Part of Life and Death: How organ donation is faring in India

Even in death, one can save many lives. And that holds true for deceased organ donors. With many superstitions attached to the extraction of organs of a deceased individual — as desecration of a dead body is considered taboo in many religions — it has been quite difficult to make reluctant family members agree to allow doctors to harvest the organs of their loved ones who have passed away.

In 2013, the total number of organ transplants in the country was a mere 5,000, but that increased threefold to nearly 15,000 in the year 2022.

Kidneys are the most demanded organs, followed by liver, heart, lung, pancreas and small bowels. The wait lists for kidney transplants are generally higher than for other organs. According to law, only a blood relative can be a living donor for kidneys and liver and the remaining patients have to register themselves to be eligible for getting organs through the central registry.

In India, the National Organ and Tissue Transplant Organisation (NOTTO), established under the Transplantation of Human Organs and Tissues Act, 1994, manages organ donation and transplant activities based on guidelines stipulated by the World Health Organization.

NOTTO’s coordination with regional and State-level authorities has resulted in more organs of deceased donors being utilised for saving lives. In 2016, 2,265 organs were utilised from 930 deceased donors, while 2,765 organs could be utilised from 904 deceased donors in 2022. In 2019, India had 550 transplant centres registered with the States and 140 non-transplant organ retrieval centres.

In 2019, most living donors were kidney donors (8,613) or liver donors (1,993). There were few heart and pancreas transplants in 2019, with the percentage of female donors being higher at 65.4% (5,633) and 54.3% (1,084), respectively. Also, 84% (10,600) of the transplants were from living donors compared with 2,023 deceased donors.

According to a study titled “Organ Donation and Transplantation in India in 2019” by Vasanthi Ramesh and Chaitali Pal from NOTTO and Safdarjung Hospital, New Delhi, India is the third largest country in terms of absolute number of transplants owing to higher demand due to both communicable and noncommunicable diseases among its population. Moreover, the country is the epicenter of various water-borne, vector-borne and zoonotic diseases, in addition to social and health inequalities among the population. All this combined results in end-stage organ failure in many patients, which requires organ transplantation.

India has also been submitting organ donation and transplant data to the Global Observatory on Donation and Transplantation and it is the only country in the WHO South-East Asia Region to have consistently done so since 2013.

As the total number of organ transplants has been increasing annually, the gap in supply is widening. If the data of the year 2019 is analysed, there were 29,636 kidney patients on the waitlist, 7,362 for liver, 975 for heart, 343 for lung, 121 for pancreas and 14 for small bowels. In the same year, 8,138 new patients were added to the kidney transplant wait list. The endless wait also resulted in 569 patients with kidney-related ailments succumbing to the disease. On December 31, 2019, 38,164 patients were on dialysis.

When the researchers interviewed 1,178 family members asking for consent to donate organs, 457 (39%) refused to give their nod.

The Indian Government is actively trying to increase the rate of organ donation of deceased persons through heightened awareness activities by providing information and education. As far as living donors are concerned, recently, as a public welfare measure, the Government allowed Special Casual Leaves of up to 42 days to Central Government employees who donate an organ to another human being.

To streamline procedures, NOTTO is working on a transplant manual as a step-by-step guide for implementation of the organ donation and transplantation progamme in hospitals, apart from a standard course for training of transplant coordinators.

Small Regions With Large Flight Paths: Fifth phase of regional airline connectivity gets airborne

Travelling has always been a painstaking and time-consuming task in India, more so when rural or far-flung areas are taken into consideration. For the past many decades, the only modes of public conveyance have been rickety buses and three-wheelers while travelling locally, and long-haul buses and trains for lengthy distances.

With cities enticing the rural population with better employment opportunities and a healthier lifestyle, migration from villages to metropolises has increased by leaps and bounds. Along with this, the demand for conveyance has also increased manifold. Now, people want to rush from point-A to point-B within the shortest possible period. However, affordability has always been a cause for concern as not everyone can pay fares demanded by the airlines.

The Indian Government pitched in to address this issue by introducing the UDAN (Ude Desh ka Aam Naagrik) Scheme in 2017. This regional airport development programme is part of the Regional Connectivity Scheme (RCS) under National Civil Aviation Policy, 2016 for upgrading under-serviced air routes and for providing affordable and subsidised airfares to the common man. The scheme would be in parlance for 10 years.

Six years ago, the RCS took flight by connecting Shimla to Delhi. As of now, there are 473 routes and 74 operational airports, heliports and water aerodromes, which have become game-changers for the Indian aviation sector in Tier-II and Tier-III cities.

Following four successful rounds of bidding, the Ministry of Civil Aviation on April 21, 2023 launched the 5th round of the RCS to further enhance connectivity to remote and regional areas of the country and to achieve last-mile connectivity.

UDAN 5.0 not only focuses on Category-2 (20-80 seats) and Category-3 (above 80 seats) segments, but the earlier cap of 600 kilometres has been waived and there is no restriction on the distance between the origin and destination of the flight. Now, no predetermined routes would be offered and only network and individual routes proposed by the airlines would be considered. The same route would not be awarded to a single airline more than once, whether in different networks or the same.

The action plan would have to be submitted by the airlines after two months from getting approval and they would have to mention their aircraft acquisition plan/availability, crew, slots, etc at the time of the technical proposal. While the earlier deadline for commencement of operations was six months from award of the route, it has now been reduced to four months.

Monopoly on a route would be curtailed through withdrawal of exclusivity if the average quarterly PLF (Passenger Load Factor) is higher than 75% for four continuous quarters.

The Government claims that the UDAN Scheme has benefited a diverse set of stakeholders. While passengers have got the benefits of air connectivity, airlines have received concessions for operating on regional routes, and unserved regions have received direct and indirect benefits of air connectivity for their economic development. Tourism and commerce have reportedly been the prime beneficiaries of this scheme. The government provides a grant (Viability Gap Funding) to the airlines to bridge the gap between their cost of operations and the expected revenue.

According to the Government, the fifth phase of the scheme will connect new routes and bring it closer to the target of making operational 1,000 routes and 50 additional airports, heliports, and water aerodromes in the future.