The organ donation gap just passed a ghastly milestone in India – last year around 5 lakh Indians died awaiting an organ transplant! That is more than the number of soldiers killed in all our wars put together. India has a rate of less than 0.2 donors per 1 million population.
If you ever need an organ for a transplant in India, be assured you won’t be spoilt for choice.
After scrambling to streamline the organ donation market for decades, the Union Health Ministry is ready with its guidelines for (cadaver-based) kidney donations in India. The draft guidelines propose a first-ever national registry of patients in the wait-list, and include a system to prioritise organ supply.
Here’s decoding the guidelines for you -
1. No Give, No Take. Well, Kinda!
So a patient who has donated an organ earlier or is a close relative of a person whose organs were donated after death get preference in allocation.
2. Your City, Your Organs
If an organ comes up in Mumbai, Mumbaikars will be the first ones to benefit, followed by those in Maharashtra and then on the lists of other states.
3. Priority Score
Before you get a score card, the urgency of transplant will be approved by a state-level kidney advisory committee and only then can you be put on the active wait-list. Scoring criteria -
Kids under the age of 6 years get three points, between 6 and 12 you get two points and between 12 and 18 years, one point.
One point for each month of dialysis – so the longer your treatment, the higher your chances of getting an organ.
Three points for a previous failed kidney transplant.
A maximum of five points for previous donors who themselves require a kidney or relatives of people who donated the organ after death.
The new guidelines have also increased the maximum age of a recipient from 65 to 75 years.
4. Blood Group Trumps Your Score
If a type O kidney comes up and the first in line is a type A patient then instead of discarding the kidney for a mismatch, the organ will go to the first patient with the matching blood group.
Flaws With the Guidelines
These guidelines do not score people on the urgency of the transplant or the projected lifespan of the recipient.
Another big loophole -the guidelines do not have a system to keep a tab on failed kidney procedures.
In the US, kidney transplants have a 93% success rate in the first year, 83% by the end of the third year. That’s massive, partly because their organ supply act comes down with heavy penalty for under-performance. If the number of failures exceeds 50%, US authorities red flag that transplant unit and it runs the risk of decertification.
But puts patient first and ensures that doctors do proper tests on the organs and not put poor quality, diseased kidneys in patient just to build transplant statistics.
Is Altruism Enough Or Time To Compensate Kidney Donors?
Singapore is an example that has made paying donors for organs legal. Iran has eliminated wait-lists for kidneys entirely by paying its citizens to donate.
Paying a willing donor for their organ should not be confused with the illegal trade of organs. To make the practice more transparent, the government should amend the law to remove existing ambiguities. Lay down specific criteria for payment, perhaps spelling out fixed amounts.– Dr Sundar, Nephrologist
But in India the law is too rigid to make way for paid donors and there are ethical issues.