KIDNEY TRANSPLANT IN INDIA

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Picture Courtesy: www.jehangirhospital.com

Context: Around 2 lakh Indians reach end-stage kidney failure annually, but only 12,000 receive transplants, creating a large gap.

Details

• The demand for kidney transplants in India surpasses the availability of legally donated organs, leading to a black market for organs.
• Legal regulations, ethical concerns, and the disparity between organ supply and demand create a complex and challenging landscape.
• The exploitation of vulnerable individuals, particularly those in poverty, for organ donation, has been a major ethical issue, sparking debates about how to regulate and monitor transplant practices more effectively.
• Efforts to address these issues involve stricter regulations, increased awareness about organ donation, and improvements in healthcare infrastructure to facilitate legal and ethical organ transplants.

Kidney ●The kidney is a bean-shaped organ that is located in the lower back, on either side of the spine. Each kidney is about the size of a fist and weighs about 150 grams. ●The kidney consists of two main parts: the renal cortex and the renal medulla. ○The renal cortex is the outer layer of the kidney that contains millions of tiny filtering units called nephrons. ○The renal medulla is the inner layer of the kidney that contains the collecting ducts and the renal pyramids. ●It filters about 180 litres of blood plasma per day, removing waste products such as urea, creatinine, uric acid, and drugs, as well as excess water, salts, and minerals. ●It reabsorbs about 99% of the filtrate, retaining substances that are needed by the body such as glucose, amino acids, sodium, potassium, calcium, phosphate, bicarbonate, and water. ●It secretes substances that are not needed by the body or are harmful to it such as hydrogen ions, ammonia, potassium, and some drugs. ●It excretes urine, which contains waste products and excess fluids that are eliminated from the body. ●It regulates several aspects of blood composition and volume such as blood pressure, blood pH, blood osmolarity, electrolyte balance, and fluid balance. ●It produces hormones that have various effects on other organs and systems such as; ○Renin, which activates the renin-angiotensin-aldosterone system (RAAS) that controls blood pressure ○Erythropoietin (EPO), which stimulates red blood cell production in the bone marrow ○Calcitriol (active form of vitamin D), which promotes calcium absorption in the intestines and bone mineralization ○Prostaglandins (PGs), modulate inflammation, pain, fever, and blood flow.

Kidney Transplant in India

• A kidney transplant involves replacing a diseased kidney with a healthy kidney from a live or deceased donor. The transplanted kidney takes over the filtration function of the failed kidneys, eliminating the need for dialysis.
  • Kidneys, located on either side of the spine, play a crucial role in filtering waste, minerals, and fluids from the blood. Kidney failure can lead to the accumulation of harmful levels of waste and fluid in the body, raising blood pressure.
• Approximately 2 lakh patients in India await organ donation, with only around 15,000 donors available. The annual requirement for kidneys is estimated to be 2-3 lakh, but only about 12,000 transplants occur annually.
• The government is promoting deceased donors or cadaver donations to address the demand-supply gap. Post-2012, there has been an increase in organ donations, and India's Kidney Transplant Programme is the second largest globally.
• Advances in immunosuppressive drugs and induction agents have reduced rejection events. Changes in transplant methods, including minimally invasive techniques, contribute to lower post-operative complications.
• Southern states like Tamil Nadu, Pondicherry, Kerala, and Andhra Pradesh perform relatively better in terms of transplantations and awareness. Chandigarh in the North has done well in terms of donors per million people.
• The cost of kidney transplants in private hospitals in India ranges from Rs. 5 to 6 lakh, with post-treatment monthly costs and lifelong medicines adding to the financial burden.

Indian Transplant Law

• India strictly prohibits organ donations in exchange for money to safeguard economically vulnerable donors from potential exploitation.
• Transplantation Act (1994): The law allows transplants from deceased donor pools or living donors primarily close relatives like parents, siblings, children, spouses, grandparents, or grandchildren. Altruistic donations from distant relatives or friends are allowed but undergo stringent scrutiny to prevent financial transactions.
• Documentation and Scrutiny: Rigorous documentation, including proof of identity, family relations, and financial status for both donors and recipients, is mandated. Interviews are conducted to verify relationships.

Challenges and Reasons for Kidney Trafficking

• High Demand: India faces a considerable gap between kidney demand and available transplants. Approximately 2 lakh Indians reach end-stage kidney failure annually, yet only around 12,000 kidney transplants are conducted annually.
• Accessibility and Cost: Kidney transplants are relatively affordable, making them a more feasible option. Over 500 centres in India facilitate kidney transplants, providing potential loopholes to bypass regulations.
• Viability and Durability: Kidneys have longer survival outside the body compared to other organs, making them preferable for both legal and illegal transactions.

Addressing the Challenges

• Promoting Deceased Donations: India aims to boost deceased donations by introducing an Aadhaar-linked registry, increasing awareness to encourage donations upon brain deaths. Currently, only 16% of transplants use deceased organs, a figure that experts believe can be significantly augmented with enhanced awareness.
• Reduction in Transplant Demand: Strategies to reduce the number of individuals requiring transplants through preventive healthcare could help bridge the demand-supply gap.

Organ transplantation landscape in India over the last five years ●Transplantation Statistics (2018-2022): ○Kidney transplants were the most common, accounting for 75% of total transplants. ○Liver transplants ranked second (22%). ○Heart transplants were the third most common. ●India is the second-highest country globally for kidney transplants, following the United States. Notably, this ranking is based on living donations rather than cadaver donations. ●Both organ donation and transplantation figures decreased during the COVID-19 pandemic but more than doubled afterwards. ●Over 80% of organ transplants in India are living donations. Living kidney donation is highlighted as a relatively straightforward process, allowing the donor to lead a normal life with one kidney. ●The central government made policy changes, removing an age barrier that restricted organ donation from individuals over 65. This allows seriously ill individuals in this age group to receive donations from living donors.

Conclusion

• The landscape of kidney transplants in India presents a multifaceted challenge involving stringent legalities, ethical concerns, and the need for enhanced awareness. The objective remains to facilitate ethical and accessible transplant avenues while curbing illegal activities and exploitation in organ transactions.

Must Read Articles:

Organ Donation: https://www.iasgyan.in/daily-current-affairs/organ-donation 

Organ Transplantation in India: https://www.iasgyan.in/daily-current-affairs/organ-transplantation-in-india 

PRACTICE QUESTION Q. What are the primary challenges contributing to the gap in organ transplantation accessibility and availability in India, and what measures are being taken to address this issue?