Organ Donation Myths, Realities And The Future Of Kidney Transplants In India
We are currently facing a silent epidemic of non-communicable diseases (NCDs), with diabetes mellitus (DM) leading the charge. According to the ICMR (Indian Council of Medical Research), 10.1 crore Indians are diabetic. The WHO estimates that around 2.5 crore Indians are prediabetic at high risk of developing diabetes. Hypertension, or high blood pressure, is also extremely common, affecting an estimated 22–23% of Indians. Together, these two silent diseases are the leading causes of chronic kidney disease (CKD). Various researchers have pegged the prevalence of CKD in India between 10–17%, and these numbers are alarming.
Dr Tanmay Pandya, HOD & Director, Nephrology & Renal Transplantation, Sarvodaya Hospital, Sector-8, Faridabad shares all you need to know:
While CKD spans a broad spectrum, the most dreaded stage is kidney failure, also known as End-Stage Kidney Disease (ESKD), where most patients require kidney replacement therapy. In India, over 3 lakh new patients are diagnosed with ESKD annually and require some form of kidney replacement therapy. Globally, available options include either dialysis or kidney transplantation. Considering quality of life, life expectancy, and financial impact, kidney transplantation is clearly the preferred modality especially in the resource-limited settings of India.
For transplantation, the foremost requirement is a donor kidney. This may come from organ donation at the time of brain death, or, more commonly in India, from another person. In our society, owing to several reasons, donation from a living, related donor is the primary source of kidneys for transplantation. The process is governed by the Transplantation of Human Organs Act, passed by Parliament and implemented across states and union territories.
Humans have two kidneys working seamlessly as a single unit, providing one of the most efficient organ systems in the body. Remarkably, if one kidney is removed for some reason, the other can largely compensate. For a healthy person, the impact of removing one kidney is negligible. This forms the rationale for kidney donation from a living donor. Several studies have addressed the health implications of organ donation and concluded that the practice is safe when the donor is carefully selected. One calculation shows the risk of developing CKD after donation is only 0.24% higher compared to non-donors, a minuscule, medically and ethically acceptable number. Similarly, living liver donation is also largely safe, as the liver can regenerate the donated segment within months, leaving practically no long-term impact.
That said, living donors do face short- and long-term risks, primarily related to surgery. Donor selection is therefore a meticulous, rigorous process involving multi-speciality consultation and a battery of investigations to ensure safety. Only when a donor is deemed fit is the donation approved. Post-surgery, recovery is similar to other major operations. Most donors can return to routine activities within two weeks, though heavy physical work should be avoided for a while longer. Donors are counselled to adopt a healthier lifestyle, including regular exercise, balanced nutrition, and complete avoidance of smoking and alcohol. Periodic health checkups are mandatory to ensure long-term safety.
Despite its safety, the donor pool remains small for any given patient. Generally, only close relatives are accepted as donors, but incompatibility such as mismatched blood groups or tissue types often creates challenges. Treatments exist to overcome these incompatibilities, but they come with added costs and risks. An innovative solution is kidney swap transplantation. In this system, two or more donor–recipient pairs are matched to overcome incompatibility and achieve successful transplantation. Swap transplants are legally permitted in most Indian states, and organisations like the Indian Society of Organ Transplantation (ISOT) and the National Organ & Tissue Transplantation Organisation (NOTTO) actively promote them. Multi-way swaps sometimes involving up to 10 pairs have been successfully performed in India. Institutions such as IKDRC, Ahmedabad, routinely conduct 100–150 swap transplants per year. ISOT has also developed software to help doctors find suitable matches.
Swap transplantation has thus emerged as a life-saving alternative in kidney transplantation in India, significantly expanding the donor pool and utilising available donors more effectively.
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