Organ donation: Why it needs more than a to be or not to be approach
10 Jan 2023
Anup Seth, Chief Distribution Officer at Edelweiss Tokio Life Insurance highlights that 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
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 system for the deceased that harvests organs for donors. The country also credits information systems implemented by Spain’s ministry of health for raising donations from 15 million to 30 million in under 10 years. As part of its program, professionals, mostly doctors, evaluate and explain medical conditions of in-bound patients and educate them on the donation drive. Furthermore, the program not only harvests organs from brain-dead patients but also from patients that have observed circulatory death (stopping of heartbeat and breathing). The country’s organ donation rate of 46.9 per million people in 2017 is a testament to the program.
In the US, statistics indicate a growth in donors in recent years. Nearly 95 percent of US adults support organ donation according to Donate Life America foundation. To most US citizens, agreeing for a donation is a simple selection while applying for a driving license. While technological innovation such as drones and improvement in preservation facilities have helped, yet 22 people died every day in the US waiting for organ donation.
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) to 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 utilised fully in preservation of life-saving organs. Once organs are frozen, there is no way to prevent cell damage or bringing organs 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 heart (4 hours), lungs (6 hours), liver (12 hours) and kidneys (24 to 36 hours) consistently observed cell damage. Perfusion machines allows trained surgeons to ensure 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 transplantation. While perfusion techniques can give a few extra minutes to the operating surgeon, there is still a need for infrastructure such as testing centers, tissue banks and new technologies such as drones that could help address meeting the organ demand.