The world may have marked Organ Donation Day on Tuesday, but statistics in the state show there is little to celebrate. The rate of organ donation in Karnataka is an appalling 10-12% per year, while at any point there are 900 patients waiting for kidney transplants. Even as doctors cry out that spreading awareness is the first step in encouraging people to donate, an illegal organ trade is still rampant. Bala Chauhan and Luna Dewan report

Awareness about organ donation among the public as well as medical professionals is still
dismally low in Karnataka.

According to the Zonal Coordination Committee of Karnataka for Transplantation (ZCCK), that facilitates availability and transplantation of organs, there are 903 people waiting for a kidney, 100 awaiting a liver transplant and 34 awaiting a heart.

At any point of time there are 900 patients undergoing dialysis and waiting for kidney transplants in Karnataka, followed by people awaiting liver transplants and innumerable patients waiting for cornea transplants.

Dr Ramesh, secretary, ZCCK, believes that large-scale awareness about organ donation among the public as well as medical professionals is much lacking in Karnataka. Figures show that since January 2012 there have been only 40 organ transplantations (23 kidneys, 1 heart, 10 liver and 26 corneas) in the State.

With the rate of organ donation in Karnataka standing at around 10-12% per year, it is obvious that there is a critical gap between the number of organs donated and the number of people waiting for a transplant.

More than two lakh people die every year from terminal liver disease and liver cancer in India. Of these, 25,000 could have been saved through timely surgery. Every year, 100 liver transplants are needed but only about five to six surgeries are done.

Dr Ramesh says both the public and medical professionals must be made more aware that brain dead cases can be saviours for those with end stage organ failure who still have a chance to live if an organ is donated.

Medical professionals must counsel the family and relatives of brain dead patients about organ donation. “Hospitals that are recognised for conducting organ transplants should have a grief counselling section,” he says.

Dr Sudarshan Ballal from Manipal Hospital says cadaver transplants in India are significantly low due to socio-cultural reasons. “There are lots of myths and misconceptions among the people, including those involved in the treatment at various levels.

There is a need to create a focused and sustained awareness programme that hinges on education of the masses, including the medical fraternity, government authorities and other stakeholders involved in the process of cadaver transplants.”

‘Organs of one person can give life to six others’

Grief counsellors are not messengers of death but hope and life. Their role is to gently counsel a grieving family whose relative proclaimed to be brain dead, to accept that they have lost their dear one but can still keep her/him alive by agreeing to donate his/her organs.

Dr Chinna Durai, chief consultant at the Critical Care Unit of Columbia Asia Hospital in Hebbal has successfully counselled five families this year.

They all agreed to donate the organs of their relatives, who were declared brain dead because of a bad accident or stroke.

“The first step — of breaking the news of brain death — is difficult but it prepares the family for the worst. Once they accept, some of them agree to donate with the hope that their loved one has infused life in six people in his death.

The harvested organs of a brain dead person can give life to six people, who may be on the waiting list for various organ transplants,” said Dr Durai.

The Zonal Coordination Committee of Karnataka for Transplantation (ZCCK), that facilitates availability and transplantation of organs, has done 13 cadaver transplants this year, which is the highest since the Committee’s inception in 2006, says Dr Ramesh, secretary, ZCCK.

“It is not that people don’t wish to donate organs but they are not okay with the idea of donating organs of a relative, who might have met with a bad accident and is brain dead but is breathing on external support,” says a top forensic surgeon at a well-known private hospital in the city.

He continues, “Our hospital gets lots of calls from people who inform us of a death in the family and request us to harvest the organs of the deceased. But apart from the cornea, none of the other organs of a dead person can be harvested for transplant.”

City’s medicos walk the talk

To mark World Organ Donation Day on Tuesday, medical professionals from 30 hospitals that are recognised centres for organ transplantation in the State pledged their organs to promote the cause of organ donation. ZCCK has provided each of the participating hospitals with Pledge Cards.

Hospital employees, management personnel, doctors and para-medical staff pledged their organs and supported the cause of organ transplant.

Major hospitals pledging on the day were Manipal Hospital, Apollo Hospital, Columbia Asia Hospital, Baptist Hospital, Mallya Hospital and M.S. Ramaiah Hospital. The pledging will continue till Thursday.

Today, illegal organ trade stronger

The gap between demand and supply of organs for transplants, red tape, poverty, and lack of awareness, has fostered the trafficking of human organs, even though the organ donation law has been tightened. Buying a kidney for as little as Rs 20,000 is not difficult in the city.

The illegal trade is run by touts who include autorickshaw drivers and hospital attendants among others, with the alleged collusion of officials.

‘Related’ donors must include extended family too: Doctors

The amendment in 2011 to the Organ Transplant Act, 1994 extended the definition of a ‘relative’ who can donate his/her organs to include grandparents and grandchildren. But top transplant surgeons in the city say this is just not enough.

The immediate past president of the Indian Society for Organ Transplant, Dr Ajit Huilgol, said that the definition of ‘related’ donors should include uncles and aunts and extended family for better availability of organs. There is a huge gap between the demand and supply.

A patient suffering from renal failure has only two options – dialysis or transplant. Dialysis is not a cure; it is a painful, inconvenient process that bleeds the family of its income. Transplant is a cure and adds quality to life. It’s a wrong notion that organ donation from a relative is voluntary.

This is not always the case,” Dr Huilgol said. He says that the statistics about the number of patients with renal failure on dialysis and those who have gone through transplant should be made available at all transplant centres to create public awareness and transparency.

Dr Nandakumar Jairam

Medical Director and Chairman, Columbia Asia Hospitals.

Organ donation is probably one of the most important advances in modern science, enabling patients to get a renewed lease of life.

However despite being a life saver, cadaver transplant as a treatment option is yet to have any significant presence in India.

In fact, Karnataka still lags far behind other States in the South with as low as 10 to 12 cadaver transplants being done each year.

Among the other South Indian States, Tamil Nadu has been doing quite well in relation to organ donation. It is the endeavour of the medical community to take this step forward.

There are many reasons attributed to this situation, beginning with low awareness, to lack of well-defined policy, to societal influences and many more.

There is a dire need to regulate and drive this entire cause with renewed vigour, with the active support of its stakeholders, including government, healthcare professionals, NGO’s, pharma companies, insurance companies and other special interest groups.

This part of medical science is particularly gratifying as it also means that one can continue to live and contribute to the improvement of life through others even after death.

However, societal pressures and red tape in general have been slowing down the process to a great extent.

The public should understand the fact that one brain dead person can save up to five lives. Hence, besides the general public, the family and kin in such case should be made aware and counselled about donating the vital organs which otherwise would go waste.