Indian Transplant Newsletter. Vol.18 Issue No.57. July 2019 - October 2019

Has the Deceased Donation Programme Slowed Down in India


 

The current data coming from many states in India indicate that the deceased donation programme has  slowed down lately. The year 2017 was a good year for the programme but this has not been so for the last two years. The deceased donation rate was consistently rising from 2012 to 2017 and went up over four times,  but after this it has not seen any rise.[1] In any case only 13 of the 36 States and Union Territories were contributing to  deceased donation transplantation in India and in the last three years no new state or Union Territory has been added to the list of contributors. The whole of Eastern India, except for a few deceased donations in Kolkata, has not seen any donations happen.
It is noticeable that Tamil Nadu the leader state in the programme also has plateaued over the last few years. The reasons being given are - a few bad media reports about the programme creating a trust deficit, fall in the fatal road traffic accidents in Tamil Nadu, and some hospitals not being able to perform as well as previous years. The state of Kerala peaked in 2015, but fell after that.[2]  For the last three years it has been affected by many public litigations regarding brain deaths followed by knee-jerk reactions by the government in clamping down on the programme with some government orders without proper investigations and brain death audits.[3,4] However, in this downturn the only state that has shown a rise has been the state of Maharashtra. In this state there is a unique system with many independent organ donation bodies (Zonal Transplant Coordination Centres) working in around four cities that spearhead the programme and look after all the local logistics to make donations happen. 
The need to review this slowdown is becoming increasingly urgent as the waiting lists have grown (Figure 1) and corrective measures are required to bring the programme back on track. 
The Daunting Task of Handling a Foreign National’s Organ Donation in India 
In deceased donation in India there are occasionally unusual donations that happen and one such donation is when a foreign national becomes brain dead and the family wishes to donate the organs of their family member.  There have been a few such instances in the country which were handled partly by the transplant coordinators from MOHAN Foundation. With no clear-cut protocols these donations sometimes can become quite daunting and time consuming with uncertainty about their outcome.
In the first such donation that happened way back in 1998, the family members actually travelled to India from the USA when the donor families were being honoured at a function held in Chennai in October 1999.[5] In the second such donation by a lady from France (where they follow the presumed consent law) despite the language issue the donation went through.[6] And in a third donation in Mumbai, a donor family from Nepal decided to donate. Nepal is a neighbouring country however the complexity was similar with multiple permissions required including the embassy. Equally complex and challenging is the transfer of body after donation and this requires multiple clearances. The unclear and long-drawn-out procedures can put off families from donating. There are no easy solutions but like post-mortem procedures, foreign national donations require simplification and a clearly laid out procedure too. 
References
1. Shroff S. Twenty-five years of transplantation law in India – Progress and
    the way forward. Indian J Transplant 2019;13:151-3.
2. http://knos.org.in/yearlystatistics.aspx 
     [Last accessed on 2019 October 25]
3. https://www.thehindu.com/news/national/kerala/Not-against-organ-
    donation-but-premature-brain-death-certification- 
    doctor/article16458706.ece [Last accessed on 2019 October 25]
4. https://scroll.in/latest/874900/kerala-issues-standard-guidelines-for-
    declaring-patients-brain-dead [Last accessed on 2019 October 25]
5. Navin S, Shroff S. HONOURING ORGAN DONOR FAMILIES. Indian
    Transplant Newsletter. Vol. II Issue: 5 (February 2000); Available at:
    http://www.itnnews.co.in/indian-transplant-
    newsletter/issue5/HONOURING-ORGAN-DONOR-FAMILIES-125.htm
    [Last accessed on 2019 October 25]
6. www.mohanfoundation.org. India: Donor Memorial: Donor Memorial of
    Marie Therese Hampart Zoumain. Available at: 
    https://www.mohanfoundation.org/donor-memorial/donor-
    profile.asp?tid=57 [Last accessed on 2019 October 25]

The current data coming from many states in India indicate that the deceased donation programme has  slowed down lately. The year 2017 was a good year for the programme but this has not been so for the last two years. The deceased donation rate was consistently rising from 2012 to 2017 and went up over four times,  but after this it has not seen any rise.[1] In any case only 13 of the 36 States and Union Territories were contributing to  deceased donation transplantation in India and in the last three years no new state or Union Territory has been added to the list of contributors. The whole of Eastern India, except for a few deceased donations in Kolkata, has not seen any donations happen.

It is noticeable that Tamil Nadu the leader state in the programme also has plateaued over the last few years. The reasons being given are - a few bad media reports about the programme creating a trust deficit, fall in the fatal road traffic accidents in Tamil Nadu, and some hospitals not being able to perform as well as previous years. The state of Kerala peaked in 2015, but fell after that.[2]  For the last three years it has been affected by many public litigations regarding brain deaths followed by knee-jerk reactions by the government in clamping down on the programme with some government orders without proper investigations and brain death audits.[3,4] However, in this downturn the only state that has shown a rise has been the state of Maharashtra. In this state there is a unique system with many independent organ donation bodies (Zonal Transplant Coordination Centres) working in around four cities that spearhead the programme and look after all the local logistics to make donations happen. 

The need to review this slowdown is becoming increasingly urgent as the waiting lists have grown (Figure 1) and corrective measures are required to bring the programme back on track. 

References

1. Shroff S. Twenty-five years of transplantation law in India – Progress and the way forward. Indian J Transplant 2019;13:151-3.

2. http://knos.org.in/yearlystatistics.aspx [Last accessed on 2019 October 25]

3.https://www.thehindu.com/news/national/kerala/Not-against-organ-donation-but-premature-brain-death-certification- doctor/article16458706.ece [Last accessed on 2019 October 25]

4. https://scroll.in/latest/874900/kerala-issues-standard-guidelines-for-declaring-patients-brain-dead [Last accessed on 2019 October 25]

 


How to cite this article:
- Shroff S , Navin S. Has the Deceased Donation Programme Slowed Down in India. Indian Transplant Newsletter. Vol.18 Issue No.57. July 2019 - October 2019

How to cite this URL:
- Shroff S , Navin S. Has the Deceased Donation Programme Slowed Down in India. Indian Transplant Newsletter. Vol.18 Issue No.57. July 2019 - October 2019; Available at :
https://www.itnnews.co.in/indian-transplant-newsletter/issue57/Has-the-Deceased-Donation-Programme-Slowed-Down-in-India-923.htm

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  • Keywords: deceased donationWaitlist,Knee-jerk reactions,Daunting,Clear-cut protocols,Corrective Measures,Public Litigations