Road map to organ donation in Tamil Nadu: an excellent model for India.

Abstract

DEAR EDITOR, Organ shortage is a huge public health concern worldwide. While Spain tops the list of organ donation rate with 35.3 per million population (pmp), India lags far behind with 0.26 pmp. In a country like India, which needs informed consent for organ donation, it is difficult to meet the organ demands as contrast to countries like Spain, where it is presumed consent, which makes easier to get adequate organs for donation. Tamil Nadu is one of the well-developed states of India with organ donation rate of 1.8 pmp, which is seven times higher than the national average, Chennai in Tamil Nadu fairs even better with 14 pmp, which is on par with developed countries like Germany.[1,2] Even though, the country had passed “The Transplantation of Human Organ Act” in 1994, it was “The Hithendran effect” in 2008 which brought paradigm shift in the attitude of Tamil Nadu's people toward organ donation. Hithendran's organs were donated by his parents after he was announced brain death. Multi Organ Harvesting Aid Network (MOHAN) Foundation, a non-governmental organization, had taken a major effort in the initiation and promotion of organ donation program in Tamil Nadu.[3] In 2008, Government of Tamil Nadu had started Cadaver Transplant program (CTP), the first of its kind with the best organ-sharing network in the country. CTP is the backbone of organ donation that integrates government hospitals, private hospitals, NGO, donors, recipients, police and social workers. This is an excellent example for a successful public-private partnership program.[4] According to “The Transplantation of Human Organ Act,” commercial organ donation is illegal in India. The motive for organ donation should be purely altruistic and in case of donation from non-relatives, clearance should be obtained from government authorization committee. The organ cost involved in deceased donor is nil apart from the cost incurred for perfusion fluids and intensive care costs in maintaining the donor. Tamil Nadu Chief Minister's Comprehensive Health Insurance Scheme covers transplantation cost for poor recipient patients. For the recipients, the average cost of the transplantation surgery varies from `200,000 to `25,00,000 depends upon the type of transplantation.[5] Government of Tamil Nadu had passed several government orders to promote organ donation which includes procedure to be adopted for cadaver transplant, criteria for nontransplant centers to retrieve organs, mandatory declaration of brain deaths, postmortem procedures and a counseling department for all registered hospitals. Organs obtained from hospitals are distributed to required patients through common waiting list registered in Tamil Nadu Network for Organ Sharing. Tamil Nadu has been divided into three zones namely, north, south and west to minimize the time of ischemia of organ and to ease organ distribution.[1] Cadaveric organ donors in Tamil Nadu have increased from seven in 2008 to 131 in 2013.[4,6] The general guidelines for allocation of organs is that the retrieving hospital has the right over the retrieved heart, liver and one kidney and the other kidney will go to the common waiting list. The Tamil Nadu model has been possible only through strong political commitment together with the participation of NGO's like MOHAN foundation and the presence of a well-coordinated committee consisted of transplant coordinator, transplant team from both retrieval and transplant hospitals, grief counselor; even there is a nodal officer for green corridors (an open route without blocks or traffics, where all traffic signals are green) in the traffic police department for coordinating the transport of retrieved organ to the respective hospitals for transplantation. Above all the public attitude for organ donation in Tamil Nadu, as evident from a recent study, 75.3%, was in favor of donating their organs.[7] Other initiatives are “Organ Protection and Donation Initiative” and use of mobile applications. Former focuses on the reduction of demand of organs for diabetic patients by appropriate strategy to protect their kidneys and other organs. Later was launched for motivating people to sign up for organ donation. This includes e-donor card and pledging cornea donation through social network.[8] Moreover, Toll free 24 × 7 helpline number has been introduced for organ donation. Since eye donation has been widely practiced in India, a protocol named “Sri Ramachandra protocol for organ donation,” has been used during emotionally difficult situation in the event of brain death; according to the protocol, the family members will be counseled initially for eye donation if they are willing, further counseling will be done for other organs, if the family members are not willing even for eye donation, further efforts will be abandoned.[9] Within a short span of time, Tamil Nadu state of India has achieved a tremendous success in organ donation rate; this successful implementation is possible only through strong political commitment, public-private partnership, positive public attitude along with well-established program and its strategies which should be taken as a role model not only for other states of India but also for other countries where organ donation rate is still low. To conclude, with growing demands for organs worldwide, it needs further thrust from remaining part of the under developed and developing nations of the world to keep in par with other developed countries in organ donation.