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India Needs ‘Opt-Out’ Model for Organ Donation to Meet Shortages: Doctors

- Vinod Kumar

To address shortages of organs available for transplant, India needs an opt-out model for organ donation on the lines of some European countries where consent for organ donation is assumed to be granted by everyone unless an individual while alive had explicitly opted to bar donating his/her organs after brain death.

Said Dr. Tanmay Pandya, HOD & Director – Nephrology and Renal Transplantation, Faridabad: “India faces an acute shortage of organs harvested from cadavers for transplant. More than 2.5 lakh new kidney failure patients are diagnosed in the country each year. Transplant is the only long-term solution in these cases. However, kidneys harvested from people declared brain-dead account for less than 5% of kidney transplants happening in India. The rest are contributed by living donors such as family members. As a result, vast majority of patients of kidney failure continue to remain on dialysis.”


Organ donation rates are very discouraging in India. Increasing the percentage of people who opt to donate organs after death will radically change the organ transplantation scenario in India for the better.


Said Dr. Tanmay Pandya: “All organs that can be donated are in short supply in India. The nationwide deceased donation rate is less than 1 per million population here, compared to countries like Spain where this figure is 34. The difference is that Spain in 1979 moved to a ‘soft opt-out’ organ donor register, meaning that when someone dies, it is presumed they want to donate their organs, unless they actively opted out of the system when alive. India should explore a similar system which is being adopted in other Western countries too. If deceased donation rates improve to 8 to 9 per million population in India, there will be no need to harvest organs from living donors, and the waiting list will drastically reduce.”


He added: “There are other reasons too for low organ donation rates. Not many patients are declared brain dead in India, especially in smaller towns, due to lack of awareness among doctors and the belief that as long as the patient’s heart is beating, there is hope. This impacts the identification of potential donors. Even for brain-dead patients, the next of kin needs to give consent, but they are so emotionally devastated at the time, any talk with them for organ donation is very awkward and painful. They are not in the frame of mind to talk and cannot comprehend the donor formalities. Many of them are suspicious that the hospital may try to sell the donated organs. There are some misconceptions too. Many people feel that if they donate an organ, they will be born without that organ in their next birth.”


The solution is a continuing pan-India campaign to encourage organ donation, the doctor added. “Awareness about organ donation should start early in one’s life. School children should be taught about organ donation as part of their biology class. Also, movement of donated organs from one state to another wherever there is a need should be encouraged and made easier. For this, coordination between states needs to improve. In the absence of an opt-out system in India for organ donation, the family of donors should be incentivized by the government in some way to make them more receptive to the idea.”

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