Anil (name changed) was on the list of recipients for organ transplant in Hyderabad as his kidneys had failed. While on a visit to a nearby place, the 35-year-old received a message about a potential match. He dropped everything and rushed back to Hyderabad only to learn that the donor’s kidneys had an issue. It was so near yet so far for Anil. But for hundreds of desperate patients, functioning organs harvested from cadavers are providing a new lease of life.
Days earlier, Hyderabad witnessed the heart-warming tale of hope when the parents of 14-month-old brain-dead child agreed to donate the kidney. Now, the kidney has given a lease of better life to a 58-year-old woman. The recipient had been undergoing dialysis for about seven years.
The gap in numbers
According to doctors, one deceased person whose brain fails before the heart, can save the lives of eight patients. But in a nation of 130 crore people, the organ donation rate is only 0.25 per million which means that not more than 2,000-2,500 organs are available for transplant from deceased donors. An estimated 1.8 lakh person die due to renal failure every year. The number of renal transplants is around 6,000 only. An estimated 2 lakh patients die of liver failure annually, and about 10 to 15% of them can be saved with a transplant. About 25,000 liver transplants can be done from harvested organs, but only 1,500 surgeries are performed. Similarly, about 50,000 people suffer from heart failure, but hardly 40 to 50 heart transplants are performed in India. In case of cornea, about 25,000 transplants are done every year against a requirement of 1 lakh.
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This mismatch between the number of organ recipients and organ donors is changing slowly, as the case with parents of 14-month baby shows. In the six months of the current year, Telangana has already carried out a substantial number of organ transplants, with 327 life-saving procedures recorded so far. The transplants in 2023 include 170 kidneys, 105 livers, 11 hearts, and 41 lungs.
As per the data maintained by the National Organ and Tissue Transplant Organisation (NOTTO), 15,561 organ transplants took place in the country in the calendar year 2022. As of March 31, 2023, there are 4,49,760 organ donors registered in the country and the number of patients waiting for organ replacement in the country is 49,745. Bharati Pravin Pawar, Minister of State in the Ministry of Health and Family Welfare, while answering a question in the Rajya Sabha on March 14, 2023, said that Telangana stood third in organ donation among all the States and Union Territories during the year 2020, 2021 and 2022. Tamil Nadu stood first followed by Maharashtra.
The number gap shows that availability is the biggest problem in the matter of organ transplantation. Health is a State subject in India and every State has its own nodal agency in charge of allocation of human organs. In Telangana, Jeevandan, a government-funded organisation, has been instrumental in facilitating organ transplants by ensuring a systematic approach to organ allocation and procurement. The nodal centre of Jeevandan is located in the Nizam’s Institute of Medical Sciences (NIMS) Hyderabad.
Transplant Coordination Programme
One of the key contribution of the Jeevandan is the courseware that trains transplant coordinators. Men and women who counsel patients, donors and help navigate the complex world of organ donors and recipients. Since the inception, for the first time in the country, about 100 transplant coordinators are being trained every year. The course consists of 60 lectures which are held monthly in different hospitals. The syllabus covers all aspects of organ transplantation, including legal, psychological, medical and surgical aspects. The training involves workshops on basic and advanced life support, brain death declaration forms, case scenario discussion grief counselling, organ packing etc.
The role of transplant coordinators has garnered significant recognition in the western world since the 1970s, becoming an integral part of transplant teams. India, too, has acknowledged the importance of transplant coordinators for the past two decades, but it is only in recent years that their presence and influence has gained substantial momentum. The catalyst for this recognition in India came with the implementation of the Transplantation of Human Organs Act in 2011 and the Transplantation of Human Organs and Tissues Rules in 2014. These pivotal pieces of legislation made it a mandatory requirement for every transplant centre to have a dedicated transplant coordinator as an essential component of their team.
Success stories
Among the success stories is that of 27-year-old Saikiran Bollampalli, hailing from Chennur in Mancherial district. He had registered as a donor with Jeevandan in 2019 after experiencing kidney failure. For four years, he endured thrice-a-week dialysis sessions until he received a call from Jeevandan on July 9, 2023. The call informed him about a potential kidney match from a 19-year-old donor. With a sense of urgency, Saikiran and his family rushed to NIMS hospital, where after a night of comprehensive tests, he underwent a successful kidney transplant on July 10. As of now, more than two weeks after the transplant, Saikiran’s urine output and other vital parameters are promising. The entire transplant and treatment costs were covered under the government’s Arogayasri scheme.
A similar story is that Sridevi Polavarapu, a 50-year-old patient from Hyderabad, who had registered for a kidney transplant with Jeevandan in 2019 due to high creatinine levels. On July 8, 2023, she underwent the transplant at Star Hospital, Banjara Hills. The transplant was facilitated free of cost through Jeevandan. The surgery amounted to ₹6.9 lakh, and some additional costs were incurred due to complications after the transplant. A significant portion of these expenses was covered by medical insurance. On Wednesday, she was discharged from the hospital.
