When the 23-year-old physiotherapy student who was brutally assaulted in a Delhi bus was sent to a Singapore speciality hospital last week for a likely organ transplant, many in India asked why she died soon after she was sent abroad but the questions remain.
India boasts of a healthcare sector growing at over 15 per cent annually but it is still far from catering to patients requiring organ transplants.
According to doctors and experts, the healthcare sector currently generates around Rs 500 crore of annual revenue from organ transplants, against a potential of at least Rs 5,000 crore. In other words, organs are available to just a tenth of the patients.
“There is a huge potential in the segment but a majority of the need remains unmet,” says Sunil Shroff, managing trustee of the Mohan Foundation, a non-governmental organisation which focuses on organ donation.
Data from the Organ Retrieval Banking Organisation (Orbo) at Delhi’s All India Institute of Medical Sciences (Aiims) depicts the huge gap. Every year, 15,000-20,000 livers are required but only 500 are transplanted. The need for kidneys is estimated at 100,000-150,000 a year, of which merely 3,500-4,000 are transplanted. The number is no less alarming for eye corneas, one of the most commonly transplanted organs. Every year, 100,000 corneas are required but only 25,000 are transplanted, Orbo data shows.
Neelam Mohan, director, department of pediatric gastroenterology, hepatology & liver transplantation, at Medanta-The Medicity Hospital, Gurgaon, said even the numbers for heart transplants are low because it can be given only by cadaveric donors or brain-dead persons.
“The gap is huge. In a population of 1.2 billion, even if we extrapolate the numbers, merely 10,000 organ transplants happen in total across the country every year,” she said.
According to Samiran Nundy, chairperson, surgical gastroenterology & liver transplantation, at Delhi’s Sir Ganga Ram Hospital, it is worse for organs such as the intestines, pancreas and lungs. These have hardly ever been successfully transplanted in India, doctors say.
Organs that can be transplanted are the heart, liver, kidneys, lungs, pancreas and intestines. Tissues that can be donated and transplanted include heart valves, corneas, bones, bone marrow, tendons, middle ear and skin. While the Transplantation of Human Organs Act, 1994, legalised brain death and provided regulations related to the retrieval, storage and transplanting of human organs, experts suggest a primary reason for the huge disparity between demand and supply is lack of awareness and acceptance of brain death in society. The law was again amended in 2011, to facilitate availability and keep a check on illegal practices.
“Only five to 10 per cent of total organs donated in India are from brain-dead people,” says Shroff. Agrees
Rahul Grover, nephrologist at Fortis Hospital at Vasant Kunj, Delhi. “In western countries like the US, Germany and Spain, there is voluntary donation of all organs of brain-dead perso. But in India, it is mostly living relatives who donate.”
Lack of awareness is one aspect. There are various other challenges such as inadequate infrastructure, health insurance and facilities.
“There is an urgent need to have an organised network to facilitate organ donation and transplant. It involves various processes such as contacting the donor, as well as the patient, testing of the organ, organ transportation, etc,” says Grover.
Most doctors complain that unlike in developed countries, India lacks an organised network and data base for the process. “There is no central data base for availability and requirement of organs,” says Mohan Foundation.
According to Grover, though AIIMS has an organ sharing network, it does not operate across the country.
The highly complicated procedures, coupled with low volumes, contribute to making organ transplant an expensive affair. “We also require a robust health insurance system to make organ transplant a success,” says Shroff.
Mohan said though availability of infrastructure and expertise is not a major concern for common transplants like the kidney, liver or heart, much of it still remains in private hospitals and is expensive. The expertise for other transplants like intestine and pancreas is very rare.
“It is not just about the surgery. Many hospitals fail to do successful transplants because they are incapable of handling the post-surgery care. The care of the patient post-transplant, to manage rejection and infection, is the most difficult part,” says Mohan.
The cost of transplant varies between a public and a private hospital. For instance, while a kidney transplant costs around Rs 2 lakh in a public hospital, it ranges between Rs 3 lakh and Rs 4 lakh in private ones. The cost is much higher for the liver, heart and pancreas.