for organ donation and explaining brain death.

Pledge cards for organ donation are available with hospitals authorised for organ transplant and with nongovernmental organisations such as the National Kidney Foundation, Mumbai (Tel. 22814892) and Narmada Kidney Foundation, Mumbai (Tel. 28368634).