Organ donation needs more awareness, beginning with doctors

Lalita, a widow with three young children, felt the world closing in on her when doctors told her she immediately needed a kidney transplant. Fortunately, she found a donor, and 10 years later is leading a healthy and happy life with her now grown-up children. Not everyone is as lucky as her because organ donation is still a taboo and an estimated 500,000 people die each year in India because of non-availability of organs.

In a nation of 1.2 billion people, there are just 0.08 people per million population who can be called organ donors.  "One of the foremost steps to be taken in order to encourage organ donation is to motivate doctors of every department. In most cases, where a patient dies of heart failure, for instance, the doctor doesn't know or doesn't think that organ donation could be an option. The Chennai model is a good example in this case because with a slight change in legalisation, there have been more donors and more heart transplants are taking place," Kewal Krishnan, a cardiac surgeon at Delhi's Max Hospital, told IANS.

According to Krishnan, an accident victim or a victim of stroke can become a heart donor. An individual who may have died of a cardiac problem can become a donor of other organs like the liver or the kidney. "Seventy percent of those who have received a heart transplant can work up to 9-10 years and lead an active life. For most of them in fact, there is no limitation of activity; so it's really a new lease of life," Krishnan pointed out.

Nephrologist Dinesh Khullar also felt the need to encourage cadaver organ donation, which means organ harvesting of a person who is brain dead. "In many developed countries, cadaveric donations constitute 90 percent of organ donors, but in India it's a different scenario. On an average, India has 150,000 to 200,000 new patients with severe kidney problems every year. They either need regular dialysis or a transplant. But only 6,000 of these new patients manage a kidney transplant - and we are not even talking about old cases. Of these 6,000 successful cases, only 300 are from cadaveric donations," he said.

Understandably, organ donation and especially cadaveric donation is an emotional issue for families. But people working in the field - NGO workers - say that for most families this gesture is comforting in some ways. "When you understand that even in your loss, your loved one can save five lives through organ donation and enhance the lives of as many as 30 people through tissue donation, it gives you some kind of solace. It is the only positive outcome of your loss," NGO worker Sumita Nath said.

Doctors, however, stress the need for raising the awareness of their own community on the subject. "When a doctor realizes that a patient's chances of survival are less than a year, when it's a 50-50 percent situation despite maximal medical therapy, he should broach the subject with the patient and his or her family," Krishnan said on the sidelines of such an awareness programme organized by Max Hospital earlier this week where doctors, NGO workers and those who have donated or received organs took part.

Referring again to the Tamil Nadu model, Krishnan said that in most hospitals, posters can be found outside the Intensive Care Units (ICUs) that if a person dies or is brain dead for two-three hours, the health ministry should be immediately informed. There is also an organ sharing network between hospitals, which was facilitated by an NGO, the MOHAN Foundation.

"Instead of waiting for the government to take steps to update a national organ registry, I think hospitals, government or private, can also form a network in the northern region, like in Tamil Nadu. Through this, if a person is brain dead, an independent organ procurement team can approach the family and talk to them about organ donation. Even in case of a young accident victim, such an option can be discussed with the family and other lives can be saved," Krishnan suggested.

Khullar also stressed the need to give organ donors some incentive - not monetary - but in ways of hailing them as heroes. "I remember the case of a liver transplant, where a young woman was the donor for her husband. Two years later, he needed a kidney transplant and she again donated. In a different case, a young IT professional did the same for his father, first a liver then a kidney transplant. Both these cases had an emotional quotient, which we only considered after taking the donors' health in view. But if there were enough donors, would such tough decisions have to be taken by such young people?" Khullar asked.