Last year, the nodal authority National Organ & Tissue Transplant Organisation (NOTTO) decided to submit data on organ transplants from hospitals in India to the Global Observatory on Donation and Transplantation.

Except no one expected India to pretty much top the list in organ transplantations—second only to the US. Not private hospitals, and certainly not the Indian government.

Vasanthi Ramesh, a doctor and the director of NOTTO, had hoped that the data would get more Indians to pledge to donate organs. And she was not disappointed. In November 2019, an organ donation drive in India led by insurer Edelweiss Tokio Life broke the Guinness World Record for pledges in a single day. It managed 54,626 pledges, managing over 100,000 in total over the course over the same month.

Promising as the pledges may be, India’s organ donation rate is still pretty low. Even as pledges grew rapidly from 9,000 to over 1.5 million in the past two years, the rate is abysmal—under 0.5 organ donors per million people. This stands in stark contrast to figures from other countries: 30.7 in the US and 43.6 in Spain, for example. Further, while India sees close to 150,000 brain deaths a year, only about 900 deceased donations happened last year.  

Ultimately, those in need of organs don’t get them. An estimated 500,000 Indians die every year due to this reason.

The processes for organ transplantation in India are bleak at best, said the head of the organ transplants department of an Indian hospital chain on condition of anonymity.

For one, the majority of organ donations in India are done by the living, as opposed to retrieving organs from the dead. This may sound like an endless stream of kindness, but it’s often a case of organ harvesting for commercial gain

Gender discrimination

More Indian men receive donated organs and more Indian women tend to donate organs. In the US, women constitute 62% of kidney donors and 53% of liver donors. In India, 74% women donate kidneys and 60.5% donate liver in India

Most Indian states lack the resources to retrieve organs and make them available for transplants —in which case organ pledges don’t mean much.

In a country that has earned the dubious distinction of being the kidney bazaar of the world—dominated by living donations by the poor for money—NOTTO’s objective is to increase the number of deceased donations. This also makes sense for hospitals—transplants are a great revenue stream. Heart and lung donations, which can only come from the deceased, can improve hospital earnings considerably. While a kidney transplant could earn a hospital up to Rs 5 lakh ($7,022); with lung, heart or liver, this amount can go up  to an estimated Rs 35 lakh ($49,159).

AUTHOR

Ruhi Kandhari

Ruhi writes on the impact of healthcare policies, trends in the healthcare sector and developments on the implementation of Electronic Health Records in India. She has an M. Sc. in Development Studies from the London School of Economics.

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