Illegal ‘Live’ Organ Trade on Rise as Donors Fail to Volunteer

A STITCH IN TIME

Getting right donor at right time remains a far cry here as superstitions, non-declaration of brain-dead patients make 1000s die for want of donors

As many as 1.25 lakh Indians died in road accidents last year, but only less than 20,000 of them had donated their organs — such as kidneys, liver, pancreas, heart, etc — for potential recipients. Thousands died either for want of donors or because they had to wait for too long, like former Maharashtra chief minister Vilas Rao Deshmukh had to: he got a donor, but it was too late. Lalitha Raghuram, country director, Mohan Foundation, one of the country's largest NGOs that promote organ donation, knows the hazards of doing what she does only too well. She says unlike in the West, most hospitals in India don't declare their 'brain-dead patients'— and that is one of the major wrenches in getting the right organ at the right time for the medically needy, she affirms. Mohan Foundation has tie-ups with many hospitals across seven Indian cities, including Delhi. 

Huge Shortage 
"Of 20,000 Indians who require a new liver, only 500-600 of them get it. Of 50,000 patients who need a new kidney, only 5,000-7,000 of them get it," says Avnish Kumar Seth, director, gastroenterology & heptobiliary sciences, Fortis Memorial Research Institute, Gurgaon. Seth was previously with the armed forces where he helped set up AORTA (armed forces organ retrieval and transplant authority), which, formed in 2007, is active in many cities across India. The goal of organisations, such as Mohan Foundation and AORTA, is to identify potential 'brain dead' donors—brain-death is a condition which is irreversible, but where the vital body functions can be briefly 'maintained' in an ICU. "Only the organs—liver, pancreas, kidneys, eye, heart, lungs etc—of a brain-dead or a live person and not a person who dies of a cardiac arrest are useful for a recipient," says Seth. In India, it is the Transplantation of Human Organs Act, 1994 that legalised the concept of 'brain death' for organ donation. Such donations can't be charged a fee. 
Brain-dead vs Live 
The case of 'live' donors is an altogether a different story. Though many of them donate organs of their own volition, illegal trade in 'live' human organs flourishes in many parts of the world, including in India, where a kidney sells for a price as high as . 1,50,000; the donors are typically paid as low as . 5,000. Dr Naresh Trehan, Delhibased cardiac surgeon and chairman of multi-specialty medical institute Medanta, says lack of awareness is a big obstacle to getting potential donors. "It is tough to ask a grieving family to donate the organs of their loved one to a strange patient. Counsellors do manage it. But it is tough," he says, emphasising that it is easier to 'handle the situation' if the brain-dead person "has already pledged his organs in the event of his brain-death". 
The Act of Pledging 
How do you pledge your organ then? Well, you can log on to websites such aswww.mohanfoundation.org or www.dorso.org (launched by the Delhi government) and pledge your organs. AORTA also offers a similar option. Typically, you have to take a print out of the donor card that is created once you fill up the form and keep it with you—and inform members of your family about it; Institute of Liver and Biliary Sciences is in charge of supervising Dorso (Deceased Organ Retrieval Sharing Organisation). "These donor cards are not mandatory for donating your organ. It is just an expression of your interest in donating your organs. Once it is retrieved from your wallet or your pocket (after you are brought brain-dead), the hospitalknows that you wanted to donate your organs," says Manisha Gupta, Gurgaon-based programme manager at Mohan Foundation. 
Opt-in & Opt-out 
In fact, India follows an 'opt-in' system of organ donation—which means you are a donor by consent (for example, being a recipient of a donor card). But your family can still decide to donate your organ even if you haven't expressed your intention to do so—but that is their wish. Most countries abroad follow the opt-out system—which means if you hadn't objected to organ transplant, your organs are donated to a recipient. 
Transplant Coordinators 
Most counsellors who are tasked with convincing families to donate the organs of their loved ones are trained. Seth calls them transplant counsellors. Mohan Foundation offers one-month workshops to a oneyear diploma for counsellors across categories. Trehan says they are doing a good job in hospitals that have created such a tough job category. He adds, "Luckily, more and more people are becoming donors. Hospitals and governments should be in the forefront of the campaign to spread awareness about organ donation." Meanwhile, he cautions about using un-transplantable organs. Gupta explains, "Those are organs that are unhealthy before the brain-death of a person. Ours is the diabetic capital of the world and so many hearts are not transplantable… it is a specialised team of doctors who evaluate an organ before it is transplanted." This process of evaluation is as crucial as declaring a person braindead. Typically, it is a panel of four doctors—which includes a neurologist, a neuro-surgeon besides an authorised specialist and a hospital's medical officer—who confirms brain-death. 
Religion as Hurdle 
Dr Ashok Seth of Fortis Escorts Heart Institute says what is crucial is that healthy organs should be transplanted as soon as possible from a donor to the recipient. "As of now, there are many hurdles in finding donors, including superstitions … some people think you won't attain moksha (salvation) without an organ and with another person's organ. These must be overcome through constantly educating people," he says. "Then only can we build a robust donation system here as in the West… Then only can we save more lives," he adds. 
ullekh.np@timesgroup.com