Need for speed
Speed is of essence when it comes to harvesting organs from brain-dead patients. Stepping in to ensure that there is no delay is the unlikely role of Hyderabad Police who have turned ferrying of beating organs from one hospital to another into a smooth operation.
On the morning of June 20, the Hyderabad traffic police arranged a green channel for facilitating the transport of lungs from Yashoda Hospital, Secunderabad, to Apollo Hospital, Jubilee Hills. The distance of 12 km was covered by the ambulance in eight minutes. In a similar instance, on June 2, an ambulance transporting lungs from the Rajiv Gandhi International Airport to KIMS Hospital, Secunderabad, was provided a green channel and the distance of 35.3 km was covered in 23 minutes.
“To initiate the process, the hospital responsible for the organ’s transportation sends an alert to the city traffic police’s command centre. Subsequently, the control room assesses the best and fastest route for the organ’s journey to the destination hospital,” informed G Sudheer Babu, Additional CP (Traffic) of Hyderabad City Police. Once an organ is deemed ready for transport, a critical time window is in place to ensure its swift delivery to the recipient. As a part of this process, all traffic junctions along the route are alerted, ensuring seamless passage and minimal delays. Since the beginning of 2023, the Hyderabad traffic police have facilitated organ transport on 12 occasions up to the present moment.
A slow but steady change
Over the years, the Jeevandan programme has made remarkable strides in the realm of organ donations and transplantations. Starting with 41 brain dead donors and 119 cadaver organ transplantations in its inception year of 2013, the programme has witnessed an exponential growth trajectory. Fast forward to 2022, the numbers soared to 194 brain dead donors and 530 cadaver organ transplantations, a testament to the programme’s increasing impact. As of the current year, 2023, the Jeevandan programme has already recorded an impressive count of 121 brain dead donors and 327 organs transplanted. The cumulative tally since its inception in 2013 has now reached an awe-inspiring 1283 brain dead donors and 3515 cadaver organ transplants.
As per the available data, the State witnessed a commendable rise in organ transplants from 201 organs in 2020 to 530 organs in 2022, and the trend continues to show promise in 2023. In 2020, 201 organs were successfully transplanted, comprising 97 kidneys, 70 livers, 14 hearts, and 20 lungs. This marked the beginning of the State’s upward trajectory in organ donations and transplantations. The following year, 2021 saw a significant surge in organ transplants, with 478 organs being transplanted in total. The distribution of these life-saving organs included 228 kidneys, 139 livers, 26 hearts, and 83 lungs. This remarkable increase reflected the growing awareness and willingness among the people of Telangana to donate organs and save lives. The momentum continued in 2022, witnessing a record 530 organ transplants in the State. Of these, 263 were kidneys, 171 livers, 31 hearts, and 65 lungs. The steady rise in transplant numbers demonstrated the effectiveness of the State’s efforts in streamlining organ allocation and enhancing healthcare infrastructure.
While private hospitals dominate the whole organ donation in the Sate, government hospitals are unable to match the mark. Jeevandan data suggests that since 2013, there have been 28 organ donations at NIMS, followed by eight at Osmania General Hospital till 2018 and zero organ donations at the hospital since 2019. The reason for the low numbers is because majority of the times patients in the last stage are referred to government hospitals. The patients we get have BP levels of 60/120, 50/130 and there is no chance to declare brain dead of the patients.
The cost of organ transplantation in India ranges from ₹6 lakh to ₹36 lakh, depending on the organ. The maximum cost charged is for heart followed by lung and kidney. After the transplant, majority of the patients have to continue medications life long. A kidney recipient shared that he has to spend ₹2,000 to ₹3,000 for his medicines monthly.
South leads the nation
“One of the primary hurdles in India’s organ donation scenario is the lack of awareness among the masses. Many potential donors and their families remain unaware of the life-saving impact their organs can have on those in dire need,” says G Swarnalatha, incharge of Jeevandan.
“Additionally, cultural and religious beliefs play a significant role in shaping attitudes towards organ donation, often influencing decisions about whether to opt-in for donation. A key distinction in organ donation systems between India and some European countries adds to the complexity. India operates on an opt-in system, requiring explicit consent for organ donation. In contrast, countries like Spain and France follow an opt-out system, where consent for donation is assumed unless otherwise stated,” says the doctor.
“One of the most challenging situations arises when next of kin refuse to consent to organ donation after a brain diagnosis. Such instances pose a significant hindrance to advancing the organ donation programme. Severe lack of organs and poverty are the main reasons why illegal organ trading is thriving. Despite these challenges, India has seen commendable improvements in organ procurement rates,” says Dr. Swarnalatha. South Indian states, in particular, have made remarkable strides in establishing robust deceased organ donation and transplantation systems, outpacing other regions in the country, the doctor added.
“Cultural and religious beliefs play a significant role in shaping attitudes towards organ donation, often influencing decisions about whether to opt-in for donation”G. Swarnalathaincharge of Jeevandan
