The Times of India

Title : The secret lies in simplifying rules and converting desire into action
Author : By Rahul Kansal
Location :
Article Date : 08/09/2014
Red Tape & Few Ways Of Asking People If They Wish To Donate Among Key Problems
Over the past week, this newspaper has presented some grim snapshots of the acute problem of organ donation in India. Our effective donation
rate, at 0.26 donations per million persons, is less than 1% of the corresponding rate in most developed countries. Last year, 852 deceased donors
were harvested for organs against over a million recipients waiting in queue.
Why is the situation so bad? What can be done to address it?
For a moment, let's examine this as a `marketing' problem that'd be faced by a new product concept that's failed to penetrate the market. Typically ,
a new brand first tries to generate awareness; it then seeks to create interest and desire. Finally , it seeks action, in the form of trial and, hopefully ,
regular purchase. Where does organ donation stand on this awareness-interestdesire-action scale?
Let's start with awareness. A TOIIPSOS study last year (conducted in 8 metros among English-language newspaper readers) showed that 96%
were aware of the organ transplantation concept. Most had a fair idea of which organs can be transplanted, over 85% mentioning eyes and kidneys.
Twothirds of the respondents knew organs could be received from donors after death. Even if one discounts for the evolved profile of the
respondents, basic awareness doesn't appear to be the central problem.
Even if people are aware, how open are they to the idea? Are there taboos in Indian society that mark us out as particularly resistant?
Our religious beliefs are often held up as a major obstacle. Anecdotally , one hears of myths that a `mutilated' body will come in the way of a person
achieving salvation. But, as vociferously pointed out by spiritual leaders from across faiths, there's nothing in any re ligious text that can be linked to
these superstitions. In one voice, they call organ donation the biggest act of giving. Empirical evidence bears out that taboos against donation are
nowhere as strong or widespread as sometimes imagined. Dr Avnish Seth of Fortis says of all families requested by his hospital over the past three
years to agree to organ donation, over 40% gave their consent. The cumulative success rate at the Army Command hospital is even higher. Even if
the `real' nationwide willingness to donate were a fraction of these proportions -say 10% -it could enable a 50-fold increase in donations compared
to the abysmal number actually achieved.
So if willingness doesn't appear to be a critical bottleneck to organ dona tion, what is?
The real problem lies
like in many aspects of Indian life
in our inability to convert desire into action.
To begin with, there's virtually no mechanism to simply ask a potential donor to pledge his organs. In Canada, the US and most of Europe a medical
insurance or a driving licence applicant is asked if he'd want to be a donor.
Even if just a fourth of all people say yes, that's a huge number. In India, lakhs of potential donors never become active donors because no one ever
asks them. An even bigger problem is red tape. Organ harvesting from the brain dead involves a fragile 5-to-24hour window of opportunity . Within
this limited aperture, as many as 8 steps must be taken -ranging from a stringent process for certification of brain death, to ascertaining whether the
deceased had pledged his organs, to counselling grieving families, to obtaining a no-objection certificate from police, to matching the donor's organs
to an appropriate recipient. The steps are so cumbersome that, Dr Seth says, most hospitals never bother to initiate the process.
A drastic simplification of the processes is necessary . This must start with a national donor registry , which would help identify a patient facing
imminent death as a pledged donor, and enable the hospital to quickly start preparing for the process.
The legal processes to enable harvesting can be simplified, without any loss of ethical rigour. Every hospital capable of performing a surgery should
be mandated to appoint a transplant coordinator to manage the donation process. The regular hospital staff tends to be way too busy attending to
the patient overload to wade into the organ donation process within the tight time window. The problem of organ donation in India isn't about
philosophical or sociological obstacles. It's about the will to act.