Organ transplant is one of the fascinating and challenging disciplines of surgical practice. At same time, the global issues with organ donation and transplantation programs go through multiple hassles right from the procurement of organs, transportation, long recipient lists, low availability of deceased donors , infrastructure and expertise of healthcare and multiple grey areas discussed later in same section.
This highly specialised surgical branch is well practiced in many major cities by transplant teams across the world very successfully. Kidney and liver transplant are the major organs transplanted as they can be obtained by the living donor( family, siblings and friends). The other organs like cornea, lungs , heart , intestinal , pancreas and skin are majority done from organ obtained by deceased donors.
The overall transplants performed world wide were 139024 in 2017( source http://www.transplant-observatory.org) out of which 37447 Deceased Donor transplants( brains dead individuals as donors). Inspite, long waiting list of recipients across all the nations the organ donation rate remains significantly low.
Majority, of countries fall in two type of categories for organ donation: “ Opt in” where consent is obtained from patient or his relatives before donation. Major countries ( USA, Brazil, India etc ) follow this policy. The second policy which relatively successful as considered with organ donations is”Opt out” policy where the consent is implied by patient that the organs will be donated when he is brain dead until unless the patient or his relatives opted out for donating organs. Most of the European countries follow “Opt out” policy and are relatively successful with number of organ donation when compared to countries which follow “ Opt in “ policy.
This less low rates of organ donation raises the question weather one should practice the principles of altruism for organ donation. New Zealand is one of the the countries in world which mandatory follow it during the application of driving license. But at the same time, it is not considered as informed consent at the time of brain death as relatives still need to give their consent for organ donations.
The lower rate of organ donations are considered as results of lower motivation in society for organ donations along with social, sentimental and regional belief behind organ donations. Theoretically, most of religions favour organ donations but practically there are many regional misconceptions spread in religious values. On the contrary, we believe most of the patients belong to different religions won’t give consideration when it comes to recipient of organs. This dogmatic attitude towards organ donation and transplant programs raise the questions on humanitarian behaviour and values itself. But at the same time, the only hope lies in educating the society about need and value of organ donations.
Transplant Tourism/ Organ Trading has been certainly a black mark on healthcare industries and healthcare professionals over the time again and again despite of rigid protocols and laws. This in turn question about the way we run the transplant programs at global level. Incentives for organ donation as been eyed as double edged sword where one school of thought agrees as it will help the donor family. On the other side, there is trading of organs from poor to rich for money which in turn damage the noble ideology of organ donation and saving lives.
Interestingly organ donation programs also reflects gender inequality. The number of deceased female donors are more compared to males and on the other side, recipients are predominantly males. The overall problems faced by the transplant patients, surgeons and organisations certainly indicate towards developed of robust transplant programs in coordination with government agencies with international collaboration to combat the various issues related to transplant programs. This could possibly curb down the black market associated with organ trading, setting up new religious and traditional values and educating the society in correct direction about the need of organ donation.
After all “ Humanity is bigger than one religion” !
Dr Saurabh Bansal ( Surgeon)
Founder and Managing Director
SHL Surgeons House Limited