Issues associated with Kidney Transplant in India:
India’s Organ Donation Status:
Increasing Requirement and Ongoing Scarcity:
- In India, there are more than 300,000 patients waiting to receive organ donations.
- The growing demand for organ donors has not been met by the available supply.
- Because of the shortage, almost 20 people pass away every day while waiting for an organ transplant.
A Slow Rise in the Number of Donors:
- Over time, the total number of donors—living and deceased—has increased slowly.
- The number of donors rose somewhat from 6,916 in 2014 to roughly 16,041 in 2022.
- For the past ten years, India’s dead organ donation rate has continuously been less than one donor per million people.
Transplanting kidneys:
- The supply and demand for kidney transplants in India are significantly out of balance.
- There is a significant gap between the 200,000 kidney transplants required annually and the 10,000 kidney transplants performed annually.
Need for kidney transplantation:
- About 17% of people in India suffer from Chronic Kidney Disease (CKD), which is highly prevalent due to the country’s high rates of diabetes, malnutrition, overcrowding, and inadequate sanitation.
- End-stage renal disease (ESRD) is a result of CKD.
- For ESRD, a kidney transplant is frequently the best course of action.
- About 20% of transplants might be performed in the developed world, including the United States.
Methods for a patient to get a kidney:
- From an individual who has passed away:
- This is limited because there aren’t enough donations.
- the specific requirements regarding the type of death
- infrastructure required for kidney collection and storage.
- Ask a friend or relative to donate: However, the recipient and the donor must have compatible tissue and blood types; these donors are frequently incompatible.
What actions are necessary?
- Since kidney exchange frequently needs to happen across family units, regulations for kidney exchange are necessary.
- Regulations must be changed immediately to release two cutting-edge kidney exchange techniques:
- kidney exchanges
- kidney “chains.”
- Families prefer almost simultaneous surgeries for all donors and recipients in kidney swaps because nobody wants to lose a kidney without receiving one.
- Each patient in a kidney chain receives a kidney before their relative donates. As a result, chains have far less hospital resources and participant uncertainty than swaps.
An analysis of a kidney chain and kidney swap case:
Kidney exchange:
- Sunita and Zoya, two strangers in need of kidneys, are one example.
- Both Zoya and Sunita’s spouses are incompatible with one another.
- Swap donations are feasible, though, if Sunita’s spouse and Zoya’s spouse get along well.
Kidney chain:
- Sonu is an example of an altruistic donor who gives his kidney without expecting anything in return.
- Assuming compatibility, Sonu contributes to Sunita; Sunita’s spouse donates to Zoya; and Zoya’s spouse donates to another compatible individual.
India’s absence of chains and lack of swaps is due to:
- In India, swap transplants are lawfully permitted with the proper authorization; nevertheless, donor-recipient pairs may only consist of close relatives.
- This restriction does not apply to Kerala, Punjab, or Haryana.
- Non-near-relative donor-recipient couples have lately been permitted by High Court rulings upon verification.
- In order to put swaps on level with direct donations, the restrictions governing them must be loosened.
- There is no national coordinating authority for swaps, in contrast to national, regional, and State lists for direct transplant from cadavers.
- This is a missed chance because it is simpler to locate compatible swaps in larger and more varied pools.
- In India, kidney chains are practically nonexistent, while there are sporadically exchanges.
- Kidney donation for charity is prohibited in every state but Kerala.
- Since one cannot donate kidneys without receiving a kidney (for a family member) in return, one cannot begin a chain.
- Kidneys from brain dead or deceased patients are not used for chains or cycles—only direct transplants are performed on them.
The Way Ahead:
- Kidney underground markets have proliferated in part due to too strict restrictions governing swaps and chains.
- The phrase “selling a kidney” to get out of debt is widely used.
- Due to the fact that these underground markets operate “off the books,” without the appropriate legal and medical precautions, they put all of their desperate participants in danger.
- The Transplantation of Human Organs and Tissues Act of 1994 initiated the process by acknowledging the potential for brain-stem death transplantation.
- A nationwide organ transplant initiative was launched along with the legalisation of exchange transplants in the 2011 amendment.
- However, the national network was initially underdeveloped.
- The Transplantation of Human Organs and Tissues Rules of 2014 state that only close relatives may get exchange transplants.
- Recent changes made by the government provide for greater latitude in the age and residency criteria when registering to receive an organ.
- However, the basic problem of insufficient kidney supply remains largely unaddressed by these improvements.
- Encouraging altruistic donations, non-near relative donations for exchanges, and upgrading the kidney-exchange infrastructure are all advantageous.
- India can reform chains and exchanges without inventing new things.
- Global precedents have been sufficiently set: among other countries, Australia, Canada, Israel, the Netherlands, and the United States currently permit charitable donations.
- Kidney chains and exchanges are registered at the national level in both Spain and the UK.
- In particular, the United States has advanced in enabling thousands of chains and swaps.
- Spain even participates in international kidney exchange partnerships.
- In order to enhance the lives of lakhs of individuals, India’s true challenge is to emulate and learn from such successful current policies.
