Organ donation: Why it needs more than a “to be or not to be” approach

While India is considered as the pharmaceutical and medical hub of the world, it has always fallen short of meeting the demand for organs. According to a ministry of health and family welfare report, the annual demand is 1.8 lakh renal patients, 2 lakh liver patients, and 50,000 heart transplants in addition to 1 lakh requests for corneal transplant. Of 2019, the deaths in the country were estimated 76.41 lakhs according to data from the civil registration system. If organs from 10 percent of the deceased were to be harvested, patients could have found a new lease of life. Cultural factors for years have made organ donation approaches like a “to be or not be” system. Given the poor infrastructure in hinterlands, challenges around collection of organs, and transportation, it is not the cultural approach but quality infrastructure that needs solutions.

Learnings from leading transplant countries

Data from the Global Observatory on Donation and Transplantation, shows countries such as Croatia, USA, Portugal, Spain, France, United Kingdom, Iran, and Israel observing more transplants in recent years. Spain’s success is attributed to a presumed-death system that harvests organs for donors. The country also credits information systems implemented by Spain’s ministry of health with raising donations from 15 million to 30 million in under 10 years. As part of its programme, professionals, mostly doctors, evaluate and explain the medical conditions of in-bound patients and educate them on the donation drive. Furthermore, the programme not only harvests organs from brain-dead patients but also from patients who have observed circulatory death (stopping of their heartbeat and breathing). The country’s organ donation rate of 46.9 per million people in 2017 is a testament to the programme.

In the US, statistics indicate a growth in donors in recent years. According to the Donate Life America foundation, nearly 95 percent of US adults support organ donation. To most US citizens, agreeing to make a donation is a simple selection while applying for a driving licence. While technological innovation such as drones and improvements in preservation facilities have helped, yet 22 people die every day in the US waiting for organ donation.

New techniques

While industry practitioners recommend infrastructure such as hospitals, and laboratories to ensure testing of harvested organs, there are newer techniques and standards. Preservation techniques, for instance, have grown beyond the ice box to include cryogenation (dipping in liquid nitrogen) and perfusion techniques. In the case of tissues, medical science is still working on ways to ensure cryogenic freezing techniques. Liquid nitrogen, which can freeze things within a snap, is yet to be fully utilised in the preservation of life-saving organs. Once organs are frozen, there is no way to prevent cell damage or bring organs back to life during the reheating stage. This is where scientists are identifying techniques such as perfusion.

Despite being placed inside an ice box, harvested organs such as the heart (4 hours), lungs (6 hours), liver (12 hours), and kidneys (24 to 36 hours) consistently showed cell damage. Perfusion machines allow trained surgeons to ensure the transport of nutrient-rich fluids and make up for cell-oxidative damage. In a landmark surgery last year, doctors managed to retrieve a non-beating heart using a perfusion technique during a transplant. While perfusion techniques can give a few extra minutes to the operating surgeon, there is still a need for infrastructure such as testing centres, tissue banks, and new technologies such as drones that could help address meeting the organ demand.

(This article was authored by Mr. Anup Seth, Chief Distribution Officer at Edelweiss Tokio Life Insurance)