Global Nephrology: Kidney Donation in India

The trials and tribulations that patients have to face world-wide to get access to kidneys are magnified in India.

In India, only a fraction (≈10%) of the estimated 100,000 individuals who develop kidney failure are able to receive dialysis – either because of the cost of chronic dialysis or the limited availability of dialysis spots. On the other hand, kidney transplant from a donor is also not that straight forward either.

I met my friend and long-time colleague Dr. Bharat Shah in Mumbai a couple of days ago in Mumbai. Bharat Shah is one of the leading nephrologists in India and has a large transplant practice in Mumbai. I recall reading an article in DNA, a local Mumbai newspaper, titled "It's easy: Fly to Singapore, fix kidney" that quoted Bharat extensively. The article was about the difficulties potential kidney transplant recipients face in getting access to an organ.

For example, a mother has to have the consent of her relatives in order to donate to a child. Only recently, grandparents were added in the list of family members who can donate a kidney. And, only family members are able to donate.

Perhaps, worse still, this past year the government introduced new guidelines that require every hospital conducting transplantation to convene an “authorization committee” to review and approve the kidney transplant. The committee needs to comprise of "members from civil society", in addition to the transplant unit designated doctors; and, each of these members needs to be approved by the state. The new committee also needs to have a DMER person (i.e., state government representative), a retired judge, a prominent person from  society (a retired member of the civil service [IAS officer of class I or class II]), and a representative from the hospital administration.

This is beaurocracy run amok because, according to the DNA article, the convening and processing of activities by the authorization committee frequently takes time and the delay can have consequences for the potential recipient. 

Those who can afford it go abroad for the kidney transplant – Singapore being a popular destination.

But because of the lack of proper co-ordination between the hospital and authorities the hospital finds it hard to obtain authorization letters on time and there are delays in scheduling the transplant that can be for months.

Why this overly intensive regulation and scrutiny? Probably because of an over-reaction to the illegal trading in organs and commercial transplantation.

The bottom-line: countries around the world are striving to address the shortage of organs by implementing processes and procedures to increase the availability of organs. India seems to be going in the opposite direction. An enormous tragedy given the very limited availability of dialysis.