Organ Exchange Between Unrelated People May Enlarge Donor Pool: Experts

Opening up organ exchange between unrelated individuals may enlarge the donor pool, but policy concerns and risks remain, experts say. Media reports have claimed the Centre is in talks with non-profits and transplant surgeons about the prospects of opening up organ exchange between unrelated individuals.

The current laws mostly allow living donations from close relatives such as parents, siblings, children, spouses, grandparents, and grandchildren.

In the case of unrelated or altruistic organ donations from distant relatives, in-laws, or long-time friends, additional scrutiny is done to rule out financial exchange.

"Allowing organ exchange between unrelated individuals could significantly expand the donor pool in India, saving countless lives.

Medically, the primary concern is the risk of organ rejection, as genetic dissimilarity increases this risk. However, advancements in immunosuppressive therapies have made transplants between unrelated donors more feasible and successful," Dr Sudeep Singh Sachdev, Director and Senior Consultant Nephrology at Narayana Hospital, Gurugram, told IANS.

"This will enlarge the donor pool and help patients waiting for transplants. At present India's donation rates are very low compared to countries with good transplant numbers," said Dr Bishnu Panigrahi, Group Head of Medical Strategy and Operations at Fortis Healthcare.
However, the experts also stressed the need for strict regulatory controls.

"While the potential benefits include reduced wait times and better health outcomes for patients, the risks include higher chances of complications and the ethical dilemma of ensuring truly altruistic donations, free from coercion or financial incentives," Dr Sachdev told IANS.

He also called for "robust regulatory frameworks and comprehensive pre-transplant evaluations."

"We need strict regulatory controls where for such non-related transplants the authorisation committee should not be a hospital authorisation panel but an external committee where at least two must be government nominees, a lawyer of standing and a social worker. These four must be the quorum, physically present for authorisation approval," Dr Panigrahi said.

However, not all experts believe in the need for altruistic organ donations in India.

Dr Arvinder Soin, Chairman and Chief Surgeon at Medanta Institute of Liver Transplantation, told IANS that although it may increase the donation rates modestly, it also opens up the possibilities of exploitation of the poor by the rich.

He called for improving deceased donation rates in India, which currently stands at "a pathetic 0.7 per million compared to 38 per million in the US".

"I believe for India, unrelated altruistic donation is not the answer to improving transplant rates at this stage. Rather, all attempts should be made to promote deceased donor organ donation by widespread government and NGO-led public campaigns, mandatory declaration of brain death in all ICUs, and required requests from families of clinically brain-dead patients. This would yield far better dividends in terms of organ availability and save thousands of more lives," the doctor said.

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