Nayanika Konger

Currently the active waiting list for kidney transplant stands at 5,810 while it is 470 for liver. Between March and October 2020, when the Covid-19 infections were peaking, the Tamil Nadu State Transplant Agency or Transtan recorded organ donations from 17 brain dead patients. There was a fall in the number of donors in Tamil Nadu from 185 in 2016 to 27 in 2020.

The pandemic in 2020 brought out the worst and the best in all of us. We as a society learnt that it is important to invest in our healthcare, research, development and education sectors. Healthcare was seen to be the most burdened till date, with immense pressure on both the caregivers and patients. One department that faced a definite setback was the Surgery, especially the organ transplants. Doctors have quoted in interviews that many did not turn up for health check-ups, some opted to continue treatment instead of surgery. In some cases, the patient’s family preferred dialysis, instead of transplant and risking morbidity during a pandemic and making a viable kidney, a medical waste.

Elective surgeries including live donor transplant were halted in many countries. Transplant programmes suggested screening of deceased donors to prevent inadvertent transplantation from a Covid-19-infected donor. Covid hence created a crisis of organ donation. Patients that required transplants and those with end-stage organ failure were put in a very vulnerable position. The risk of donor-derived transmission, the reliability of diagnostic tests, healthcare resource utilization and the effect of immunosuppression became much higher than the usual. This writer lost a dear and beloved one in December 2019 due to multiple organ failures in need of a combined liver and kidney transplant in a long -drawn struggle even before the pandemic, and with the pandemic this struggle increased manifold.

There are mainly two types of transplants, live and cadaveric (deceased donor), and there exists a waiting list for it. Upon the disheartening news of an untimely demise, if the deceased is declared brain dead, the organs could still be viable and can be donated for the purpose of transplant. This gives more people an array of hope enrolled in the line. The above definitely occurs with due permission, consent and counselling of the grieving family members. Moreover, if a person registers him/her/themselves as organ donors prior to any kind of bereavement, the organ/s get registered to the list.

This list is pan-India and one needs to register as soon as possible and the earlier one registers the better are the chances to receive a viable organ in time. According to the rules set up by the National Organ and Tissue Transplant Organization India, organs are allotted in a slotted manner, and are released in rotation on emergency according to capacity. Liver cirrhosis is often the cause for the early onset for the need of a liver transplant. Cirrhosis on a broad scale can be either alcoholic or non-alcoholic fatty liver disease (NAFLD). The latter is often related to lifestyle choices and the body’s immune response to it.

From the personal experience of medical counselling with the doctors, with regards to combined kidney and NAFLD transplant, I learnt that fatty liver and obesity are highly likely indicators to developing the symptoms and later ill health. There is no medication in case of NAFLD, but you can reverse fatty liver diseases with lifestyle changes at the earliest.

Statistics from January 2020 reveal that in India, an estimated 220,000 people with end-stage renal disease require kidney transplantation and only around 7,500 kidney transplantations are performed at 250 kidney transplant centres in India. Of these, roughly 90% come from living donors and 10% from deceased donors.

The truth is very hard to digest, however, the sooner you can accept, more are the chances for you to save the life of your loved ones. One should not hesitate for a moment if the diagnosis has been confirmed and a transplant is recommended. Patients often choose to ignore the symptoms and reach for help when the symptoms get worse. In the longer run it costs extra time, looking for either donors or waiting their turn in the list. The cost incurred for transplant also needs to be taken into account. It is a good idea to start a fundraiser on platforms such as Milaap or Ketto.

For cadaveric transplant, the match of the blood group of the organ is a must, whereas, for live transplant, the donor has to be a family member. One also has to undergo a series of fitness tests and clearance from the medic’s side. In a few exceptional cases, if the blood group of the family member is not a match, there can be a swap transplant procedure, provided the patient has the strength to withstand the weight of the immunosuppressants used in the surgery. The Liver Transplant Society of India (LTSI) released some special guidelines for transplant centres across the country in order to make transplants amidst the pandemic hassle-free.

Often, conversations surrounding transplant are sparse and hence people in most cases are unwilling to donate. Liver and kidney transplants happen to be the most common form of transplant. The liver of a donor regenerates after a few months and a kidney donor can survive well with one kidney. However, not much about it is discussed unless they are put in tight a spot. Many are even scared to speak about it fearing legal repercussions. Humour is often a tool that is used to deflect the grave seriousness that comes with the topic.

Tamil Nadu received the best State award for transplant for the sixth consecutive year in 2020. Surgeons and transplant counsellors have faced several challenges during the pandemic. Dr Mohammed Rela, senior transplant surgeon, said: “There were more patients who died waiting for an organ compared to those who acquired the viral infection while in hospital waiting for transplant.”

Currently the active waiting list for kidney transplant stands at 5,810 while it is 470 for liver. Between March and October 2020, when the Covid-19 infections were peaking, the Tamil Nadu State Transplant Agency or Transtan recorded organ donations from 17 brain dead patients. There was a fall in the number of donors in Tamil Nadu from 185 in 2016 to 27 in 2020.

The transplant procedure is complex and takes a toll on the caretakers and family/friends too, impacting anybody irrespective of age, gender, caste, class or religion. It is time we as a society should come together to make organ donation a cherished endeavour in life.