Organ donation in India: Crucial role of medical care professionals
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/MJDRDYPU.MJDRDYPU_25_17
With increasing lifespan, higher incidence of diseases such as diabetes and hypertension, the number of cases of terminal organ failure is increasing. Organ transplantation is often the only possible long-term treatment for these cases. Thus, demand for organ donors, live as well as deceased, is ever increasing. However, there is a significant gap between the number of donors and the number of terminally ill patients on the waiting list waiting for organs to become available for transplantation.[1] This demand has resulted in significant efforts on part of each nation to increase the rate of organ donation. At present, countries such as Spain, Croatia, and USA sport a deceased organ donation rate of 28–40.2 persons per million populations while India has an organ donation rate of 0.34.[2] With this rate of organ donation, India is unable to meet organ transplant requirements of the ailing patients. Organización Nacional de Trasplantes is the National Transplant Organization in Spain which conducted a project on how to increase the rate of organ donation. One of their recommendations was to focus on medical care professionals and their ability to identify a potential donor and to counsel the family. Under the auspices of this organization, Spain went from an organ donation rate of 14 in 1989 to 40.2 in 2015.[1]
A medical care professional is involved in almost every step of organ donation beginning with his or her role in education of the general public regarding organ donation. Queries by interested donors are often addressed to the trusted “family doctors” who will help clarify their doubts and also guide them about the forms to be filled and submitted to either NOTTO or closest ZTCC in India or any other relevant organization in respective countries. Information about health status of different types of donors about different organs that can be donated and about the law governing these activities is also related to the public by the medical care professionals. Radunz et al. studied the knowledge and attitude of medical care professionals of a German university hospital toward organ donation and found that 21% of the staff needed further education concerning organ donation. The authors concluded that more education of the hospital staff was necessary for them to have a positive impact on the attitudes of the general public toward organ donation.[3] Thus, knowledge of a medical care professional regarding organ donation is very crucial to increasing the awareness levels among the general public. Identification of the brain death and declaration of the same followed by counseling for organ donation are activities carried out by medical care professionals. A study was conducted by Abidin et al. which involved medical care professionals from two tertiary hospitals in Malaysia and they found some factors influencing recovery of organs from deceased donors in the hospitals. One of the factors was nonrecognition of brainstem death. The authors concluded that misunderstanding about brainstem death hindered identification of potential donors in Malaysia. Other factors observed were lack of knowledge about how to contact the organ transplant coordinators and passivity in approaching the families of potential donors to counsel for organ donation.[4] In the Intensive Care Units in India, brain death is not promptly declared due to lack of understanding and doubts about legal procedures of certifying brain death.[5] Palaniswamy et al. while sharing their experiences with Tamil Nadu model of TRANSTAN stated that success of organ donation program at any hospital lies in prompt identification, declaration, certification (of brain death), and counseling.[6] A doctor with poor understanding of brain death, especially the concept of death in the presence of a beating heart and normal body temperature, may never identify brain death. Hence, he/she may also never counsel the family members of the potential donor regarding organ donation. Here, Palaniswamy et al. observed that India has no formal and mandatory training programs in organ donation. University endorsed degree in organ donation could be the key to running a successful organ donation program in India.[6] Schaeffner et al. carried out a study involving 1136 medical students and physicians and reported that only 8% felt sufficiently prepared to approach families of potential organ donors. The authors reported a strong association between higher education of participating medical care professionals and positive attitude toward organ donation.[7] In the article by Dr. Apoorva Sindhu et al., 37.2% of the final year medical students believed that brain death was not legal in India. A medical care professional who believes that brain death is not legal in India will not counsel family of potential donor regarding organ donation. Furthermore, only 40.9% were aware of the portals of registration to become organ donors. Organ donation is not only about activities such as declaration of brain death, counseling of family, and retrieval and transplant of organs, but it also involves prior sensitization of the general public about organ donation and encouraging maximum people to commit to organ donation by registering to be organ donors. Here, lack of knowledge in a medical care professional regarding portals where one can register is a loophole in this chain of events. Thus, education of medical care professionals by including relevant concepts of organ donation during years of medical education as well as through CMEs seems to be the way forward. Manyalich et al. in Spain and Essman and Lebovitz in Ohio, USA conducted such training programs for health sciences students with positive consequences.[8],[9] Such training programs could include lectures covering topics such as basics of tissue and organ donation, the current crises in this activity, brain death and its determination, ethical issues, pre- and post-transplant procedures, and donor and recipient experiences. These education programs, if conducted regularly, could positively influence the interaction between the medical care professionals and the public on topic of organ donation. This could finally result in rise in organ donation rates.
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