"Artificial organs are the future. A decade from now, people will look back and ask ‘did you actually take out kidneys and livers from healthy people?' It's so barbaric," said Dr Harsh Jauhari, chairperson of the department of renal surgery, Ganga Ram Hospital.
The successful implantation of an artificial heart that would allow a 15-year-old Italian boy to live a normal life for 20-25 years has given hope to organ donor-strapped countries such as India where almost 200,000 die each year waiting for a donor. Apart from corneal transplantations, only 4,600 organs are transplanted in India each year.
The Italian job is not the only reason for hope. University of California San Francisco (UCSF) researchers led by researcher of Indian-origin Shuvo Roy announced the successful development of an artificial kidney that uses nanotechnology to get thousands of microscopic filters and a bioreactor to mimic the metabolic and water-balancing roles of a real kidney.
Over the next five to seven years, Roy's goal is to apply silicon fabrication technology along with engineered-compartments for live kidney cells to shrink that large-scale technology into a small device that can then be implanted in the body.
"The wonderful thing about artificial organs is that the patients can live a normal life without the need for immune suppressant medications, which cost between Rs 6,000 and Rs 8,000, and need to be taken for the rest of your life to prevent the body from rejecting a implanted foreign tissue," said liver specialist Dr Anupam Sibal, who is also medical director, Apollo Hospital.
Though a lot of work has gone into developing an artificial liver, success has been elusive. "Unlike the heart, which has a mechanical pumping function, or the kidney with its filtering function, the liver is a complicated organ that works as a detox and biochemical factory, which is a challenge to amalgamate with synthetic function," said Sibal. Even though living donors can donate a part of their liver, only 500 of the estimated 20,000 people requiring a liver transplantation need it.
So acute is the shortage that the Union Ministry of Health is considering proposing presumed consent organ donation – presumed consent puts everyone automatically on the donor register unless she or he declares otherwise – to push up organ retrieval. The idea, however, was dropped because of its potential for misuse in a country such as India; many who do not want to donate would not even know they need to register themselves as a non-donor.
In India, "explicit consent" is needed. Under "explicit consent", the donor or the family needs to clearly say they want the deceased person's organs to be harvested. Some European countries such as Spain, Belgium and Italy have an informed consent law, which allows hospitals to harvest organs from dead or brain-dead people who have not registered themselves as non-donors. "Spain has the highest organ donation rates in the world, with 40 people donating per million population, as against India's 0.05 per cent (per million)," said Dr A.K. Seth, head of gastroenterology and liver diseases at B L Kapoor Hospital in central Delhi.
Shortage of voluntary donations has created the black market for organs such as kidneys and livers – which can be retrieved from live donors – to boom. In the case of the kidney alone, from the 150,000 people who suffer end-stage kidney failure each year and need a transplant, barely 3,500 find a donor.
"In the absence of human donors, the only option is pig organs or artificial organs. It's a no-contest," said Jauhari.