Evolution of deceased-donor transplantation in India with decline of commercial transplantation: a lesson for developing countries

Abstract

The positive impact of a structured deceased-donor program has resulted in a reduction in the number of commercial transplantation operations taking place in India. The engagement of private and government stakeholders has revealed the positive impact of deceased organ donation in India. The best example is the Tamil Nadu state model, where deceased donations have increased to 1.2 per million population compared to the national average of 0.08 per million population. In the last 30 months 994 organs were transplanted. The donation and transplantation in the Government-run hospitals have provided organs to the poor sections of the society free of cost. Immunological surveillance of the prospective recipients remains a challenge, as there is a paucity of immunological laboratories in transplant centers. Generic immunosuppressive drugs manufactured by the local pharmaceutical industry have been shown to be noninferior, and have greatly reduced the cost of achieving immunosuppression.

Number Needed to Treat as a Tool for Cost Effectiveness Analysis: A Case Study in Renal Transplantation

“…In India, nearly 80% of the tertiary care facilities providing transplant services are available only in the private sector which is out of the financial reach of an average Indian patient [17]. Moreover, health-care insurance coverage is available to<15% of the total Indian population [6]. This has reduced the deceased-donation rate to as low as 0.08 per million population per year [18].…”

“…For instance, the annual rate of renal transplantation in India is 3.25/million population/year, which is far low when compared to the prevalence of end-stage renal disease (ESRD) patients i.e., 150/million population/year. Data shows that>90% ESRD patients die within months of diagnosis as this therapy is either not affordable or not accessible [6]. Renal transplant requires long-term treatment with immunosuppressant's to ensure graft survival and prevent graft rejection.…”

“…Long-term immunosuppressive therapy is not only expensive but has its own adverse effects too [7]. Studies on clinical effectiveness and cost-effectiveness of such drugs might help clinicians to select a drug that is cost-effective and make a difference in the patient outcome by optimizing accessibility [6]. Similar studies have been undertaken for other therapeutic areas and have helped clinicians take the best course in a given situation [8].…”

Bold policy changes are needed to meet the need for organ transplantation in India

“…9 The deceased donations that take place are largely due to the efforts of a few state governments, nongovernment organizations, and hospitals that are highly committed to transplantation. 10 The provision of health care in India is the responsibility of individual state governments. India's universal publicfunded health-care model aims to provide basic access to health care for its citizens free of charge.…”

Overcoming roadblocks on the way to national self-sufficiency: exploring the deceased donor potential in India

“…Strategies to increase deceased donation by developing a multi‐faceted team approach targeting various areas of deficiency have been successful in the southern Indian state of Tamil Nadu which has an impressive deceased donation rate of 1.2/million population compared with 0.08/million population for the rest of the country . This success was based on the involvement of all stakeholders, using dedicated transplant coordinators, educating, and engaging patients and the media.…”