Editorial: The donor conundrum

CHENNAI: The highly skewed distribution of organ donation in India was highlighted earlier this week, when data from 1995 to 2021 was made public. For every woman who received an organ, four men got transplants in the country. As many as 36,640 transplantations were carried out, of which over 29,000 were for men, and 6,945 were for women. Per experts, there are more male cadaver donors; however, more women are living donors. Of the total organ donations in India, 93% were living donors, which is representative of the majority of women donors.

A paper published in the Experimental and Clinical Transplantation Journal in 2021 found gender disparities in living organ transplantation. Close to 80% of living donors were women, mostly wives or the mothers, while 80% of the recipients were men. The difference in numbers were attributed to economic and financial responsibilities, societal pressures, as well as ingrained preferences. The burden of bread-winning, implicitly placed on men, and the cultural upbringing where women are taught to take care of their families are some of the reasons why more women tend to be donors, while more men are likely to be recipients.

Note that India has one of the world’s lowest rates of organ donation. The demand for organ donation far exceeds its supply – India’s rate of deceased organ donors falls short of one donor per million population, whereas the US has 40 donors per million. A pain point is the grey area on unrelated organ donations in India. Over the past few years, as many as 2,000 cases of unrelated organ donations have been filed in courts. In a majority of cases, courts ruled in favour of the petitioners and sent the matter back to the hospitals or authorisation committees for due consideration.

The decision regarding whether the donation could be commercially motivated or influenced by income disparity is usually deferred to the medical institution or clearance committee. The Union Health Ministry’s Human Organs Rules, 1995 was set up to establish regulations governing the removal and transplantation of human organs. The main objective was to prevent illicit trade in organs and recognise brain death as a valid form of death. This in turn, would enable donations in such circumstances to mitigate organ shortages. Similarly, states are also mandated to establish authorisation committees responsible for approving organ transplants between living donors and recipients, such as in liver and kidney transplants. The committees have to ensure compliance with the Transplantation of Human Organs and Tissues Act (THOA), 1995.

However, stakeholders believe that the law which was meant to prohibit commercial dealings in human organs, now provides protection for those commercial dealings. The interpretation and application of a clause within the THOA allows for removal and transplantation of human organs from unrelated donors to recipients provided the donor has authorised it for reasons such as affection, attachment or other special reasons. This clause has often been subjected to misuse and misinterpretation.

A silver lining has emerged in Tamil Nadu where CM Stalin has initiated a programme to felicitate deceased organ donors with full state honours, a measure that has boosted the drive for organ donation in the region. Inspired by the TN model, Karnataka is also now mulling a policy to recognise donors through certificates of appreciation.