The Waiting List

Ajish Francis, Goa Medical College

CRIME. MYSTERY.

A plot centered around organ donation which encompasses these two genres. When I first heard about the Indian web series Breathe(2018) from a friend, I expected it to be another cliched show. Like the ones that involve an organ racket waiting to be busted. Maybe he didn’t pitch the idea of how good it was properly, or maybe I was more interested in the bedside class. My stout little professor was explaining the importance of generalized edema with facial puffiness.

But it wasn’t the crime or the mystery that drew me to the show. Oddly enough, for a thriller, it was the drama that caught my eye. It was a rude awakening. In spite of being in a medical college for more than three years now, and being around so many end stage liver disease and kidney disease patients, it took a movie to make me empathize with their plight.

The moment a patient gets registered by a hospital at www.notto.gov.in, their life swings between hope and despair. Their life is determined by a set of rules and to a larger extent, luck. The MELD (Model of End Stage Liver Disease) score, age, super urgent listing criteria etc., determine who gets to live and who does not. It’s like a complicated triage except the disaster here is our own selfish desire. The desire to see ourselves perish with an intact body knowing entirely well that it might save someone’s life.

India’s organ donation rate stands between 0.25 – 0.5 per million compared to Croatia’s 36.5. To put things in perspective, at 1 per million most of our current demands will be met and at 2 per million the need for live transplants for kidneys would decrease.

One approach that is currently followed, especially in cases of living donor transplants of kidney and liver, is Directed Organ Donation. It differs from conditional transplant which involves transplants to a particular community on the basis of race and religion. Directed transplant is organ donation to a particular individual such as a friend or a relative. In case of inability to find an ideal donor within the family or friends, hospitals across the world have adopted cross donation or donor exchange programs wherein organs of donors who can’t donate to their kin are exchanged. Since this principle is based on equivalency, there are no ethical issues and improves the rate of transplants.

Post donating his own kidney, Fr Davis Chiramel came up with the idea of using the principle of cross donation to start a chain. He set up Kidney Federation of India and started the initiative by having Kochouseph Chittilapalli, the founder of V- Guard industries, as the first donor. Although such steps are indeed a leap towards ensuring higher transplant rates, we need to realize that one of the most effective ways is to ensure cadaveric transplant. With around 1.5 lakh brain deaths occurring due to accidents and many more due to intracranial bleeds and tumors, the need for a living person to donate his organs would nearly cease.Then, ethical conundrums like whether patients of alcoholic liver damage be given lesser preference for transplant would not exist.

Chronic excessive alcoholism is a mental disorder and yet a large part of the society believes that transplants should not be given or at least restricted for alcoholics.The fact that doctors need to apportion on organs like a scarce resource deeming certain people worthy over others is unfortunate. Taking nothing away from the plot of Breathe, the MYSTERY that intrigued me more was how in a country with probably one of the highest accident rates, there is still an acute shortage. The real CRIME is in fact denying people the right to live. Every time I think about transplants, I remember that puffy face of the patient my professor was explaining about. I wonder if she ever got the chance to live a full life. Did she outlive the list or did the list outlive her?

References –

[1] Allocation Criteria For Deceased Donor Liver Transplantation In Delhi/NCR, www.notto.gov.in

[2] Nallusamy S, Shyamalapriya, Balaji, Ranjan, Yogendran. Organ donation – Current Indian scenario. J Pract Cardiovasc Sci 2018;4:177-9

[3] Dutta, S., 2020. The Agony Of Being On The Waiting List For Organ Transplant In India | NDTV-Fortis More to Give: Be an Organ Donor. Available at: < https://sites.ndtv.com/moretogive/the-agony-of-being-on-the-waiting-list-for-organ-transplant-in-india-2055/#:~:text=When%20diagnosed%20with%20the%20necessity,numbers%20paint%20a%20woeful%20picture > [Accessed 27 August 2020].

[4] Peter A. Ubel, Liver Transplantation and Surgery, Vol 3, No 3 (May), 1997: pp 343-346

[5]https://www.financialexpress.com/auto/gallery/most-dangerous-roads-in-the-world-countries-with-highest-road-deaths-and-its-not-india-on-top/photos/730573/6/

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