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Soon, national body to procure, distribute organs by Kounteya Sinha

After allowing swapping of organs, India is working on another landmark step in organ transplantation: a single apex national organization that will procure and distribute human organs.

Union health ministry is setting up the autonomous National Organ Procurement and Distribution Organization (NOPDO) at the Centre and 10 State Organ Procurement and Distribution Organization (SOPDO) under the country's new National Organ Transplant Programme (NOTP). Delhi, Mumbai, Chennai, West Bengal, Hyderabad, Ahmedabad, Chandigarh, Thiruvanthapuram, Lucknow and Bangalore have been identified as locations for SOPDO.

NOPDO will work towards increasing the availability of organs from cadaver donors, build capacity for retrieval of organs and transplantation and roll out post-transplant services to both recipients and living donors.

A Union health ministry official said, "We intend to bring all organ banks - both public and private - under the NOPDO. The director general of health services is planning the new NOTP. We will meet experts from AIIMS and other organ banks in first week of February. We are also looking to tie up with all private banks."

Also on the anvil is the Indian Organ Donor Register, enabling individuals to record their legal consent to become an organ or tissue donor after death, at an estimated cost of Rs 100 crore.

The Register will ensure that consent (or objection) to donating organs for transplantation can be verified by authorized medical personnel across India. In the event of death, information about the decision will be accessed from the Register and provided to family.

"This registry will have information on all types of organ procurement, matching, distribution, transplantation and complications. It will also maintain entries of transplant centres, transplant surgeons, dialysis physician and dialysis centres," a ministry note says.

The ministry wants to reward organ donors. Certificate of recognition will be given to donors by the transplant centre. "Steps would be taken to make provision for diagnostic tests at subsidized cost to transplant recipients and donor patients through the public sector healthcare delivery system. Free annual health check up to living donor and free treatment of all donor-related complications would be promoted," it adds.

The ministry intends to modify the Rashtriya Arogya Nidhi (RAN) to make provision for transplantation in private centres with a financial assistance. Financial aid for immuno-suppressant drugs has been kept aside, which would benefit about 5,000 patients annually at about Rs 1 lakh per year.

"Medical Insurance for the donors may be funded by the recipient," a ministry says. The official added, "We want to enhance facilities for organ transplantation throughout India, establish network for equitable distribution of retrieved deceased organs, increase organ availability through change in attitude and facilitating the retrieval of deceased organs, building up human resource like training required manpower. Incentives will also be doled out to transplant donors and recipients on follow up."

The ministry also intends to establish 10 new facilities for kidney and two for liver transplantation both in public and private sector. Besides, 10 existing kidney and two liver transplantation facilities will be strengthened. The ministry is also increasing networking of the transplant centers for organ sharing. There are about 200 kidney, 30 liver and 14 heart transplant centres in India.

"We will soon conduct training of retrieval team members, transplant surgeon, dialysis physician, nurse, grief counselors and dialysis technician through a structured programme. Leading centres like Sir Ganga Ram Hospital, Apollo and Medanta Medicity will be involved in the training programme," an official said.

"Deceased organ retrieval is going to be main area for improving supply, although living organ transplant particularly for kidney and liver needs to be continued. More dialysis centres, transplant centres with transplant surgeons and nurses will build up the capacity of improved services. Free or subsidized diagnostic services and immuno-suppressant drug supply for the poor and needy will ensure better compliance and outcome of transplant services," a ministry note says.

India faces a huge shortage of donated organs. While Spain has 35.1 organ donors per million people, Britain has 27, USA (26), Canada (14) and Australia (11). India's count stands at 0.08 donors per million population.

It is estimated that every three minutes, a patient requires an organ transplant. More than two lakh Indians require transplantation annually. However, not even 10% get it. Once a patient is declared brain dead, almost 37 different organs and tissues can be donated, including heart, kidneys, liver, lungs, pancreas and lungs. Whereas, when a brain dead patient is kept for autopsy for hours, h/his heart finally fails, after which only a few tissues like cornea, bone, skin and blood vessels can be re-used.

In India, 1.5 lakh new patients get end-stage renal failure every year. Of these, only 3,500 undergo kidney transplants. About 6,000 get dialysis while the rest perish. At present 0.1% of all donations is cadaver, while 1.6 lakh people die of road accidents every year. Around 4.5 lakh patients require organ transplants annually. Only 35,000 organ transplants have taken place in our country in the past decade. On an average, 3,000 people die every year because of lack of timely organ transplant surgeries. About 40 needy patients can benefit from donation of an entire human body.