Getting organ donation to tick again (Need more families to come forward)

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 Getting organ donation to tick again (Need more families to come forward)

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• Organ donation day: When this Day is celebrated by GoI on November 30, the aim is to promote organ donation and transplantation. Many patients suffering from organ failure (kidneys, lever etc.) get a new lease of life through such gifted organs, from people who lose their lives.
• Negative perceptions building: Many altruistic donor families are rethinking their donations. Kerala went from 76 deceased donors in 2015 to just 8 in 2018. Fear was that patients were wrongly declared brain-dead when they weren't (a wrong perception).
• Root cause of problem: The hugely privatised health-care in India is creating the trust gap. Doctors may be trapped in profit-seeking, in tertiary care.

1. When organs come free, the transplantation costs anywhere from Rs.5 to 25 lakhs. The huge sums include hospital profits, leading to suspicion in donor family's mind.
2. Majority of donors are from lower middle class or below, and majority of recipients are from the strata that can afford costly transplantation and lifelong medication.
3. 75% of donated hearts and lungs are never taken due to sheer costs involved.

• Possible solution: Can govt. hospitals handle this process? Very few today can do such complex surgeries. Since India spends just 1.2% of GDP on healthcare (too low), that money must go to areas that benefit the largest numbers. (so organ transplantation isn't a priority)
• Trade-off: Governments in developing nations need to decide what to prioritise – near-universal coverage of high priority services, or expansion of low- and medium-priority services. So, nations like Thailand spend money first on organ-failure prevention, and not on organ transplantation.
• Solutions: How to resolve the issues of trust gap and inequality?

1. Regulation of hospitals through rules and acts is attempted. 2019 was the 25th year of the 1994 Transplantation of Human Organs Act, 1994. Involving civil society, and self-declarations, will improve compliance.
2. Central govt's involvement demotivates hospitals, and only States must govern it.
3. Making donations process publicly transparent will build trust.
4. To resolve the "organs from poor to the rich" problem, every third or fourth organ must be transplanted in private hospitals for free, to a patient from govt. hospitals. This is cross-subsidisation by hospital, doctor and recipients to that section of society that's donating the most organs.

• Summary : Organ donation and transplantation in India is getting shrouded in mistrust and inequality, and it is time for building confidence in the system.

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