Kidney transplant crisis in India

Kidney transplant crisis in India

GS-2: Government of India policies and interventions related to health

(UPSC/State PSC)

Important for Prelims:

Kidney transplant crisis in India, Chronic Kidney Disease (CKD), Human Organ Transplant Act-1994, National Organ and Tissue Transplant Organization (NOTTO).

Important for Main Exam:

Scenario of organ transplantation in India, Challenges and Way Forward, Conclusion.

14/03/2024

Context:

This article highlights the kidney transplant crisis in India and suggests that innovative approaches to kidney swaps and kidney chains can increase transplants and this suggests that India should adopt successful international practices to help its citizens and reduce illegal kidney sales.

Scenario of Organ Transplantation in India:

  • India ranks third in the world in terms of organ transplantation.
  • Alarming situation: The shortage of kidney organs in India is worrisome.
  • Organs from deceased donors accounted for about 17.8% of all transplants in 2022.
  • The total number of deceased organ transplants increased from 837 in 2013 to 2,765 in 2022.
  • The total number of organ transplants – with organs from both deceased and living donors – increased from 4,990 in 2013 to 15,561 in 2022.
  • Every year an estimated 1.5-2 lakh people require kidney transplant.
  • In the year 2022, only one person out of every 10,000 will receive a human organ. Of the 80,000 people who needed a liver transplant, less than 3,000 could receive a human organ in the year 2022.
  • In the year 2022, only 250 out of 10,000 people could undergo heart transplant.
  • Prevalence of CKD: Due to diabetes, malnutrition, overcrowding and poor sanitation, the prevalence of chronic kidney disease (CKD) is high in India, affecting about 17% of the population.
  • ESRD: CKD often causes end-stage renal disease (ESRD) and kidney transplantation is often the best treatment.
  • Lack of facilities: Unlike India, the United States and other developed countries can do about 20% of the transplants. Notably, a large part of this gap is due to the more stringent regulations in India rather than the lack of medical facilities.

Kidney transplant in India

Transplant Requirement:

  • Transplantation is often superior to alternatives on all important dimensions: quality of life, patient comfort, life expectancy, as well as cost-effectiveness.

Method of obtaining kidney:

  • There are four main ways a patient can receive a kidney:

From a dead person-

    • Challenge: It is hampered by lack of donation, special circumstances required depending on the nature of death and the infrastructure required to collect and store the kidneys.

With donation from a relative or friend-

    • Challenge: The donor and recipient must be compatible in terms of blood type and tissue type; Such relative/friend donors are often inconsistent.

kidney swap-

    • It is done when two incompatible donor-recipient pairs exchange kidneys.
  • For example: Sita and Salma, who are incompatible with their respective spouses, can swap donors if compatibility is found, allowing a transplant.

Kidney Chain-

    • It starts with a charitable donor. This donor gives a kidney to a compatible recipient, whose incompatible donor gives to another compatible recipient, creating a chain of donations.
  • For example: Sunil is an altruistic donor who donates his kidney without any expectation of a kidney in return. Sunil donates to Sita (assuming compatibility), Sita donates to Salma, and Salma donates to someone else and so on.
  • Kidney 'swap' and kidney 'chain' are two innovative methods of kidney exchange.

Challenges related to kidney transplant in India:

Less use of technologies:

  • There are very few swap transplants and almost no chain transplants in India due to legal barriers.

Differences in swap transplant rules:

  • Swap transplants are legally permitted in India with appropriate permission, but only close-relatives are permitted as donor-recipient pairs.
  • While Kerala, Punjab and Haryana are exceptions by allowing non-closely related donor-recipient pairs after verification.

Almost no kidney chain:

  • Donating a kidney to charity is illegal in all states except Kerala.
  • Kidneys of the deceased or brain dead are not used for chains or bicycles.
  • The lack of kidney chains is potentially a greater missed opportunity than swaps because the chains significantly drain hospital resources and create uncertainty for participants.

Lack of coordinating authority:

  • Unlike national, regional and state lists for direct transplantation from cadavers, there is no national coordinating authority for swaps.
  • This is also a huge lost opportunity, as larger and more diverse pools make it easier to find compatible swaps.

Proliferation of black markets:

  • Strict laws regulating swaps and on-chain have contributed to the proliferation of black markets for kidneys. These black markets put everyone at risk, as these operations are conducted without proper legal and medical safeguards.
  • There is a mainstream reference to 'selling a kidney' to relieve the financial crisis.

Slow reforms on kidney laws:

  • Reform of kidney exchange laws has been slow.
  • Transplantation of Human Organs and Tissues Act 1994: It began to recognize the possibility of transplantation from brain-stem death.
  • 2011 amendment: In 2011, swap transplants were legalized and a national organ transplant program was launched.
  • But initially the national network remained underdeveloped.

Missing the fundamental issue of inadequate kidney supply:

  • Recent reforms of the government i.e., new National Organ Transplant Guidelines (February 2023) allow greater flexibility in age and residence requirements when registering to receive an organ.
  • But these reforms largely ignore the fundamental issue of inadequate kidney supply.

National Organ and Tissue Transplant Organization (NOTTO):

  • In the year 2015, NOTTO has been established under the Directorate General of Health Services, Ministry of Health and Family Welfare, located in New Delhi.
  • Its main objective is to act as the apex center for all India activities for procurement, distribution and registration of organs and tissues for donation and transplantation in the country.

Transplantation of Human Organs Act, 1994:

  • This Act lays down rules for separation and storage of human organs and also regulates transplantation of human organs for medical use to prevent commercial use of human organs.

Way forward:

  • There is a need for regulations for kidney exchange because kidney exchange must often take place between family members.
  • There is an urgent need to reform these rules to liberate innovative kidney exchange methods – kidney ‘swap’ and kidney ‘chain’.
  • Organ donation should be promoted as it can save lives and benefit the entire society.
  • Private hospitals should provide free transplants to people who donate most of their organs.
  • There is a need to allow and encourage non-close relative donation for altruistic donation, swaps, and improve kidney-exchange infrastructure.
  • India needs to implement regulations like Australia, Canada, Israel, Netherlands and US to overcome kidney shortage.
  • National level registries should be created for kidney chains and swaps, as in Spain and the United Kingdom.
  • The US in particular has made progress in facilitating thousands of swaps and chains.
  • Contact international collaboration like Spain for kidney exchange.
  • Laws for organ donation and organ exchange should be made easier.

Source: The Hindu

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Mains Question:

Discuss the way forward to address the kidney transplant crisis in India.