World Kidney Day 2022 – Kidney Health for All

By Dr Indakiewlin Kharbuli

Being an organ donor is a decision worth taking since not only can it give a new lease of life to someone, but is also the noblest way to live on after death. Did you know that one organ donor can save eight lives? Or that on average, 25 different organs and tissues can be donated by a donor through transplantation? Unfortunately, despite its immense potential to save lives, organ donation has not found acceptability in our country. There are countless heart-wrenching stories of people who die awaiting an organ transplant in a futile wait of a call that a suitable match has been found. Nearly five lakh people die in India every year waiting for that one chance.
Organ donation is the process of medically removing a healthy organ or tissue from one person for transplantation into another. Common organ transplantations include the kidney, heart, liver, corneas, pancreas, intestines, and lungs. Organ donation is of two types- living donor organ donation and deceased organ donation. In the case of the former, a person can donate their organs like the kidney, liver, skin, or bone marrow without it impacting either the function of these organs or their health. Kidney donation is the most common type of living-donor transplant. Individuals can donate one of their kidneys, while the other kidney can perform the requisite functions. Deceased organ donation is donating an organ after death for transplantation.
Permission is usually given by the donor or by their family after death. The process of pledging an organ is simple- a donor card is issued to a person willing to donate after their death.
In India, organ donation is regulated by the 1994 Transplantation of Human Organs and Tissues Act that allows deceased and living people to donate organs. This law also intends to regulate the removal, storage, and transplantation of organs, and prevent any illegal dealings for commercial purposes. In 2019, the government launched the National Organ Transplant Programme for Organ Donation with a whopping Rs 149.5 crore budget for boosting organ donation.
Despite the government identifying the gaps in organ donation, the statistics related to organ donation are grim in India. There is a huge gap between the demand for organ donation and its supply. Notwithstanding its massive population, India’s organ donation rate is a mere 0.01% which is among the lowest in the world. Seventeen people die every day for want of donors. Only 4% of the 1.5 lakh kidney transplant surgeries needed are performed every year across India. The scenario is equally dismal for people awaiting a donated liver- of the two lakh patients who die of liver cancer or liver failure annually in India, 15% can be saved with a timely transplant. A staggering two lakh people die of liver diseases because of the shortage of donors. There are 50,000 patients in need of a heart transplant every year, yet only 350 have been conducted in the last 24 years.
The reasons for the extremely low levels of organ donation in India include ignorance, religious superstitions, a belief in life after death, emotional reasons, and an extreme grief reaction after a loved one’s death which leads to an unwillingness to do a surgical procedure on the dead body. Relatives of organ donors don’t want their loved ones to “be “disfigured” or “suffer” after death or in the next birth. However, the fact is that donated organs are removed surgically, which doesn’t impair the body.
Contrary to the prevailing belief that religion prohibits organ donation, most faiths allow it. The act of giving is encouraged in all religions across the world. After all, what greater act of giving than gifting life to someone.
India has come a long way since the organ donation scandals of the 1990s and 2000s. There is also a prevalent myth that the rich, famous, or powerful get preference during organ donation. The list of persons awaiting donation is now automated and thoroughly documented- there is little scope of individual discretion. Preference criteria are based on age, the seriousness of the illness, duration of waiting for an organ transplant, etc.
Most doctors focus on saving the lives of their patients. It is also pertinent to remember that organ donation is considered only after brain death. Moreover, the transplant team is separate from the doctors treating the patient and has to certify that a person is brain dead only after conducting several tests over several hours. Except for the eyes, doctors can’t take organs from patients whose hearts have stopped beating.
Another myth about organ donation is that only people above 18 years can donate organs. However, the truth is that even children or those in their Seventies and Eighties can successfully donate organs. Children who need a transplant need organs smaller than those of an adult. While legally, children can’t decide on their own, parents can sanction the decision knowing it’s what their child wants.
Once the decision to donate an organ is taken, the process is simple. The legal (and voluntary) procedure involves issuing a donor card to a person willing to donate their organs. Once an individual decides to donate in his lifetime, they can fill up a form either online or in a hospital to register to show their intent to donate. Upon registration, the donor gets a donor card. However, the card has no legal value; the final consent to donate is taken by the family members. The other way of donation is when a patient is declared brain dead, which means there has been permanent damage of all brain functions, with the condition being irreversible. Once a person has been declared brain dead, a death certificate is issued and the treating doctors inform the family that the deceased’s organs can be donated. Once the family’s consent has been obtained, the lookout begins for a prospective recipient. Recipients must be registered in the waiting list handled by National Organ and Tissue Transplant Organisation (NOTTO). They then have to wait until a matching donor is found. In case the recipient is registered in the same hospital as the deceased donor, then the organ is directly given to him/her. If the donor is not found within the hospital, the hospital’s transplant coordinators inform NOTTO, which is the main body for coordinating and arranging the organs and their distribution. Once the recipient is found, the process of organ retrieval commences and the organ is packed in an organ transplantation icebox.
Since it’s World Kidney Day today, let’s know more about the most common transplant in today’s times- the kidney transplant. It is usually performed on people whose kidneys are either damaged or have entirely stopped working. Kidney damage occurs due to diseases like diabetes, hypertension, cystic kidney, glomerulonephritis (inflammation of glomeruli), and a majority of the patients- 70% to 85%- who undergo a kidney transplant in India report satisfaction with their transplanted kidney. Kidney transplant patients have a better quality of life, less risk of death, fewer restrictions on diet as compared to those on dialysis. It is also more cost-effective than dialysis. Family members are often the most compatible living kidney donors. However, successful donor transplants are also common with kidneys donated from unrelated people. Living kidney donation is safe provided one is in good health overall. The hospital stay for most donors is usually up to one day. Most people can go back to work between two-eight weeks after surgery.
So, what are you waiting for? Pledge to be an organ donor and save lives.
(The writer is MD(Medicine), DM(Nephrology), Woodland Hospital, Shillong)

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