The realization of cadaveric transplantation is a dream yet to be fulfilled in J&K’s healthcare sector. Advocating for this cause, concerned officials emphasize the pressing need for immediate administrative intervention, infrastructural enhancements, and robust awareness campaigns.
By Tauheed Ahmad
In the expansive canvas of Jammu and Kashmir’s medical landscape, a formidable challenge looms large—the stark contrast between the escalating demand for organs and the glaring inadequacy in their supply. Despite governmental efforts, symbolized by the establishment of the State Organ and Tissue Transplant Organization (SOTTO) in 2019, progress in addressing this pressing issue has been disappointingly minimal.
The absence of an active pursuit from medical institutions, including esteemed facilities like SKIMS (Sher-i-Kashmir Institute of Medical Sciences) and GMC Jammu, where the SOTTO, established in September 2019 with its office in Super Specialty Hospital, Government Medical College, Jammu, to seek necessary funds or upgrades for organ retrieval or transplantation facilities hampers progress in the region’s medical sector.
Dr. Irfan Lone a Transplant Coordinator in SOTTO, his observations echo the need for urgent administrative intervention to expedite the establishment of cadaver transplant centers. The gap between theoretical discussions and actionable strategies becomes more pronounced as institutions fail to actively seek upgrades or funds, further hindering the region’s progress in organ transplantation.
In a somewhat ironic revelation, Dr. Irfan Lone, provides insights into the intricate process hospitals navigate to establish organ transplant centers. The journey kicks off with hospitals, even prestigious institutions like SKIMS and GMC Jammu, submitting requisition applications through SOTTO.
“Once received, these applications take a journey to the Director General Health Service in New Delhi, where a three-member evaluation team carefully inspects the proposed infrastructure to ensure it meets the required standards. This critical examination determines whether the aspiring centers are deemed fit for the life-saving endeavor of organ transplantation” he informed.
Surprisingly, despite the potential for such transformative initiatives, SOTTO has not yet received any applications from hospitals.
“To date, SOTTO has not received any applications from hospitals or specialty hospitals seeking funds, facility upgrades, or the establishment of facilities for organ retrieval or transplantation”, Dr Irfan revealed.
Highlighting the staggering demand for organ transplants in India, Dr. Saleem Wani, Professor and Head of the Department of Urology, and Kidney Transplant Surgeon at SKIMS, Soura, Srinagar emphasizes with kidney transplantation serving as a poignant example. Despite 1.8 lakh individuals annually requiring transplants, only 5,000 kidney transplants are performed, emphasising the critical need for both living and cadaveric organ donations. Chronic kidney diseases, fueled by factors like diabetes and hypertension, underscore the necessity of organ availability, positioning kidney transplantation as a vital and cost-effective strategy.
Beyond kidney transplantation, Dr. Saleem broadens the scope by illuminating the demand-supply gap across various organs, emphasizing the potential of cadaveric transplantation to overcome this challenge. He reveals the shocking statistics: a demand for 30,000 liver transplants annually, with only 1500 being performed, and a need for 50,000 heart transplants, while only 15 see fruition. Cornea demands reach 10 lakh, yet only 35,000 are fulfilled, highlights the urgent imperative for cadaveric transplantation to alleviate the region’s growing organ scarcity.
Dr. Saleem’s work focuses on unravelling key barriers hindering the realization of cadaveric transplantation in Jammu and Kashmir. He works towards enhancing awareness among the masses about the significance of cadaver donation, sensitizing the medical fraternity to the ethical and procedural aspects, and championing the establishment of efficient green corridors. The lack of robust infrastructure, administrative inertia, and limited awareness initiatives are the challenges he actively tackles, aiming to transform theoretical discussions into tangible, and lifesaving action.
“Ensuring the safe and swift transportation of organs is of paramount significance,” affirms Dr. Saleem Wani. While the presence of capable doctors in districts is acknowledged, we must underscore the critical administrative aspect. The necessity of robust technical infrastructure cannot be overstated for efficient organ retrieval. Aligning the technicalities of retrieval with those of super-speciality hospitals is essential to maintain standardized and seamless procedures in this life-saving endeavour, he added.
