30th November 2019: The Hindu Editorials Notes: Mains Sure Shot


Question – Address the issues related to organ donation in India and how can they be solved?(200 words)

Context – Indian Organ Donation Day.

Organ donation:

  • Indian Organ Donation Day is observed by the Government of India on November 30.
  • It is observed with the primary objective of promoting organ donation and transplantation so that a number of people suffering from organ failure, such as the kidneys and liver, can get a new lease of life using organs gifted by others who have lost their lives (such as in road accidents or other reasons).
  • Organ donation is closely associated with altruism i.e. selfless concern for the well-being of others.

What do we mean by organ and tissue donation?

  • Organ and tissue donations are medical processes that save and transform lives. Organs are retrieved from a donor and transplanted into someone who needs it, while tissue donors help transform lives through eye and tissue donations.
  • The anonymity between donor and recipient is upheld.

Issues with organ donation in India:

  1. The negative perception that is growing among people leading to undermining the altruistic donation mindset of donor families. A classic example of this is the steep drop seen in Kerala — from 76 deceased donors in 2015 to eight in 2018 — due to a perceived, however unfounded, scandal that private hospitals were declaring persons brain dead when they were not really so, in order to harvest their organs and profit from them.
  2. The highly privatised health-care system in India and the growing trust gap between patients and doctors trapped in the profit-seeking business of tertiary care.
  3. Suspicion originating from the fact that while an organ comes free, as donated to society, transplanting it to another person costs anywhere between ₹5 lakh and ₹25 lakh, including profit to the hospital. Hence the unavoidable suspicion that unethical practices may take place — as highlighted in a recently published book, Healers or Predators? Healthcare Corruption in India.
  4. There is one more factor. The reality that a majority of accident victims who become donors are lower middle class and below, while the majority of organ recipients are from the small number of persons who can afford transplant surgery and costly lifetime medication thereafter. The cost factor is the key reason why more than three quarters of donated hearts and lungs do not get taken.

If hughly privatised health-care system is the problem then can public hospitals come to the rescue?

  • The answer to this is no because firstly, there are very few public hospitals in the country do kidney transplants and less than five do liver and heart transplants.
  • The public spending on health care remains an abysmal 1.2% of GDP — less than a third of what even some developing countries spend — priority should be on spending the limited allocation on areas that would benefit the greatest number of persons.
  • So how can this limited amount allocated to healthcare be spent so that it benefits the greatest number of people?
  • By spending the money on dialysis. The rationale behind this is that if dialysis happens early then treatment can start early and the failure can be prevented.  A given amount, if spent on organ failure prevention will save many more lives than if spent on organ transplant.
  • For example, a World Health Organisation Consultative Group in its 2014 report points to a study in Thailand which finds that money spent on dialysis can save 300 times more healthy life years than if spent on tuberculosis control (or any disease control).

How to deal with the trust gap?

  • One usual approach is to regulate hospitals through acts and rules. In the 25th year of the Transplantation of Human Organs Act, 1994 , it is time to revisit its effectiveness. Substitution of bureaucratic procedures for hospital and transplant approval by self-declaration and mandatory sample verification involving civil society will improve compliance — as proved in other countries — and will also help get more hospitals involved. 
  • Further amendment is needed to ensure full State autonomy in this area, avoiding the Central government’s interference in organ distribution, which is now demotivating many hospitals.
  • Apart from this, all State organ distribution agencies need to make their operations fully transparent. Steps such as making online organ distribution norms and the full details on every organ donation will help build public confidence in the system.
  • Also as we see organs are donated by the poor and used by the rich. As India figures in the top 10% of unequal countries in the world and among the top 10% of high proportion population spending more than a tenth of their income on health, this inequality must be considered and regulations must be made to address this serious issue. The poor should not be deprived. This must also be considered in light of the fact that the organ comes totally free to a hospital from a donor. 
  • One approach to solve this could be to mandate that every third or fourth transplant done in a private hospital should be done free of cost to a public hospital patient. This will amount to cross-subsidisation, with the hospital, the doctor and the recipient footing the bill for free surgery to the section of the population that donates a majority of organs.
  • Also the government should work to raise awareness about organ donation and can give some incentive to families of persons who donate.
  • Also the government must take educational awareness steps to burst the belief among the families of some donors that organ donation will affect afterlife and so on.

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