The Sum of our Parts

Deceased donor transplantation allows all members of society to benefit from transplantation, says Dr Christopher Taylor Barry

The Sum of our Parts
There are many questions that Anand Gandhi’s award winning, thought provoking and brilliant film, The Ship of Theseus brings forth. In every visually stunning frame, the dialogues are searing and compelling. Clearly, Gandhi doesn’t want you to walk away empty-headed. Weaving through three narratives are different viewpoints around organ donation and a bigger question that needs our attention. How are we really greater than the sum of our parts?

The film resonated at a deep level with Dr Christopher Taylor Barry, associate professor at the University of Rochester MedicalCenter who specialises in liver transplant, laparoscopic liver surgery and living donor transplant. He also performs pancreas transplants and general surgery. But that is his day job. What he is truly passionate about is spreading awareness about organ donation.

Q. What are the most common objections to registering to become an organ donor?

As many as 6,935 lives are lost every year due to organ failure. That equates to 19 deaths every day.

One of the most common objections to registering to become an organ donor is when we are told; “Medical professionals will not try to save my life if they know that I’m an organ donor.” This is a pervasive myth, but it is absolutely false. The first-response medical and paramedical professionals to an accident or medical catastrophe are only concerned with saving lives. It is only after all efforts fail and the patient becomes brain dead does a completely separate team of transplant and organ donation professionals come into the picture. Doctors taking care of patients in the emergency room and intensive care unit are not involved in the organ donation consent process.

Another concern that surfaces is that the process of organ allocation is not fair, that is, “My organs will go to the highest bidder.” The fact is that deceased donor organs are not monetised commodities. An equitable allocation process ensures that each organ is offered to the patient who is in most need from a purely medical perspective. Deceased donor transplantation allows all members of society, regardless of socioeconomic status, to benefit from transplantation and will decrease (or even eliminate) the need for black market organ trafficking activity.

The third most common reason is attributed to religion. “My religion does not permit organ donation.” This is untrue. In fact, all major religions support an individual’s decision to become an organ donor. It is an incredibly compassionate deed that bestows good karma. Indeed, it is a profoundly spiritual act that honours the sanctity of life.

Q. You were in India recently to support certain NGOs with their mission to spread awareness and dispel concerns. What are the measures being taken to combat the human organ black market?

For about $1,600 dollars (Rs 1,00,000), you can sell your kidney. You may be able to negotiate a slightly higher price if you are young, but there is the possibility that you won’t get paid at all or less than you were promised. Maybe you’ll be able to pay off some immediate debts, but evidence shows that you are unlikely to be able to rise out of poverty. Increasing efforts to establish a robust and efficient deceased donor transplant system in India are actually being driven by a desire to curtail illegal transplant activity. Anywhere in the world where there are desperately poor people hoping to rise from the depths of poverty, there will inevitably be some others who will try to take advantage of this desperation for their own benefit. There are also desperately ill people with financial resources to seek care at any cost. Therefore, a black market in human organs for transplantation exists.

Since the passage of the amendments to Transplant of Human Organs Act (THOA) in 2009, Tamil Nadu has become the leading state in deceased organ donation with rates 10-15 times higher than the rest of the nation. Other states in northern and western India are catching on, and thanks in large part to the efforts of NGOs such as MOHAN Foundation, National Network for Organ Sharing, Organ India, Zonal Transplant Coordination Centre, and Shatayu (just to name a few), significant momentum is accumulating toward establishing robust systems to support deceased organ donor transplant throughout India.

Q. What is the way forward to increase deceased donor transplant activity?

Education is first and foremost, both for medical professionals and the general public. To increase the number of hospitals capable of managing potential brain dead donors for organ recovery by specialised transplant centres, we need a focused curriculum engaging hospital neurologists, neurosurgeons, intensivists, ethicists, administration, nursing staff, and pathologists to understand brain death declaration, management of donors, interaction with transplant coordinators and donor families, and proper performance of organ recovery surgeries.

Public education efforts need to “normalise” the concept of organ donation as a socially acceptable and good deed. They also need to effectively address valid public concerns and misperceptions. Finally, robust funding mechanisms need to be established, likely through cooperation of philanthropic and government-driven initiatives.

(Shaku Selvakumar is a US-based marketing and digital communications

expert; and founder of Coeuredge, a digital experience company)

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