In a notable broadcast of ‘Mann ki Baat’ in 2015, Prime Minister Narendra Modi passionately encouraged the nation to consider organ donation, emphasizing its significance as the most impactful contribution. However, a substantial obstacle stands in the way of this noble cause. Despite the willingness of potential donors, the prohibitive costs associated with transplantation procedures present a formidable challenge. Private healthcare facilities, which predominantly conduct such operations, demand substantial amounts ranging from Rs 15 lakh to Rs 25 lakh and beyond.
Compounding this issue is the distribution of healthcare institutions across India. With a reported 1, 96,312 hospitals in the country (India Brand Equity Foundation), only a fraction—14,379 to be precise—are government-operated, according to the National Health Profile of 2007.
The National Organ Transplant Organisation (NOTO) reveals a stark reality: only 301 hospitals, encompassing both government and private sectors, are equipped to perform transplant procedures nationwide. This glaring mismatch in numbers underscores a crucial aspect of the organ transplantation challenge, prompting a closer examination of the accessibility and affordability of healthcare infrastructure.
The National Organ and Tissue Transplant Organization (NOTTO) also reveals a concerning trend in India’s organ donation landscape, with the deceased organ donation rate consistently below one donor per million populations for the past decade.
As per NOTTO’s data, countries like Spain and the United States demonstrate significantly higher donation rates, ranging from 30 to 50 donors per million populations. NOTTO also highlights disparities among Indian states, with Telangana, Tamil Nadu, Karnataka, Gujarat, and Maharashtra reporting the highest numbers of deceased organ donors.
This discrepancy underscores the need for strategic interventions and awareness campaigns to address the disparities and enhance organ donation rates.
The performance of government hospitals in the realm of organ transplantation comes under critical examination, revealing a disheartening track record. A glance at the statistics from premier institutions like AIIMS and Ram Manohar Lohia Hospital in Delhi paints a bleak picture. As of now, several years since the 2018 statistics reported 141 transplants, the total number of cadaveric transplants conducted by AIIMS remains in the hundreds despite its stature. While Ram Manohar Lohia Hospital’s record stands at just four. as reported by Governance Now (a multi-media initiative for participatory reportage and analyses related to governance of all institutions and processes that are vital to public life in India) in response to an RTI application.
Dr. Saleem’s impassioned plea resonates for immediate administrative commitment, infrastructure development, and extensive awareness campaigns to transition from mere aspirations to concrete actions. It’s not just about discussing the possibilities; it’s about translating these discussions into lifesaving realities. The urgency lies in proactively addressing the hurdles, strategically planning initiatives, and collectively striving to transform the theoretical discourse into a tangible, lifesaving reality.
Jammu and Kashmir’s healthcare sector stands at a pivotal juncture, offering a transformative leap through cadaveric transplantation. Dr. Saleem’s advocacy echoes the urgent need for practical measures, administrative dedication, and comprehensive awareness initiatives to bridge the ever-widening gap between organ demand and supply. His vision isn’t merely a dream; it’s a clarion call to transform the region’s healthcare landscape and bestow the invaluable gift of life upon those languishing in dire need.
The urgency is palpable in Jammu and Kashmir’s healthcare narrative, where the promise of cadaveric transplantation awaits realization. Dr. Wani’s advocacy underscores the imperative for immediate administrative intervention, infrastructural enhancements, and robust awareness campaigns to usher in a new era of medical marvels. It’s time for a paradigm shift, a collective effort to turn discussions into tangible actions, and a resolute commitment to save lives through the noble cause of cadaveric transplantation.
Religious Perspective
Mufti Nasir ul Islam highlights the dual perspective of organ transplantation, encompassing both religious and humanitarian considerations. “In the context of the advancements in medical science, organ donation becomes a crucial aspect of saving lives. Instances of loved ones or close relatives donating organs or blood to save lives are common, reflecting the humanitarian aspect”, he said.
While specific references to organ donation may not be found in religious scriptures, Mufti Nasir ul Islam points to the humanitarian aspect mentioned in the Quran: “And whoever saves a life, it is as though he had saved the lives of all mankind (5:32).” He observes that some Islamic countries, including Saudi Arabia and Egypt, have approved organ transplantation within the framework of humanity.
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