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The Potential Of Cadaver Transplantation Programme In India

In ten years since the Transplantation of Human Organ Act was passed in India, we have not made much headway with the programme. This has been due to various reasons. //First and foremost has been lack of direction and the will to seriously consider this as an alternative to living organ donation.

There has been a lack of initiative from the Government after the act was passed. Whenever there is a kidney scandal there is a knee jerk reaction from various quarters, there is some media outcry and if the allegations seem somewhat serious a few smalltime brokers are rounded up and life carries on till another such episode come to light and the same act is repeated.

Since the act was passed everyone - doctors, hospitals, authorization committee have been accused of promoting unrelated activities, in this midst no one has actually looked at some of the other countries who have quietly marched forward with the cadaver programme by increasing their donation rate per million over the last ten years.

India is today on the threshold of taking a jump from being a developing nation towards a developed nation. This is the dream of many proud Indians including our President APJ Kalam. Let us briefly examine what has been achieved in the last 10 years as far as the cadaver programme donation and transplant programme is concerned in India -

1. The 900 odd cadaver organ transplants in 10 years have shown that we in India are capable of organizing such a programme.
2 . The cadaver transplants have been done both in government and private institution although the majority have been undertaken in private institution.
3 . The brain death certification is now widely accepted by clinicians and the protocols to certify have been standardized.
4. Few centres have shared their organs and in this respect both Tamil Nadu and Maharastra have made some commendable efforts
5. Liver and heart transplants are now a reality in India and could spearhead and give momentum to the cadaver transplant programme.
Spain has the highest number of brain death patients going on to organ donation - 32 per million population. If we compare our cadaver donor rate per million population and extrapolate its potential, we can make some interesting conclusion and not only help ourselves but also help with the global organ shortage.
The current organ donation per million for cadaver in India is 0.05 per million (about 50 Cadaver donors per year).
At 1 per million donation rate we would have 1100 organ donors
- Or 2200 kidneys, 1000 hearts, 1100 Livers,1100 Pancreas and 2200 Eyes
- This should take care of almost all current demands for organs.
At 2 per million donation rate there would be 2200 organ donors and the above figures would double and there would be no necessity to undertake living kidney donations. If we did 3 per million, we could take care of all SAARC countries demand for organs
At 5 per million we would have 10,000 kidneys, 5000 hearts and 5000 livers - and we could start looking at the problem of organ shortage in rest of Asia and other parts of the world.

The cadaver programme needs to be given a priority and efforts should be made to encourage hospitals to promote the programme in India, this would result in a win-win situation for everyone including organ failure patients in other countries.

The last ten years have resulted in approx. 1000 cadaver transplants of almost all organs. If not anything else at least the programme has proved two things - one that it is possible to do organise the chain of events that lead to cadaver transplants and second that it is not only kidneys but our hospitals and doctors can do other organ transplants successfully too.

We in India may not be able to compare our economical progress with some of the western countries but countries in second league like Poland and Hungary are to day able to do an organ donation rate of 6 per million. Even the conservative society of a country like Hong Kong does - 3 per million. India today is on the threshold of taking a jump from a developing nation towards a developed nation. This is the dream of many proud Indians including our President APJ Kalam.

This special report has been published in the Editorial Indian Transplant Newsletter' ( Vol. VI, Issue 19 Page.1) - A quarterly issue from MOHAN Foundation.

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