Organ Transplant : Daily Current Affairs

Date: 10/04/2022

Relevance: GS-2: Government policies and interventions for development.

Key Phrases: Harvestable organs, Transplantation of Human Organs and Tissues Act 1994, Health Ministry, NITI Aayog, Brain stem cell dead, Near Relative donor, Artificial life, Organ procurement, Short self-life, Transplantation, Retrieval and Tissue Banking, Organ trading, Right to Health, Article 21, Human dignity.

Why in News?

Nearly 50,000 people in India are in need of heart transplants, and 200,000 of kidney transplants.

Context:

An acute shortage of harvestable organs is prompting the government to rethink the definition of “death” in the law on organ transplants.
The proposed change to the Transplantation of Human Organs and Tissues Act will aim to address an anomaly in the definition of death in death certificates.
Officials in the health ministry and central think-tank NITI Aayog have observed that there is a difference in the way death certificates define death, in case of natural death, and for brain death.
As of now, doctors harvest organs from a patient who is declared brain stem cell dead. So, there is a need to revise the definition of death specifically for the purpose of organ donation and amend the existing Transplantation of Human Organs and Tissues Act.

Situation of shortage of organs in India:

There is a wide gap between patients who need transplants and the organs that are available in India.
An estimated around 1.8 lakh persons suffer from renal failure every year, however the number of renal transplants done is around 6000 only.
An estimated 2 lac patients die of liver failure or liver cancer annually in India, about 10-15% of which can be saved with a timely liver transplant.
Similarly about 50000 persons suffer from heart failures annually but only about 10 to 15 heart transplants are performed every year in India.
In case of Cornea, about 25000 transplants are done every year against a requirement of 1 lakh.

Legal framework regarding human organs transplantation in India:

Transplantation of Human Organs Act (THOA) 1994 was enacted to provide a system of removal, storage and transplantation of human organs for therapeutic purposes and for the prevention of commercial dealings in human organs.
THOA is now adopted by all States except Andhra and J&K, who have their own similar laws.
Under THOA, source of the organ may be:
- Near Relative donor (mother, father, son, daughter, brother, sister, spouse).
- Other than near relative donor: Such a donor can donate only out of affection and attachment or for any other special reason and that too with the approval of the authorisation committee.
- Deceased donor, especially after Brain stem death e.g. a victim of road traffic accident etc. where the brain stem is dead and person cannot breathe on his own but can be maintained through ventilator, oxygen, fluids etc. to keep the heart and other organs working and functional. Other type of deceased donor could be donor after cardiac death.
Due to an acute shortage of harvestable organs Government of India amended and reformed the THOA 1994 and consequently, the Transplantation of Human Organs (Amendment) Act 2011 was enacted.

Brain Dead Patient

Brain death (also known as brain stem death) is when a person on an artificial life support machine no longer has any brain functions. This means they will not regain consciousness or be able to breathe without support.
Brain Stem death is recognized as a legal death in India under the Transplantation of Human Organs Act, like in many other countries, which has revolutionized the concept of organ donation after death.
After natural cardiac death only a few organs/tissues can be donated (like cornea, bone, skin and blood vessels) whereas after brain stem death almost 37 different organs and tissues can be donated including vital organs such as kidneys, heart, liver and lungs.
Doctors say organs harvested from a braindead person can save at least seven lives and that at any given point of time in a metro city about 10 patients are referred to intensive care units as brain-dead.

Issues and challenges regarding human organs transplantation:

High Burden (Demand Versus Supply gap)
- In India, nearly 50,000 people are in need of heart transplants, another 200,000 for kidney, and 100,000 each for liver and eye transplants every year. But supply lags far behind.
- About 200,000 patients require renal (kidney) transplants, but we get only 10,000 live donations per year. The existing gap is huge. The ratio of organ donation stands at less than 0.8 per million population while in western countries it is around 30 per million,”
Definition of Brain Stem Death patient
- Brain stem cell death definition differs from that of natural death in the certificate.
- Thus, patient’s family members consider that the patient is still alive because of functioning organs.
- So, there is a need to revise the definition of death specifically for the purpose of organ donation and amend the existing Transplantation of Human Organs and Tissues Act.
Lack of Organized systems for organ procurement from deceased donor
- Live organs have a short self-life. After retrieval of the organ from a body, the heart is alive for only 6 hours.
Maintenance of Standards in Transplantation, Retrieval and Tissue Banking
Prevention and Control of Organ trading
High Cost (especially for uninsured and poor patients)
Regulation of Non- Govt. Sector
Poor Infrastructure especially in Govt. sector hospitals
Poor rate of Brain Stem Death Certification by Hospitals
Poor Awareness and attitude towards organ donation--- Poor Deceased Organ donation rate

CONSTITUTION OF INDIA AND RIGHT TO HEALTH

The Constitution incorporates provisions guaranteeing everyone’s right to the highest attainable standard of physical and mental health.
Article 21 of the Constitution guarantees protection of life and personal liberty to all persons.
The Supreme Court has held that the right to live with human dignity, enshrined in Article 21, derives from the directive principles of state policy and therefore includes protection of health.
India is a party to the International Covenant on Civil and Political Rights and the International Covenant on Economic, Social and Cultural Rights.

Way Forward:

Despite a facilitatory law, organ donation from deceased persons continues to be very poor. In India there is a need to promote deceased organ donation as donation from living persons cannot take care of the organ requirement of the country. Also there is risk to the living donor and proper follow up of donor is also required. There is also an element of commercial transaction associated with living organ donation, which is violation of Law. In such a situation of organ shortage, rich can exploit the poor by indulging in organ trading. 
The government is bringing into effect more rules for ensuring accountability on the part of the hospitals as well as physicians. Anyway, what is the need of the hour is to have more awareness among the people for donation of organs.
There is increasing demand for organs, and at the same time there are large numbers of accident deaths occurring every day. If these organs could be transplanted, the shortage of organs can be solved to some extent. If the public is educated about the necessity of organ donation, the selling or commercialization of organs can be restricted.

Source: Live-Mint

Mains Question:

Q. Discuss the issues and challenges of Organ Transplantation in India? What steps has the government taken in this regard?